Key predictive factors of breast cancer based on race using machine learning models.

Lifespan exposure to hormone therapies and structural brain morphometry in older women.

A mechanistic digital twin of ovarian aging integrating follicular dynamics, mitochondrial decline, and lifestyle perturbations.

Disturbances in the female reproductive system are known extraintestinal manifestations of celiac disease (CD). However, the reliability of the existing literature is limited by small study populations and heterogeneous study designs. This study is the first systematic review and meta-analysis to synthesize all available evidence and provide a comprehensive evaluation of the association between CD and female menstrual and hormonal parameters. A systematic literature search was conducted in PubMed, Scopus, and Cochrane Central databases using keywords related to CD, menstrual characteristics, and hormonal markers. Studies published until August 2025 were included. Our analysis demonstrated a significantly higher mean age at menarche in girls with CD compared with controls [pooled mean difference (MD): 0.64years, 95% confidence interval (CI): 0.32 to 0.95, p = 0.0007), as well as an increased risk of abnormal uterine bleeding [pooled odds ratio (OR): 2.11, 95% CI: 1.23 to 3.63, p < 0.05] and amenorrhea (pooled OR: 4.03, 95% CI: 1.11 to 14.65, p = 0.0394). Menopausal age was not found to be earlier in women with CD (pooled MD: -1.31years, 95% CI: -3.02 to 0.40, p = 0.1053). Adherence to a gluten-free diet was not associated with age at menarche when adherent and non-adherent patients were compared (pooled MD: 0.56years, 95% CI: -0.72 to 1.83, p = 0.260). Furthermore, none of the evaluated biochemical hormonal markers (FSH, LH, estradiol, prolactin, and AMH) differed significantly between women with CD and controls. This systematic review and meta-analysis reinforces the existing evidence that CD may adversely affect several aspects of menstrual health in women without significantly impacting biochemical hormonal markers.

Hypertension poses a significant health risk for postmenopausal women, with incidence rates notably higher than for men of the same age group. The decline in estrogen levels leads to several physiological changes, such as hypocalcemia, which may contribute to the development of hypertension. This study investigates the effects of calcium supplementation on blood pressure control in postmenopausal women with hypocalcemia. We prospectively included 300 postmenopausal women diagnosed with both hypocalcemia and hypertension. The participants received calcium carbonate (1,000mg/day) in two daily doses, in addition to their standard antihypertensive treatment. Blood pressure measurements and serum calcium levels were recorded at baseline and after 3 months. Patients were divided into two groups according to serum calcium level at 3 months: those with normalized calcium levels and those who continued hypocalcemia. Women with persistent hypocalcemia at follow-up were younger at the age of menopause (mean age 48.65 years) compared to those who achieved normocalcemia (mean age 49.44 years), P = 0.017. Those who had normocalcemia had a significant SBP, DBP, and more patients achieved target blood pressure ( 0.017, 0.029 & 0.012), respectively. Use of calcium supplements to correct hypocalcemia in postmenopausal hypertensive women may help reduce blood pressure and achieve the target blood pressure.

Female reproductive factors including menopausal age and number of live births have been associated with cardiovascular disease risk, but their role in atrial fibrillation (AF) is underexplored, especially in older adults. We analyzed data from the CHS (Cardiovascular Health Study), a US population-based longitudinal study of adults aged ≥65 years including 3065 women reporting their menopausal age and 3236 reporting number of live births at participation. We followed participants for incident AF until June 2015. NT-proBNP (N-terminal pro-B-type natriuretic peptide) was measured at baseline. Maximal P-wave duration, P-wave terminal force in V1, and P-wave dispersion were calculated from baseline ECGs. We assessed the associations of menopausal age, number of live births, and NT-proBNP and electrocardiographic findings with incident AF using linear regression and a Cox model. After a median follow-up of 7.5 years, 1266 women (41.3%) developed AF. Each 5-year increase in menopausal age was associated with lower AF risk (hazard ratio [HR], 0.96 [95% CI, 0.92-1.00]). Menopausal age <40 years was associated with higher AF risk (HR, 1.21 [95% CI, 1.02-1.44]). No association was found between the number of live births and AF risk (HR, 0.98 [95% CI, 0.95-1.02]). Cross-sectional analyses showed younger menopausal age was associated with higher NT-proBNP levels, longer maximal P-wave duration, and longer P-wave dispersion. Among women aged ≥65 years, earlier menopausal age was associated with higher NT-proBNP, longer P-wave duration, longer P-wave dispersion, and higher AF risk. Number of live births was not associated with these end points.

