Years Since Menopause Research Articles

Plasma serotonin precursors and metabolite are correlated with bone mineral density and bone turnover markers in patients with postmenopausal osteoporosis.

Serotonin (5-HT) precursors regulate bone remodeling. This study aims to investigate the correlation of plasma 5-HT precursors and metabolite with bone mineral density (BMD) and bone turnover markers in postmenopausal osteoporosis (PMOP) patients. The age, body mass index (BMI), and years since menopause (YSM) were documented for 348 postmenopausal women in normal/osteopenia/osteoporosis (OP) groups, with lumbar spine and femoral neck BMD measured. Serum bone turnover markers (PINP/β-CTX) and plasma 5-HT, 5-HT precursors (Trp/5-HTP) and metabolite (5-HIAA) were measured by ELISA. OP patients were allocated to high/low expression groups following ROC analysis of 5-HT/Trp/5-HTP/5-HIAA. The relationship of plasma 5-HT/Trp/5-HTP/5-HIAA, BMD, and bone turnover markers with PMOP was analyzed using logistic regression analysis. The correlation of plasma 5-HT/Trp/5-HTP/5-HIAA with BMD and bone turnover markers was analyzed using Pearson's correlation analysis, followed by logistic regression analysis of the relationship between plasma 5-HT/Trp/5-HTP/5-HIAA and BMD, bone turnover markers and PMOP. BMI, YSM, BMD and PINP, and β-CTX levels differed among groups. Levels of plasma 5-HT precursors/metabolite were increased in OP patients. Individuals with high 5-HT precursors/metabolite levels had low BMD and high PINP/β-CTX levels. The 5-HT precursors/metabolite negatively-correlated with BMD and positively-correlated with PINP/β-CTX. BMI, YSM, BMD, and PINP/β-CTX/Trp/5-HTP/5-HT related to PMOP and were independent risk factors for OP. Plasma 5-HT precursors and metabolite negatively-correlate with BMD and positively-correlate with PINP/β-CTX in PMOP patients. Peripheral 5-HT precursors and metabolite level may be a new direction of treatment of PMOP and bone metabolism-related disorders.

Roles of Follicle-Stimulating Hormone on Bone Metabolism in Late Postmenopausal Women.

BackgroundThe effects of elevated follicle-stimulating hormone (FSH) levels on physiological changes in the bone remain unclear. This study aimed to clarify the association between FSH concentrations and bone mineral density (BMD) and bone turnover markers (BTM) in late postmenopausal women.MethodsA total of 169 Korean women were enrolled. The participants’ ages ranged from 60 to 84 years (mean age, 69.0±5.1) and reported a mean duration of 19.4±6.6 years since menopause (YSM). The participants showed an average body mass index (BMI) of 24.4±2.8 kg/m2. Age, YSM, estradiol, testosterone, and BMI were confounders in the Pearson’s partial correlation. A test for trends across the quartiles of FSH levels was performed for each variable.ResultsThe mean FSH and estradiol concentrations were 61.5 IU/L and 2.9 pg/mL, respectively. Serum FSH concentration was not significantly associated with BMD (lumbar, r=0.09, P=0.30; total hip, r=0.00, P=0.96; and femoral neck, r=0.05, P=0.62). BTM across the FSH quartiles did not show any trend association (bone-specific alkaline phosphate, P=0.31; cross-linked C-terminal telopeptide of type I collagen, P=0.90). Instead, FSH levels were negatively correlated with BMI (r=−0.34, P=0.00). In the multivariate regression model adjusted for age, testosterone, and estradiol, only BMI showed a negative value across the FSH quartiles (β coefficient −0.11, P=0.00).ConclusionsThis study identified that high FSH concentrations were not associated with bone loss or high bone turnover in women in the late postmenopausal period.

