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Bone Mineral Density Changes during the Menopause Transition in a Multiethnic Cohort of Women

Endocrine Unit (J.S.F., R.M.N.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Epidemiology (S.E.B., V.M., J.M.J., J.A.C., M.E.D.), University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Geriatrics (G.A.G.), University of California, Los Angeles, School of Medicine, Los Angeles, California 90095; Departments of Epidemiology and Biostatistics (M.R.S.), School of Public Health, University of Michigan, Ann Arbor, Michigan 48109; and Division of Research (B.E., J.C.L.), Kaiser Permanente Northern California, Oakland, California 94612

Address all correspondence and requests for reprints to: Joel S. Finkelstein, M.D., Endocrine Unit, Thier 1051, Massachusetts General Hospital, 50 Blossom Street, Boston, Massachusetts 02114. E-mail: jfinkelstein{at}partners.org.

Context: Rates of bone loss across the menopause transition and factors associated with variation in menopausal bone loss are poorly understood.

Objective: Our objective was to assess rates of bone loss at each stage of the transition and examine major factors that modify those rates.

Design, Setting, and Participants: We conducted a longitudinal cohort study of 1902 African-American, Caucasian, Chinese, or Japanese women participating in The Study of Women’s Health Across the Nation. Women were pre- or early perimenopausal at baseline.

Outcome Measure: We assessed bone mineral density (BMD) of the lumbar spine and total hip across a maximum of six annual visits.

Results: There was little change in BMD during the pre- or early perimenopause. BMD declined substantially in the late perimenopause, with an average loss of 0.018 and 0.010 g/cm²·yr from the spine and hip, respectively (P < 0.001 for both). In the postmenopause, rates of loss from the spine and hip were 0.022 and 0.013 g/cm²·yr, respectively (P < 0.001 for both). During the late peri- and postmenopause, bone loss was approximately 35–55% slower in women in the top vs. the bottom tertile of body weight. Apparent ethnic differences in rates of spine bone loss were largely explained by differences in body weight.

Conclusions: Bone loss accelerates substantially in the late perimenopause and continues at a similar pace in the first postmenopausal years. Body weight is a major determinant of the rate of menopausal BMD loss, whereas ethnicity, per se, is not. Healthcare providers should consider this information when deciding when to screen women for osteoporosis.

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