To quantify sex- and age-related differences in hypercholesterolaemia diagnosis and associated comorbidities around the menopausal transition, using a population-based real-world dataset. Retrospective, multicentre, non-interventional observational cohort study. Region-wide public healthcare system data (primary and secondary care) from Andalusia (Spain), 2016-2022. All adult patients meeting inclusion criteria with a recorded diagnosis of hypercholesterolaemia between 1 January 2016 and 31 December 2022 (n=557 034; 227 834 men and 329 200 women). None. Primary outcomes were age- and sex-stratified patterns of hypercholesterolaemia diagnosis and comorbidity burden before and after age 50 years (proxy for post-menopausal age). Secondary outcomes included comorbidity-specific comparisons between sexes across age strata and trajectory-based analyses (OR trajectories and incidence-ratio summaries). Women were diagnosed later than men (mean age 59.1 vs 56.0 years; mean difference 3.1 years, 95% CI 3.03 to 3.17). Hypercholesterolaemia diagnoses in women rose sharply around ages 50-55 and remained higher than in men at older ages. Comorbidity patterns differed by sex across age strata: compared with men, women aged ≥50 years had higher frequencies of osteoporosis (42 255 vs 2623), anxiety disorder (94 916 vs 31 374) and hypertension (147 538 vs 91 532), with statistically significant differences for these comparisons (p<0.001). Menopause age is a pivotal period associated with a shift towards higher hypercholesterolaemia diagnosis rates and a greater burden of specific comorbidities in women. These findings support sex-specific prevention and management strategies, particularly targeting the menopausal transition and early post-menopause.

The influence of pregnancy and selected aspects of female health on skeletal status and fracture incidence in postmenopausal women from the RACOST-POL Study.

Objective The relationship between early menopause and the risk of cardiovascular disease (CVD) is understudied in Asian women. This study aimed to investigate this association and its potential causality among East Asian women. Method A seven-year observational study involving 1929 postmenopausal women from the China Health and Retirement Longitudinal Study was combined with two-sample Mendelian randomization (MR) analyses utilizing genetic data from the China Kadoorie Biobank and Biobank Japan. Time-varying Cox proportional hazards models were employed for observational analysis. For MR analyses, the inverse variance-weighted method was used as the primary approach to investigate potential causality between genetically proxied age at natural menopause and CVD. Results In the multivariable-adjusted Cox regression model, early menopause was significantly associated with an increased CVD risk (hazard ratio 1.43, 95% confidence interval 1.05–1.97). However, MR analyses did not yield significant associations. Additionally, a dose–response relationship was observed between menopausal age and incident CVD risk (p-value for non-linearity = 0.022). Conclusions Early menopause was associated with a higher risk of incident CVD in the observational study, while MR findings suggested this association may not be causal. This study unravels the importance of early menopause in CVD risk assessment and informs CVD primary prevention for Asian women.

