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J Clin Endocrinol Metab. 2019 Oct 15. pii: dgz056. doi: 10.1210/clinem/dgz056. [Epub ahead of print]

Trabecular Bone Score Declines During the Menopause Transition: the Study of Women's Health Across the Nation (SWAN).

Author information

1
Department of Medicine, Division of Geriatrics,UCLA, Los Angeles, CA.
2
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
3
Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA.
4
Center of Bone Diseases - Bone and Joint Department (DAL - RHU) Lausanne University Hospital & University of Lausanne, Lausanne - Switzerland.
5
Department of Medicine,Division of Geriatrics,UCLA, Los Angeles, CA.

Abstract

CONTEXT:

Rapid bone density loss starts during the menopause transition (MT). Whether other components of bone strength deteriorate prior to the final menstrual period (FMP) remains uncertain.

OBJECTIVE:

To discern whether TBS declines during the MT.

DESIGN:

An 18-year longitudinal analysis from the Study of Women's Health Across Nation.

SETTING:

Community-based cohort.

PARTICIPANTS:

243 Black, 164 Japanese, and 298 White, initially pre- or early perimenopausal women, who experienced their FMP.

MAIN OUTCOME MEASURES:

Trabecular bone score (TBS), an indicator of bone strength.

RESULTS:

Multivariable mixed effects regressions fitted piece-wise linear models to repeated measures of TBS as a function of time before or after the FMP; covariates were age at FMP, race/ethnicity and body mass index. Prior to 1.5 years before the FMP, in the referent individual (a White woman with age at FMP of 52.2 years and BMI of 28.0 kg/m2), TBS evidenced no change (slope 0.12% per year, p=0.2991). TBS loss began 1.5 years prior to the FMP, declining by 1.16% annually (p<0.0001). Starting 2 years after the FMP, annual rate of TBS loss lessened to 0.89% (p<0.0001). In the 5 years before through the 5 years after the FMP, in the referent individual, total TBS decline was 6.3% (p<0.0001), but Black participants' total TBS loss was 4.90% (p=0.0008, difference in Black and White 10-year change). Results for Japanese did not differ from those of White women.

CONCLUSIONS:

The occurrence of an MT-related decline in TBS supports the thesis that this period is particularly damaging to skeletal integrity.

KEYWORDS:

cohort; epidemiology; longitudinal; menopause; trabecular bone score

PMID:
31613958
DOI:
10.1210/clinem/dgz056

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