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Influence of Age at Menarche on Forearm Bone Microstructure in Healthy Young Women

Division of Bone Diseases, World Health Organization Collaborating Center for Osteoporosis Prevention, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, CH–1211 Geneva 14, Switzerland

Address all correspondence and requests for reprints to: Thierry Chevalley, M.D., Division of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Rue Micheli-du-Crest 24, CH–1211 Geneva 14, Switzerland. E-mail: Thierry.Chevalley{at}hcuge.ch.

Background: Shorter estrogen exposure from puberty onset to peak bone mass attainment may explain how late menarche is a risk factor for osteoporosis. The influence of menarcheal age (MENA) on peak bone mass, cortical, and trabecular microstructure was studied in 124 healthy women aged 20.4 ± 0.6 (SD) yr.

Methods: At distal radius, areal bone mineral density (aBMD) was measured by dual-energy x-ray absorptiometry, and volumetric bone mineral density (BMD) and microstructure were measured by high-resolution peripheral computerized tomography, including: total, cortical, and trabecular volumetric BMD and fraction; trabecular number, thickness, and spacing; cortical thickness (CTh); and cross-sectional area (CSA).

Results: Median MENA was 12.9 yr. Mean aBMD T score of the whole cohort was slightly positive. aBMD was inversely correlated to MENA for total radius (R = –0.21; P = 0.018), diaphysis (R = –0.18; P = 0.043), and metaphysis (R = –0.19; P = 0.031). Subjects with MENA more than the median [LATER: 14.0 ± 0.7 (±SD) yr] had lower aBMD than those with MENA less than the median (EARLIER: 12.1 ± 0.7 yr) in total radius (P = 0.026), diaphysis (P = 0.042), and metaphysis (P = 0.046). LATER vs. EARLIER displayed lower total volumetric BMD (315 ± 54 vs. 341 ± 56 mg HA/cm³; P = 0.010), cortical volumetric BMD (874 ± 49 vs. 901 ± 44 mg HA/cm³; P = 0.003), and CTh (774 ± 170 vs. 849 ± 191 µm; P = 0.023). CTh was inversely related to CSA (R = –0.46; P < 0.001). In LATER reduced CTh was associated with 5% increased CSA.

Conclusions: In healthy young adult women, a 1.9-yr difference in mean MENA was associated with lower radial aBMD T score, lower CTh without reduced CSA, a finding compatible with less endocortical accrual. It may explain how late menarche is a risk factor for forearm osteoporosis.