To analyze the association between primary infertility and infertility type with the age of natural menopause. This is a retrospective cohort study reviewing a subset of women from the Mayo Primary Infertility Cohort (MPIC). The MPIC is a cohort of 1,001 women diagnosed with primary infertility and 1,001 age-matched referent women. In this study, we included all women at risk for natural menopause and further evaluated those who had reported natural menopause in the medical record. We compared the risk of natural menopause using Cox proportional hazard models with infertility status and infertility type as covariates. In those with documented menopause during the study period, the association between primary infertility and early and premature menopause was analyzed with χ2 testing. We evaluated the association between age at natural menopause, primary infertility status, and infertility type in this group using linear regression. In all, 461 women with primary infertility, with 530 referent individuals, were at risk of natural menopause, and of these, 340 women with infertility and 346 referent women underwent documented natural menopause on review of medical records. Women with primary infertility had an increased risk of natural menopause (hazard ratio: 1.25, 95% CI: 1.06-1.46) and underwent menopause 1 year earlier than referent individuals (β=-1.17, 95% CI: -1.82 to -0.52) after adjustment for body mass index, tobacco use, race, menstrual cycle regularity, and previous contraception use. Women with primary infertility were more likely to undergo early menopause (age 40-45) than referent women (7.6% vs. 3.0%, P=0.01). Compared with referent women, women with endometriosis underwent menopause 2.75 years earlier (95% CI: -4.38 to -1.13, P=0.0009), and women with unexplained infertility underwent menopause 1.45 years earlier (95% CI: -2.26 to -0.64, P=0.0005). Women with primary infertility had an increased risk of early menopause and collectively underwent menopause 1 year earlier than women without a history of primary infertility.

Menopausal timing is an important marker of women's long-term health, yet nationally representative evidence on menopause categories and their correlates remains limited in Iran. This study aimed to estimate the prevalence and timing of menopause and to examine sociodemographic, nutritional, cardiometabolic, and geographic factors associated with different menopause categories among Iranian women. We analyzed data from the 2021 Iran WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS), including 14,656 women aged ≥ 18 years. Menopause status and age at menopause were self-reported and categorized as premature ovarian insufficiency (POI; <40 years), early menopause (40-44 years), normal menopause (45-54 years), or late menopause (≥ 55 years). Weighted descriptive analyses and multinomial logistic regression models accounting for the complex survey design were used to assess associations with sociodemographic, lifestyle, nutritional, and cardiometabolic factors. Overall, 32.72% (95% CI: 31.87-33.57) of women were postmenopausal, with the majority experiencing menopause between 45 and 54 years. Among menopausal women, 74.37% had normal menopause, 11.15% late menopause, 9.83% early menopause, and 4.65% POI. In adjusted analyses, early menopause was associated with higher educational attainment and poor nutritional status, while moderate and good dietary patterns were protective. Late menopause was negatively associated with education and positively associated with hypertension. Diabetes and dyslipidemia were more prevalent among postmenopausal women but were not independently associated with menopausal timing. No significant predictors of POI were identified. Substantial provincial variation in menopause prevalence and timing was observed. Menopausal timing among Iranian women reflects heterogeneous socioeconomic, nutritional, and cardiometabolic patterns. Incorporating menopause assessment into routine women's health care and strengthening nutrition and hypertension prevention strategies may facilitate earlier risk identification and promote healthier aging, particularly in the context of marked regional disparities. The online version contains supplementary material available at 10.1007/s40200-026-01961-0.

The Women's Health Initiative (WHI), a randomized controlled trial, found no overall health benefit of menopausal hormone therapy. Our objective was to evaluate the hypothesis that initiating hormonal therapy prior to age 60 or within a few years after the last menstrual period provides health benefits in menopausal women. A search was conducted in MEDLINE, Scopus, and ClinicalTrials.gov from inception until August 26, 2025. Randomized controlled trials in which at least one arm was a pharmaceutical oestrogen and one arm was a placebo were included. We required studies to present clinical health outcomes. Systematic review. Menopausal women age 60 or younger or within a short time of the last menstrual period, as defined by individual study authors. Studies were categorized based on primary endpoints, namely cardiovascular disease, cancer, depression, and cognition. Risk of bias was assessed using a standard tool. The reliability of conclusions was assessed using the core GRADE method. Thirty-one papers, reporting on seventeen randomized controlled trials, met eligibility criteria. Menopausal hormone therapy in young menopausal women was not shown to have beneficial effects on cardiovascular disease, cancer, depression, or cognition with the exception of some cardiovascular endpoints in women on oestrogen alone in the WHI, a finding not confirmed in other randomized controlled trials and not confirmed in women with vasomotor symptoms. Menopausal hormone therapy in young menopausal women has not been shown in randomized controlled trials to have beneficial effects on cardiovascular disease, cancer, depression, or cognition.

