Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2491-e2501. doi: 10.1210/clinem/dgab279.
Bone mineral density (BMD) decreases rapidly during menopause transition (MT), and continues to decline in postmenopause.
This work aims to examine whether faster BMD loss during the combined MT and early postmenopause is associated with incident fracture, independent of starting BMD, before the MT.
The Study of Women's Health Across the Nation, a longitudinal cohort study, included 451 women, initially premenopausal or early perimenopausal, and those transitioned to postmenopause. Main outcome measures included time to first fracture after early postmenopause.
In Cox proportional hazards regression, adjusted for age, body mass index, race/ethnicity, study site, use of vitamin D and calcium supplements, and use of bone-detrimental or -beneficial medications, each SD decrement in lumbar spine (LS) BMD before MT was associated with a 78% increment in fracture hazard (P = .007). Each 1% per year faster decline in LS BMD was related to a 56% greater fracture hazard (P = .04). Rate of LS BMD decline predicted future fracture, independent of starting BMD. Women with a starting LS BMD below the sample median, and an LS BMD decline rate faster than the sample median had a 2.7-fold greater fracture hazard (P = .03). At the femoral neck, neither starting BMD nor rate of BMD decline was associated with fracture.
At the LS, starting BMD before the MT and rate of decline during the combined MT and early postmenopause are independent risk factors for fracture. Women with a below-median starting LS BMD and a faster-than-median LS BMD decline have the greatest fracture risk.
在绝经过渡（MT）期间，骨密度（BMD）迅速下降，绝经后仍持续下降。
本研究旨在探讨绝经过渡和早期绝经期间 BMD 丢失更快是否与绝经后早期发生的骨折事件相关，而与绝经前 MT 时的起始 BMD 无关。
妇女健康纵向研究（Study of Women's Health Across the Nation）是一项纵向队列研究，纳入了 451 名最初处于绝经前或早期围绝经期，以及过渡到绝经后女性。主要结局指标包括绝经后早期发生首次骨折的时间。
在 Cox 比例风险回归中，调整年龄、体重指数、种族/民族、研究地点、维生素 D 和钙补充剂的使用以及骨破坏或有益药物的使用后，绝经前 MT 前腰椎（LS）BMD 每减少 1 个标准差，骨折风险增加 78%（P=0.007）。LS BMD 每年下降 1%与骨折风险增加 56%相关（P=0.04）。LS BMD 下降率独立于起始 BMD 预测未来骨折。LS BMD 起始值低于样本中位数且下降速度快于样本中位数的女性骨折风险增加 2.7 倍（P=0.03）。在股骨颈，起始 BMD 或 BMD 下降率均与骨折无关。
在 LS 中，绝经前 MT 时的起始 BMD 和 MT 及早期绝经期间的下降速度是骨折的独立危险因素。LS BMD 起始值低于中位数且下降速度快于中位数的女性骨折风险最高。
