Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 106, Issue 7, Pages E2491-E2501Publisher
ENDOCRINE SOC
DOI: 10.1210/clinem/dgab279
Keywords
menopause; bone mineral density; fracture; general population studies
Categories
Funding
- National Institutes of Health (NIH)
- Department of Health and Human Services, through the National Institute on Aging (NIA)
- National Institute of Nursing Research (NINR)
- NIH Office of Research on Women's Health (ORWH) [NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495]
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The rapid loss of bone mineral density during menopause transition and early postmenopause may increase the risk of fractures. Women with a faster decline in lumbar spine BMD have a higher risk of fractures.
Context: Bone mineral density (BMD) decreases rapidly during menopause transition (MT), and continues to decline in postmenopause. Objective: This work aims to examine whether faster BMD loss during the combined MT and early postmenopause is associated with incident fracture, independent of starting BMD, before the MT. Methods: The Study of Women's Health Across the Nation, a longitudinal cohort study, included 451 women, initially premenopausal or early perimenopausal, and those transitioned to postmenopause. Main outcome measures included time to first fracture after early postmenopause. Results: In Cox proportional hazards regression, adjusted for age, body mass index, race/ethnicity, study site, use of vitamin D and calcium supplements, and use of bone-detrimental or -beneficial medications, each SD decrement in lumbar spine (LS) BMD before MT was associated with a 78% increment in fracture hazard (P = .007). Each 1% per year faster decline in LS BMD was related to a 56% greater fracture hazard (P = .04). Rate of LS BMD decline predicted future fracture, independent of starting BMD. Women with a starting LS BMD below the sample median, and an LS BMD decline rate faster than the sample median had a 2.7-fold greater fracture hazard (P = .03). At the femoral neck, neither starting BMD nor rate of BMD decline was associated with fracture. Conclusion: At the LS, starting BMD before the MT and rate of decline during the combined MT and early postmenopause are independent risk factors for fracture. Women with a below-median starting LS BMD and a faster-than-median LS BMD decline have the greatest fracture risk.
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