Hair loss is a widespread condition with a potentially severe psychological burden, especially among women. The chance of suffering from female alopecia increases with menopause, and topical treatments beyond minoxidil are scarce. Over the past several years, new combinations of natural ingredients and patented mixtures have shown promising results to improve hair shedding, thus helping recover self-esteem and confidence. In this work, results of a prospective, open-label clinical trial conducted in women of predominantly menopausal age provides evidence that the dual cosmetic serum system developed by KilgourMD displays statistically significant and clinically meaningful effects on female hair loss, measured through an objective combing test, modified hair wash test, and clinical expert evaluation, after an application period of 4 months.

To investigate the association of reproductive factors and their joint effects with lifestyle behaviours with cognitive decline in Chinese postmenopausal women. Community-based cohort study. Shanghai, China. We prospectively followed 1379 cognitively normal postmenopausal women aged ≥ 60 years for 1.8 years on average. Menopausal age, menarche age, parity, age at first live birth and breastfeeding duration were assessed at baseline. Associations between reproductive factors or their joint effects with lifestyle behaviours and cognitive decline were examined using logistic regression. The additive interaction was evaluated by the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). Cognitive decline was defined as an annual decline in Mini-Mental State (MMSE) Examination score exceeding mean decline by 1.0 SD. The ORs (95% CIs) for cognitive decline were 2.55 (1.07, 6.06) for menopausal age < 46 years and 2.32 (1.11, 4.83) for menopausal age 46-50 years compared with menopausal age > 55 years. Meanwhile breastfeeding > 35 months (2.15, 1.02-4.51) and breastfeeding 24-35 months (2.31, 1.13-4.71) had higher risks of cognitive decline than breastfeeding < 12 months. Moreover, the combination of early menopause (≤ 50 years) and insufficient vegetable intake (1.84, 1.12-3.01), physical inactivity (2.11, 1.28-3.48), suboptimal sleep duration (2.15, 1.32-3.51), or an unfavourable composite lifestyle index (CLI) (1.76, 1.06-2.94) was associated with an increased risk of cognitive decline compared with the combination of late menopause (> 50 years) and each favourable lifestyle behaviour. Similarly, prolonged breastfeeding duration (> 23 months) combined with physical inactivity (2.10, 1.23-3.59), suboptimal sleep (2.11, 1.26-3.55), or an unfavourable CLI (2.16, 1.19-3.91) showed elevated risks compared with the combination of short breastfeeding duration (≤ 23 months) and each favourable lifestyle behaviour. In addition, we found additive interactions between early menopause and physical inactivity (RERI = 1.08, 95% CI: 0.37-1.80; AP = 0.51, 95% CI: 0.19-0.83), as well as between long breastfeeding duration and physical inactivity (RERI = 0.89, 95% CI: 0.15-1.63; AP = 0.42, 95% CI: 0.07-0.78). Unhealthy lifestyle behaviours may exacerbate cognitive decline in women with adverse reproductive factors.

