Lukacs J L, Reame N E
School of Nursing, University of Michigan, Ann Arbor, Michigan 48109-0482, USA.
J Womens Health Gend Based Med. 2000 Sep;9(7):731-9. doi: 10.1089/15246090050147709.
Serum alkaline phosphatase (ALP), a gross marker of bone turnover, has been reported to be elevated after menopause, a period characterized by hallmark increases in follicle-stimulating hormone (FSH). Whether the ALP rise coincides with the perimenopausal transition when changes in FSH, estrogen levels, and menstrual cycles are first apparent is not known. The purpose of this cross-sectional study was twofold: (1) to characterize the influence of the perimenopausal transition on ALP activity and (2) to correlate ALP activity with more precise markers for bone, osteocalcin (OC), and vitamin K status assessed with undercarboxylated osteocalcin (ucOC). Thirty-eight studies of hourly FSH were conducted on cycle day 6 of the follicular phase in perimenopausal women volunteers, aged 40-54 years (mean body mass index [BMI] = 24.2 +/- 0.5). Mean FSH was used to define the perimenopausal stage (early perimenopausal, mean FSH </= 15 IU/L, n = 27; late perimenopausal, mean FSH > 15 IU/L, n = 11). As expected, late perimenopausal women had irregular and longer menstrual cycles, lower estradiol (E(2)) and estrone (E(1)) levels, and a lower frequency of ovulations vs. the early group. ALP was higher (76.5 +/- 8.3 vs. 58.3 +/- 2.7 IU/L, p = 0.045) compared with the early perimenopausal group. In a subsample (n = 10), OC was associated with ALP (r = 0.69, p < 0.03), FSH was positively related to ucOC concentrations (r = 0.7, p < 0.03), and women with E(1) concentrations <40 pg/ml had double the percentage of ucOC compared with those where E(1) was >40 pg/ml (46.3% +/- 6.6% vs. 22.0% +/- 3. 1%, p < 0.006). Clinical markers of the perimenopause are associated with a nonspecific but inexpensive marker of enhanced bone turnover (i.e., higher ALP) and correlate well with more precise markers of bone activity. These findings suggest that health-promotion strategies for preserving bone should be instituted well before the last menstrual period.
血清碱性磷酸酶（ALP）是骨转换的一个总体标志物，据报道在绝经后会升高，绝经是一个以促卵泡生成素（FSH）显著升高为特征的时期。尚不清楚ALP升高是否与围绝经期过渡阶段相符，在该阶段FSH、雌激素水平和月经周期的变化首次显现。这项横断面研究的目的有两个：（1）描述围绝经期过渡对ALP活性的影响；（2）将ALP活性与更精确的骨标志物骨钙素（OC）以及用未羧化骨钙素（ucOC）评估的维生素K状态相关联。对40 - 54岁（平均体重指数[BMI]=24.2±0.5）的围绝经期女性志愿者在卵泡期第6天进行了38次每小时FSH的检测。用平均FSH来定义围绝经期阶段（围绝经期早期，平均FSH≤15 IU/L，n = 27；围绝经期晚期，平均FSH>15 IU/L，n = 11）。正如预期的那样，与早期组相比，围绝经期晚期女性的月经周期不规律且更长，雌二醇（E₂）和雌酮（E₁）水平更低，排卵频率也更低。与围绝经期早期组相比，ALP更高（76.5±8.3对58.3±2.7 IU/L，p = 0.045）。在一个亚样本（n = 10）中，OC与ALP相关（r = 0.69，p < 0.03），FSH与ucOC浓度呈正相关（r = 0.7，p < 0.03），并且E₁浓度<40 pg/ml的女性ucOC的百分比是E₁>40 pg/ml女性的两倍（46.3%±6.6%对22.0%±3.1%，p < 0.006）。围绝经期的临床标志物与骨转换增强的一个非特异性但廉价的标志物（即更高的ALP）相关，并且与更精确的骨活性标志物相关性良好。这些发现表明，在最后一次月经之前就应该制定促进骨骼健康的策略。
