Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Division of Geriatrics, Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Bone. 2019 May;122:237-245. doi: 10.1016/j.bone.2019.02.016. Epub 2019 Mar 3.
In SWAN, we showed that accelerated loss of bone mineral density (BMD) begins 1 year before the final menstrual period (FMP) to 2 years after the FMP and slows thereafter. However, the risk of fracture depends on both BMD and bone geometry. The hip structural analysis (HSA) measures important geometric properties of bone. Changes in HSA parameters across the menopausal transition have not been previously assessed.
The current analysis uses data from SWAN, 5 years before to 5 years after FMP (N = 900, Age (mean(SD)) = 46.85(2.60), 44% White). HSA parameters at the femoral narrow neck were obtained from 2D DXA scans and normalized to baseline values. FMP was determined from annual interviews. Changes in HSA were assessed over 3 periods, 5 to 2 years before FMP (pre-transmenopausal), 2 years before to 1 years after FMP (transmenopausal), 1 to 5 years after FMP (postmenopausal). Mixed linear models with random slopes were used to estimate the rate of change in HSA parameters relative to FMP.
Loss of BMD, cross-sectional area (CSA), and section modulus (SM) and increases in outer diameter (OD) were greatest in the transmenopausal period (p for all<0.05). Changes continued in the postmenopausal period but were not statistically significant. The cumulative percentage changes over 10 years in BMD (-10.67%), CSA (-9.01), SM (-7.03) and OD (+1.95) were statistically significant.
Changes in hip geometry across the menopause transition parallel changes in BMD and provide insight into mechanisms that may increase risk of fragility fracture.
在 SWAN 研究中，我们发现骨密度（BMD）的加速丢失始于绝经前 1 年至绝经后 2 年，此后速度减缓。然而，骨折风险不仅取决于 BMD，还取决于骨几何形状。髋关节结构分析（HSA）可测量骨的重要几何特性。绝经过渡期间 HSA 参数的变化尚未得到评估。
本分析使用了来自 SWAN 的数据，包括绝经前 5 年至绝经后 5 年（N=900，年龄（均值（标准差））=46.85（2.60），44%为白人）。从二维 DXA 扫描中获取股骨颈狭窄处的 HSA 参数，并将其归一化为基线值。FMP 通过年度访谈确定。HSA 的变化在 3 个时期进行评估，分别为绝经前 5 年至 2 年（绝经前期）、绝经前 2 年至绝经后 1 年（绝经过渡期）和绝经后 1 年至 5 年（绝经后期）。使用具有随机斜率的混合线性模型来估计 HSA 参数相对于 FMP 的变化率。
与 FMP 相比，BMD、横截面积（CSA）、截面模数（SM）的丢失和外径（OD）的增加在绝经过渡期最大（所有 p 值均<0.05）。绝经后期仍有变化，但无统计学意义。BMD（-10.67%）、CSA（-9.01%）、SM（-7.03%）和 OD（+1.95%）在 10 年内的累积百分比变化具有统计学意义。
绝经过渡期间髋关节几何形状的变化与 BMD 的变化平行，并深入了解可能增加脆性骨折风险的机制。