Influence of duration of menopause on bone turnover markers in post-menopausal women

Introduction and Aim: Osteoporosis is common among women following 10 years of cessation of menstruation, due to bone loss accelerated by menopause. The study was done to evaluate the effect of duration of menopause on bone turnover markers (BTMs). Materials and Methods: The study involved 100 postmenopausal women; 50 osteoporotic and 50 non-osteoporotic. Comparison and correlation of serum calcium, phosphorus, alkaline phosphatase (ALP), serum osteocalcin (sOC) and urinary hydroxyproline (uHP) were done based on duration of menopause. Comparison of biochemical parameters was done using Independent t-test and ANOVA test for two groups and more than two groups respectively. Correlation was done using Pearson’s correlation test. Statistical significance was considered at p<0.05. Results: The sOC significantly declined and uHP levels increased between quartiles of duration of menopause among study participants. (p<0.001). However, in those without fractures, sOC and uHP were higher in those with <7 years since menopause (YSM) and then plateaued after 8 YSM. The percentage of osteoporotic women having >15 YSM was 82%. Duration of menopause correlated better with sOC (r=-0.633) than uHP (r=0.575) (p<0.001). Conclusion: Osteoporotic fractures were higher in more than 15 YSM. There was no difference in both sOC and uHP in those with fractures, proving non-significance of screening these markers once the fractures have occurred. As sOC correlates better with duration of menopause, monitoring of sOC in early years of menopause is required to prevent osteoporotic fractures and associated burden through prophylactic treatment.

Prevalence of osteoporosis in perimenopausal and postmenopausal women in Malwa region of Punjab

Background: Clinical sign of osteoporosis includes fragility fractures or a T-score that is <2.5 SD below the mean as determined by a dual-energy X-ray absorptiometry (DXA) scan of bone mineral density (BMD). People with T-scores of –2.5 have the highest risk of fracture. People with T-scores of –2.5 have the highest risk of fracture. However, maximum fractures are seen in patients with a T-score between –1 and –2.5 because of more people in this category. As there is very little knowledge of osteoporosis in perimenopausal and postmenopausal women in male region, this study will help us to know the current status of osteoporosis in these females. Aims and Objectives: The objective of the present study was to determine the prevalence of osteoporosis in 296 premenopausal, perimenopausal and postmenopausal women of more than 40 years of age attending midlife health clinic at a tertiary care center in Patiala, Punjab and to observe its correlation with age, menopausal status, body mass index, and dietary intake. Materials and Methods: A detailed medical, surgical, obstetrical, gynecological, and drug history were recorded in a pro forma designed for the study after taking the informed consent. Information about history of fracture on a trivial fall, family history suggestive of osteoporosis, socioeconomic status, educational status, and occupation was documented. Women having history of endocrinal disorders (hypo/hyperthyroidism, hypo/hypergonadism, and hypo/hypercalcemia), receiving therapeutic agents (thiazide diuretics, glucocorticoids, and osteoporosis treatment), having restricted mobility issues and with implants (at lumbar spine, hip, and lower limbs) were excluded from the study. Quantitative ultrasound (QUS) measurement of calcaneum was performed that T-score was generated based on the speed of sound and was used to classify the bone health status of the subjects. Results: Out of 296 women, 227 women had a low bone mass density, that is, <–1 SD. We divided all the participants into three groups as shown in Table 1. Group I (n = 69 [23.2%]) having normal BMD, that is, T score >–1 SD; Group II (n = 204 [69.2%]) included women with BMD between –1 and –2.5 SD (Osteopenia); and Group III (n = 23 [7.6%]) included women with BMD <–2.5 SD (Osteoporosis). Most women in perimenopausal (75%) and postmenopausal (64.6%) group were osteopenic (Group I). Out of all women with osteopenia (Group II, n = 204), 113 (52.1%) were postmenopausal and 82 (40.3%) were perimenopausal. All women with osteoporosis were postmenopausal. The difference between BMD categories and menopausal status was statistically significant (P = 0.014). In these women, the BMD was found to decrease with increase in the average number of years since menopause (YSM) (P = 0.06). Conclusion: Menopause is an important event in a woman’s life cycle which affects bone health with the prevalence of osteoporosis and osteopenia increasing with increasing YSM. QUS technology emerges as cost-effective screening tool for the early detection of osteoporosis for a large population in developing country like India.

