Risk factors influencing the bone health in perimenopausal and postmenopausal women

Abstract

INTRODUCTIONOsteoporosis is a progressive skeletal disease manifested by decreased bone mineral density and collateral damage to the bone microarchitecture, which can subsequently lead to impaired skeletal strength and elevated susceptibility to fractures.1 It is a common and complex health problem in the elderly women. It has been statistically observed that over 50% of the adults at age 50 years or older suffer from osteoporosis, among which approximately 70% are postmenopausal females.2 BMD has been widely accepted as a surrogate parameter for the diagnosis of osteopenia and osteoporosis which supports its utility as a diagnostic avenue for abnormal bone mass.3 Many reproductive and menstrual factors like parity, breastfeeding, age at first pregnancy, age at menarche, use of combined oral contraceptives (COCs) and duration of menopause might influence the risk of osteoporosis. Our aim was to investigate the correlation of these factors with the BMD of postmenopausal women and in women undergoing menopause transition phase. Firstly, it will help in reducing the unnecessary BMD testing in elderly women and secondly, it will help in prevention of osteoporosis by helping the clinician to assess the need for early intervention. ABSTRACTBackground: Bone loss is being increasingly identified in premenopausal and early postmenopausal women. The significance of low bone mineral density (BMD) in females needs to be addressed. Female reproductive system plays a major role in regulating the bone loss from menarche to senescence. The purpose of our study is to identify the menstrual and reproductive factors that may lead to decreased bone mass during the premenopausal period so that early intervention could lead to improved bone health. Methods: The study was conducted on 100 women aged 40 -60 years attending the outpatient department in Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, Haryana, India. Their age, parity, body mass index, age at menarche, age at first pregnancy, duration of breast feeding, use of combined oral contraceptive, interpregnancy interval and BMD values were recorded. BMD was measured by dual-energy x-ray absorptiometry. Pearson test was used for correlation analysis. Comparison between the groups was conducted using analysis of variance (ANOVA) and Tukey's test. Results: A significant negative correlation was established between parity, age at menarche, duration of breast feeding and BMD values. On the other hand, BMI and duration of oral contraceptive use showed a significant positive correlation with BMD values. Conclusions: Identification of risk factors for low BMD will provide the opportunity for early intervention to preventosteoporosis and will reduce the burden of unnecessary BMD testing in elderly age group for screening of osteoporosis.