Menopausal age is closely associated with women's health, but research on its association with sarcopenia risk remains insufficient. Our study aimed to explore how menopausal age affects the risk of sarcopenia in postmenopausal women. Based on the China Health and Retirement Longitudinal Study (CHARLS) database, we included 3,410 postmenopausal women from 2011-2015. Participants were divided into five groups according to menopausal age: premature menopause (< 40years), early menopause (40-44years), intermediate menopause (45-49years), normal menopause (50-55years), and late menopause (> 55years). Sarcopenia was identified using the 2019 Asian Working Group for Sarcopenia (AWGS 2019) criteria. Mixed-effects logistic regression models were used to analyze the association between menopausal age and sarcopenia. The study included 3,410 postmenopausal women with a mean age of 64.39 ± 8.68years and overall sarcopenia prevalence of 35.40%. Compared to the average age at menopause group (50-55years; 1,593/3,410; 46.70%), premature menopause (127/3,410; 3.70%), early menopause (385/3,410; 11.30%), intermediate menopause (1,098/3,410; 32.20%), and late menopause (207/3,410; 6.10%) were all associated with increased sarcopenia risk. Compared to normal menopause (50-55years), early menopause (40-44years), intermediate menopause (45-49years), and late menopause (> 55years) were associated withstatistically significantincreased sarcopenia risk, while premature menopause (< 40years) showed anon-significantelevated risk (OR = 1.40, 95% CI: 0.89-2.21, p = 0.1438). This association was stronger among women with late menarche, rural residence, married status, non-retirement, or low education levels. Both earlier and later than average menopausal agemay beassociated with increased sarcopenia risk in Chinese postmenopausal women, although the association for premature menopause did not reach statistical significance in fully adjusted models.

Objective With the decline in the average age of menopause, increased life expectancy and rising longevity among women, a significant number face menopausal challenges including physical and psychological symptoms that adversely affect their quality of life (QoL). Given the growing preference for complementary therapies over menopausal hormone therapy (MHT) and promising evidence on auricular acupressure, this study aimed to investigate its effect on QoL in postmenopausal women. Method The randomized sham-controlled clinical trial enrolled 120 eligible postmenopausal women visiting comprehensive health centers in Qazvin, Iran, between February and August 2024. Participants were randomized into intervention (n = 60) or sham (n = 60) groups using the balanced blocks randomization method. The intervention group received auricular acupressure using Vaccaria seed-embedded tapes on specific points (Chinese/European uterine, ovary, Shenmen, brain, gonadotropin and sympathetic points) over 10 sessions (4-day intervals). Participants were instructed to apply moderate pressure to each point for 20 s, three times daily. The sham group followed an identical protocol but used non-seeded tapes. Data were collected using demographic/fertility questionnaires and the Menopause-Specific Quality of Life Questionnaire (MENQOL), assessing vasomotor, physical, psychosocial and sexual domains (lower scores indicate improved QoL). QoL was evaluated at baseline, 1 month post intervention and 2 months post intervention. Data were analyzed using repeated-measures analysis of variance–analysis of covariance (SPSS version 27, α = 0.05). Results Baseline QoL scores did not differ significantly between groups. Post intervention, the intervention group showed statistically significant reductions in total QoL scores and all subscales at 1-month and 2-month follow-ups (p < 0.05). Mean differences for intervention versus sham groups in the first and second follow-ups were −28.50, −48.87 for total QoL; −2.36, −5.92 for vasomotor subscale; −2.55, −9.75 for psychosocial subscale; −10.89, −28.41 for physical subscale; and −1.62, −4.78 for sexual subscale. Based on η 2-values, auricular acupressure explained 63.4% of total QoL variance, and 61.6% (vasomotor), 39.9% (psychosocial), 66.2% (physical), and 42.4% (sexual) for the subscales. Conclusion Auricular acupressure significantly improved overall QoL and all specific domains (physical, psychosocial, vasomotor, sexual) in postmenopausal women. Healthcare providers may consider this non-pharmacological therapy particularly for MHT-ineligible patients to alleviate menopausal symptoms and enhance QoL. Some limitations such as potential social desirability bias from self-reported measures, the lack of objective biomarkers due to budget limits and unevaluated confounding factors related to living conditions highlight the need for future research with multimodal assessments.