A pilot screening study for low bone mass in Singaporean women using years since menopause and BMI

Objective Current risk assessment tools for osteoporosis have inconsistent performance across different cohorts, making them difficult for clinical practice. This study aimed to evaluate a simple screening index comprising years since menopause (YSM) and body mass index (BMI) that identifies postmenopausal Singaporean women with a greater likelihood of low bone mass. Methods The study used data from 188 treatment-naïve postmenopausal women. The associations between low bone mass and different demographic variables, including age, YSM and BMI, were assessed using multivariable logistic regression. Diagnostic performance of the calculated screening index was compared to the Osteoporosis Self-Assessment Tool for Asians (OSTA) and the Fracture Risk Assessment Tool (FRAX®). Results YSM and BMI were significantly associated with low bone mass. The area under the receiver operating characteristic curves was 0.803 for the screening index, 0.759 for the OSTA, 0.683 for the FRAX® (major osteoporotic fracture probability [MOFP]) and 0.647 for the FRAX® (hip fracture probability [HFP]). Non-parametric Spearman’s correlation between the screening index and the other models was 0.857 with the OSTA score, 0.694 with the FRAX® (HFP) and 0.565 with the FRAX® (MOFP) (p < 0.0005). Conclusions The diagnostic performance of the screening index comprising YSM and BMI was equivalent to the OSTA and the FRAX®. A risk chart was developed for clinicians to identify and recommend subjects for a further dual-energy X-ray absorptiometry scan. Validation of this model in larger and more diverse cohorts is required.

Comparison of the NOF and NOGG guidelines for spinal radiographic examination in postmenopausal Chinese women.

To compare the National Osteoporosis Foundation (NOF) and the UK National Osteoporosis Guideline Group (NOGG) guidelines for the detection of vertebral fractures in postmenopausal Chinese women. A cross-sectional study on 255 community-dwelling postmenopausal women was conducted in Hunan province in 2017. Demographic and clinical characteristics and risk factors were recorded through questionnaires. Height and weight were measured using standard methods, and bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. Vertebral fractures were diagnosed by radiography using semi-quantitative morphometry. The prevalence of vertebral fractures was 9.4%. Women with vertebral fractures were significantly older and shorter, had higher years-since menopause and height loss values and lower BMD and T-scores at the femoral neck and total hip, and were more likely to have a history of previous fractures. The sensitivity and specificity of the NOF guidelines were 91.7% and 39.8%, respectively, while the NOGG guidelines had lower sensitivity (87.5%) and specificity (32.5%). However, a higher percentage had indications for radiography in the 50-64 years age group according to the NOGG guidelines, while a higher percentage had indications for radiography in the ≥ 65 year group according to the NOF guidelines. The NOF guidelines were better than the NOGG guidelines for spinal radiography examination in the Chinese postmenopausal women.

The Value of Historical Height Loss for Detecting Vertebral Fractures in Postmenopausal Women in China

ABSTRACT Objectives The diagnosis and management of osteoporosis and osteoporotic fractures are challenging in rural and underdeveloped areas of China because medical resources are inaccessible; thus, a simple and accurate method is essential for the detection of vertebral fractures. We aimed to examine the relationship between historical height loss (HHL) and vertebral fractures in postmenopausal Chinese women. Material and Methods A cross-sectional study of 255 postmenopausal women aged 50 years or older was conducted in September 2017. Demographic data, including self-reported tallest historical height and current height were analyzed. Vertebral fractures were assessed using X-ray radiography and HHL thresholds were examined using specificity and sensitivity testing. Results The average age of the 255 participants was 66.3 ± 9.0 years and their mean HHL was 3.5 ± 2.8 cm. The 24 women who were found to have vertebral fractures were older, had more years since menopause (YSM), and a larger HHL compared to those without vertebral fractures. Logistic regression analysis showed that age was a better predictor of vertebral fractures than HHL was, and the cutoff age for detecting vertebral fractures was 71 years, with an area under the receiver operating characteristic curve of 0.750. Conclusions Although the women in this study with vertebral fractures had a greater height loss than those without fractures, it was apparent that age, rather than HHL, is the best way to determine who is most likely to develop vertebral fractures.

