Trabecular bone score and bone remodelling markers identify perimenopausal women at high risk of bone loss

Abstract

Context Bone loss is accelerated in the late perimenopause and early menopause. The date of the final menstrual period cannot be stated until 1 year after it has ended, and at that time, most of the rapid bone loss phase will have elapsed. Therefore, early detection of bone loss is crucial. Objectives To evaluate the utility of bone turnover markers (BTM) to identify the women who are more likely to lose more bone mass during the transition to menopause and quantify the loss of bone quality measured by trabecular bone score (TBS). Design, patients and setting Sixty‐four healthy premenopausal women, mean age between 44 and 57 years old, were enrolled and followed up for 5 years. Clinical features, lifestyle, bone densitometry, TBS and BTM (CTX, P1NP and osteocalcin) were measured at baseline and follow‐up. Results All women had densitometrically normal bone at the time of enrolment. After 5 years, 48.4% had normal bone mineral density, 45.8% low bone mass and 6.3% osteoporosis. Women with osteopenia/osteoporosis at follow‐up had higher CTX and P1NP at enrolment compared with women with densitometrically normal bone. The areas under the curve for the prediction of low bone mass or osteoporosis were 0.69 (P = 0.011) for P1NP, 0.69 for CTX (P = 0.013) and 0.77 (P 0.001) for OC. A significant correlation was found between P1NP increase after 5 years and the decrease in lumbar bone density (r = −0.383, P = 0.002). At baseline, 7 (10.9%) women had deteriorated microarchitecture (TBS < 1.3). Three of these women developed osteoporosis and four osteopenia at follow‐up. Conclusions Women with higher P1NP and CTX and lower TBS at baseline had lower BMD in the transition to menopause suggesting these novel tools could have potential use in identifying women at high risk of rapidly decreasing bone mass.

Osteoporosis in Premenopausal Women: A Clinical Narrative Review by the ECTS and the IOF

“…Bone turnover markers were evaluated 3 months after the fracture, which may still be influenced by the late phase of fracture healing. On another side, in healthy premenopausal women in the transition to menopause (aged 44-57) followed for 5 years, higher PINP and C-terminal telopeptide concentrations predicted lower BMD, suggesting that bone turnover markers could have potential use in identifying women at higher risk of rapid bone loss (49). Yet another recent study suggests that single bone turnover markers may not be able to identify bone loss for an individual patient (50).…”

Effects of Icariin on Modulating Gut Microbiota and Regulating Metabolite Alterations to Prevent Bone Loss in Ovariectomized Rat Model

“…The estrogen deficiency-induced PMOP has a typical symptom of bone metabolic disorder, which can stimulate RANKL production to prolong the life span of osteoclasts and reduce the life span of osteoblasts ( 35 ). Hormone replacement therapy is often used to prevent or ameliorate bone loss by promoting osteocalcin gene expression ( 4 ).…”

Are Oxidative Stress and Inflammation Mediators of Bone Loss Due to Estrogen Deficiency? A Review of Current Evidence

“…revealed that within 5 years of menopause, alveolar bone density loss was associated with elevated circulating levels of matrix metalloproteinase-2 (MMP-2) indicative of osteoclastic bone resorption [ 63 ]. Menopausal women were observed to have a higher level of bone resorption markers, like N-terminal propeptide of type I procollagen and CTX-l, and lower trabecular bone score, which correlated with skeletal microarchitecture deterioration [ 64 ].…”