End-stage renal disease (ESRD) requiring hemodialysis (HD) disproportionately affects older adults, who face increased risks of falls and fractures due to age-related changes, renal osteodystrophy, comorbidities and dialysis-related factors. Although bone abnormalities and fall risk have often been examined separately in patients with ESRD, few studies have evaluated vertebral compression fractures (VCF) in older HD patients while concurrently assessing skeletal, functional and geriatric risk factors. The role of Comprehensive Geriatric Assessment (CGA) in identifying multidimensional risk factors in this context remains underexplored. To investigate associations between bone mass, falls and VCF in older adults undergoing HD, and evaluate the utility of CGA in identifying risk factors and informing care strategies. This cross-sectional study enrolled 50 older adults (≥ 65years; mean age 67.8 (3.2), range 65-76) with ESRD on maintenance HD. Participants had multiple comorbidities, typical of this population, including anemia, cardiovascular disease and chronic liver disease. Bone mineral density was assessed using dual-energy X-ray absorptiometry. Falls, VCF, comorbidities, and medication use were documented via interviews and medical records. CGA included assessments of activities of daily living (ADLs), mobility, cognition, depression, nutrition and social support. FRAX scores and biochemical markers (parathyroid hormone [PTH], bone-specific alkaline phosphatase [ALP]) were analyzed. Falls occurred in 28% of participants, significantly associated with prior fall history (p < 0.001), advanced age (p = 0.011), anemia (p = 0.040), chronic liver disease (p = 0.044), reduced mobility (p = 0.037), depression (p = 0.01), impaired ADLs (p = 0.037) and poor nutrition (p = 0.032). VCF were present in 14%, associated with earlier menopausal age, back pain, elevated ALP and higher FRAX scores. Osteoporosis was most prevalent at the distal radius (46%). Hip T-scores were lower in the VCF group (p = 0.003). PTH and ALP were significantly higher in VCF patients (p = 0.003), indicating impaired bone turnover. Older adults on HD face a substantial burden of falls and vertebral fractures due to overlapping functional, metabolic and psychosocial factors. CGA effectively identified multidimensional risks, underscoring the need for integrated preventive strategies.

While sleep is closely related to menopause, existing research has primarily focused on the impact of menopause on sleep, leaving the influence of sleep patterns on the timing of menopause largely unexplored. This study aimed to investigate the associations of sleep duration and quality with age at natural menopause. This study included women with complete data on sleep patterns and natural menopausal age from the National Health and Nutrition Examination Survey (NHANES) cycles 2005-2018. Logistic and linear regression models, progressively adjusted for demographic, lifestyle, and health-related covariates, were used to examine the relationships of sleep duration and quality with menopausal age, analyzed both as categorical (early/late menopause) and continuous variables. Restricted cubic splines were applied to assess nonlinear associations. Subgroup analyses and alternative menopausal age classifications were also performed. A total of 2,157 women were included. Compared with medium sleep duration (7-9hours), short sleep duration (< 7hours) was associated with higher odds of early menopause in the initial model (OR = 1.41, 95% CI: 1.08-1.84, p = 0.01), but this association was attenuated in the fully adjusted model. Restricted cubic spline analysis revealed a nonlinear U-shaped association between sleep duration and early menopause (p for nonlinearity = 0.04), and an inverted U-shaped association with natural menopausal age (p for nonlinearity < 0.01), both peaking around 7.5hours. Poor sleep quality remained significantly associated with early menopause after full adjustment (OR = 1.30, 95% CI: 1.01-1.66), but not with late menopause. In subgroup analyses, short sleep duration showed a stronger association with early menopause in women with BMI ≥ 28 and those without hormone use. Interestingly, poor sleep quality was positively associated with late menopause among women with ≥ 3 live births and no history of oral contraceptive use. Short sleep duration and poor sleep quality may be associated with early menopause, with evidence of nonlinear relationships and subgroup heterogeneity. In certain populations, poor sleep quality may also be linked to later menopause. These findings highlight the complex role of sleep in reproductive aging, requiring prospective studies to clarify causal pathways.