Associations between the levels of thyroid hormones and abdominal obesity in euthyroid post-menopausal women.

The aim of this study was to explore the association between thyroid hormones and abdominal fat quantities in euthyroid post-menopausal women. Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) as well as body mass index (BMI) and waist circumference (WC) were collected from 540 euthyroid post menopausal women aged 45-65 years. Magnetic resonance imaging (MRI) was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) area. Multivariate linear regression analysis was used to determine whether abdominal fat was associated with thyroid hormones. Weight, BMI, WC, fasting plasma glucose (FPG), fasting insulin (Fins), homeostasis model assessment of insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), TSH, and fT4 were higher in the obese group than in the nonobese group (p < 0.05). The study participants were divided into four groups according to quartiles in the light of TSH reference range (0.1-4.2 mU/L). Subcutaneous adipose tissue and VAT increased with the TSH levels. Adjusted for age, years since menopause (YSM), BMI, and HOMA-IR, VAT was negatively correlated with fT4 and positively correlated with fT3 and fT3-to-fT4 ratio (fT3/fT4) (p < 0.05), while no association was found between SAT and thyroid hormones. Similarly, we found no relation between body fat distribution and TSH. Furthermore, the association of common indicators of obesity and thyroid hormones showed no significance. In euthyroid post-menopausal women, VAT rather than SAT was negatively correlated with fT4, and positively correlated with fT3 and fT3/fT4.

Exploring the link between number of years since menopause and metabolic syndrome among women in rural China: a cross-sectional observational study

The aim of this article was to explore the link between postmenopausal status according to years since menopause (YSM) and the prevalence of metabolic syndrome (MetS). This survey was conducted from January 2012 to August 2013. A total of 6022 women (3511, 58.3% were post-menopause) from Rural Northeast China were randomly selected and examined. The prevalence of the MetS was significantly higher in postmenopausal women (Post-MW) than in premenopausal women (Pre-MW) (55.0% vs. 33.1%, p .001). The risk for MetS in Post-MW increased with the number of YSM, reaching the peak level in the 5- to 9-year group (OR, 1.55; 95% CI, 1.23–1.96), and then decreased. The 5- to 9-year group had the highest risk of high glucose (OR, 1.48; 95% CI, 1.20–1.83) and high triglycerides (adjusted OR, 1.92; 95% CI, 1.53–2.41) whereas the risk for abdominal obesity, high BP, and low HDL-C was not significantly associated with the number of YSM. These findings suggested that, in China, Post-MW with 5–9 YSMs had the highest risk of MetS. YSM can be a useful screening tool to identify women at high risk for MetS.

Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women.

The purpose of this study was to investigate the association between menopause and severity of knee joint cartilage degeneration using a magnetic resonance imaging-based six-level grading system, with six cartilage surfaces, the medial and lateral femoral condyle, the femoral trochlea, the medial and lateral tibia plateau, and the patella. The study cohort comprised 860 healthy women (age 36-83 y), and 5,160 cartilage surfaces were analyzed. Age, weight, height, age at natural menopause, and years since menopause (YSM) were obtained. Cartilage degeneration was assessed using a magnetic resonance imaging-based six-level grading system. After removing the age, height, and weight effects, postmenopausal women had more severe cartilage degeneration than pre- and perimenopausal women (P < 0.001). A positive trend was observed between YSM and severity of cartilage degeneration (P < 0.05). Postmenopausal women were divided into seven subgroups by every five YSM. When YSM was less than 25 years, the analysis of covariance indicated a significant difference in medial tibia plateau, medial femoral condyle, trochlea, patella, and total surfaces (P < 0.05 or 0.01) between every two groups. When YSM was more than 25 years, the significant difference, however, disappeared in these four surfaces (P > 0.05). No significant difference was observed in lateral tibia plateau and lateral femoral condyle in postmenopausal women. Menopause is associated with cartilage degeneration of knee joint. After menopause, cartilage showed progressive severe degeneration that occurred in the first 25 YSM, suggesting estrogen deficiency might be a risk factor of cartilage degeneration of the knee joint. Further studies are needed to investigate whether age or menopause plays a more important role in the progression of cartilage degeneration in the knee joint.

Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women.

Osteoporosis, a major health problem in elderly population, especially in post-menopausal females, is diagnosed basically on clinical suspicion and bone mineral density measurement. Dual energy x-ray absorptiometry (DEXA) scan though a gold standard of diagnosis becomes unfit for screening purpose due to its prohibitive cost, unportability and lack of availability of machine. To assess the diagnostic potential of serum osteocalcin levels in primary osteoporosis. In a case-control study, 82 post-menopausal females, between 40-70 years, were subjected to measurements of bone mineral density and serum osteocalcin levels. Based on the results of DEXA scan they were divided into two: a) Control group and B) Case group. Case group was further subdivided as Osteopenia and Osteoporosis depending on their t-scores. Correlation between different BMD grades and the levels of serum osteocalcin were analysed statistically. A negative correlation was found between serum osteocalcin levels and BMD grading. Significant association of age and years since menopause (YSM) was found with serum osteocalcin levels and BMD. No association of BMI and serum osteocalcin was observed with BMD. Statistically significant difference between values of serum osteocalcin in postmenopausal non-osteoporotic women, post-menopausal women with low bone mass (osteopenia) and post-menopausal women with osteoporosis were seen. Serum osteocalcin level measurement can be used for screening purpose in post-menopausal patients. Subjects can be further assessed by DEXA scan to, if indicated.

Prevalence and risk factors of hypertension among pre- and post-menopausal women: A cross-sectional study in a rural area of northeast China

ObjectivesThe aim of this study was to assess the prevalence and risk factors of hypertension in pre-menopausal women (Pre-MW) and post-menopausal women (Post-MW) and determine whether years since menopause (YSM) is associated with hypertension. MethodsA cross-sectional study was conducted with 6324 women over 35 years of age (2616 Pre-MW and 3708 Post-MW). Questionnaires, measurements and blood biochemical indexes were collected. ResultsThe overall prevalence of hypertension among women in rural northeast China was 48.8%, and it increased with age. Post-MW had a higher prevalence of hypertension than Pre-MW (62.4% vs. 29.7%, P<0.01). After controlling for confounding variables, overweight (OR=1.97, 95% CI: 1.72–2.25), obesity (OR=2.97, 95% CI: 2.30–3.84), diabetes mellitus (OR=2.13, 95% CI: 1.73–2.62), high triglycerides (OR=1.41, 95% CI: 1.20–1.65), and history of cardiovascular diseases in first-degree relatives (OR=1.60, 95% CI: 1.42–1.81) were associated with hypertension in all participants. However, abdominal obesity (OR=1.29, 95% CI: 1.05–1.58) was associated with higher odds among Post-MW only. Hypertension was associated with being postmenopausal (OR=1.22; 95% CI: 1.03–1.46), and the risk of hypertension reached a peak level in the <5-year group (OR=1.29; 95% CI, 1.07–1.57). ConclusionsPostmenopausal status was an independent risk factor for hypertension. The risk of hypertension was highest in Post-MW with <5 YSM and then decreased. Other risk factors of hypertension were body mass index (BMI), abdominal obesity, a family history of cardiovascular disease among first-degree relatives, a personal history of diabetes, and high TG.