Prominent sex differences exist in severe mental illness (SMI), with increasing evidence pointing towards a pivotal role for sex hormones. Elucidation of these hormonal influences is crucial to tailor sex-specific prevention and treatment. To investigate potential shared genetics and bi-directional causal effects between sex hormone traits and SMI (depressive disorder, bipolar disorder and schizophrenia-spectrum disorder), we computed genetic correlations using linkage disequilibrium score regression and bi-directional summary-level Mendelian Randomization (MR). A range of sensitivity methods was applied and potential mediators were investigated using multivariable MR. Sex-stratified data from genome-wide association studies were used, if available further stratified on menopausal status. We also incorporated other sex hormone traits (progesterone, sex hormone-binding globulin, prolactin, age of menarche, age of menopause) in exploratory analyses. We found a widespread pattern of statistically significant, modest genetic correlations between oestrogen/testosterone levels and depressive disorder/schizophrenia-spectrum disorder, in both positive and negative directions and in both sexes (ranging between -0.22 and 0.13). With MR, evidence for causal effects was largely lacking; apart from weak evidence for a causal, increasing effect of testosterone levels on schizophrenia-spectrum disorder risk in males, which was mediated by CRP. Conversely, there was very weak evidence for a causal, increasing effect of liability to schizophrenia-spectrum disorder on testosterone levels in both sexes. This study offers new insights into the complex aetiology of SMI by comprehensively mapping genetic associations with sex hormone traits, emphasizing the need to further investigate sex hormones' impact on SMI using larger and more precisely phenotyped samples to identify individuals particularly vulnerable to hormonal disturbances.

Introduction Osteoporosis poses a disproportionate burden on postmenopausal women, yet access to DXA-based bone mineral density (BMD) measurement remains severely limited in rural India, with only 700–800 scanners serving over 140 million postmenopausal women. This study aimed to determine the prevalence of osteoporosis and osteopenia in a rural Delhi cohort, examine associations with lifestyle and menopausal symptom burden, and compare the diagnostic performance of five validated screening tools—OSTA, SCORE, ABONE, ORAI, and OSIRIS—against DXA-measured BMD. Methodology This community-based cross-sectional study enrolled 94 women aged 40 years and above at the Rural Health Training Centre, Najafgarh, under the SNSP Abhiyan. BMD was assessed via portable peripheral DEXA at the right calcaneus and classified per WHO T-score criteria. Participants completed a sociodemographic and lifestyle questionnaire and the validated 11-item Menopause Rating Scale (MRS). Diagnostic performance of five risk scores was evaluated using sensitivity, specificity, PPV, NPV, and ROC curve analysis. Results Mean age was 52.5 ± 8.8 years and mean age of menopause was 44.8 ± 9.9 years. BMD was abnormal in 93.7% of participants—51.1% osteopenic and 42.6% osteoporotic. Lower educational status was significantly associated with abnormal BMD (p = 0.028). Multivariate regression identified age (p = 0.038) and somatic menopausal symptom severity (p = 0.026) as independent predictors of reduced BMD. OSTA demonstrated the highest sensitivity (85.7%) and NPV (98.1%) with an AUC of 0.73. SCORE had the highest PPV (85%) but poor sensitivity (42.5%) and an AUC of 0.50. ABONE, ORAI, and OSIRIS showed moderate performance with AUCs of 0.53–0.57. Conclusion This study reveals a high burden of low BMD among rural women in Delhi. OSTA emerged as the most effective primary screening tool, supporting targeted DXA referrals in resource-constrained settings. Age and somatic menopausal symptom severity were significant predictors of reduced BMD, highlighting the skeletal consequences of estrogen deficiency. Integration of OSTA into rural primary care protocols, alongside development of population-specific screening questionnaires, is strongly recommended.