Contributions of fat mass and fat distribution to hip bone strength in healthy postmenopausal Chinese women.

The fat and bone connection is complicated, and the effect of adipose tissue on hip bone strength remains unclear. The aim of this study was to clarify the relative contribution of body fat accumulation and fat distribution to the determination of proximal femur strength in healthy postmenopausal Chinese women. This cross-sectional study enrolled 528 healthy postmenopausal women without medication history or known diseases. Total lean mass (LM), appendicular LM (ALM), percentage of lean mass (PLM), total fat mass (FM), appendicular FM (AFM), percentage of body fat (PBF), android and gynoid fat amount, android-to-gynoid fat ratio (AOI), bone mineral density (BMD), and proximal femur geometry were measured by dual energy X-ray absorptiometry. Hip structure analysis was used to compute some variables as geometric strength-related parameters by analyzing the images of the hip generated from DXA scans. Correlation analyses among anthropometrics, variables of body composition and bone mass, and geometric indices of hip bone strength were performed with stepwise linear regression analyses as well as Pearson's correlation analysis. In univariate analysis, there were significantly inverse correlations between age, years since menopause (YSM), hip BMD, and hip geometric parameters. Bone data were positively related to height, body weight, LM, ALM, FM, AFM, and PBF but negatively related to AOI and amount of android fat (all P<0.05). AFM and AOI were significantly related to most anthropometric parameters. AFM was positively associated with height, body weight, and BMI. AFM was negatively associated with age and YSM. AOI was negatively associated with height, body weight, and BMI. AOI positively associated with age and YSM. LM, ALM, and FM had a positive relationship with anthropometric parameters (P<0.05 for all). PLM had a negative relationship with those parameters. The correlation between LM, ALM, FM, PLM, ALM, age, and YSM was not significant. In multivariate linear regression analysis, the hip bone strength was observed to have a consistent and unchanged positive association with AFM and a negative association with AOI, whereas its association with other variables of body composition was not significant after adjusting for age, years since menopause, height, body weight, and BMI. AFM may be a positively protective effect for hip bone strength while AOI, rather than android fat, shows a strong negative association with hip bone strength after making an adjustment for confounders (age, YSM, height, body weight, and BMI) in healthy postmenopausal Chinese women. Rational weight control and AOI reduction during menopause may have vital clinical significance in decreasing postmenopausal osteoporosis.

Menopause is associated with lumbar disc degeneration: a review of 4230 intervertebral discs

Objective The main objective of this study was to investigate, in a population of normal postmenopausal women, the association between menopause and severity of lumbar disc degeneration from the first lumbar to the first sacral vertebra on magnetic resonance imaging.Methods Between January 2010 and May 2013, 846 normal women and 4230 intervertebral discs were retrospectively analyzed. Age, height, weight and years since menopause (YSM) were recorded. Disc degeneration was evaluated using the modified Pfirrmann grading system.Results Compared to premenopausal and perimenopausal women, postmenopausal women had more severe disc degeneration after removal of age, height and weight effects (p < 0.0001). Postmenopausal women were divided into six subgroups for every 5 YSM. When YSM was below 15 years, there was a significant difference between every two groups, i.e. groups 1–5 YSM, 6–10 YSM and 11–15 YSM (p < 0.01). A positive trend was observed between YSM and severity of disc degeneration, respectively, i.e. L1/L2 (r = 0.235), L2/L3 (r = 0.161), L3/L4 (r = 0.173), L4/L5 (r = 0.146), L5/S1 (r = 0.137) and all lumbar discs (r = 0.259) (p < 0.05 or 0.01). However, when YSM was above 15, there was no difference, i.e. groups 16–20 YSM, 21–25 YSM and 26–30 YSM (p > 0.05), and the significance correlation also disappeared (p > 0.05).Conclusion Menopause is associated with disc degeneration in the lumbar spine. The association almost entirely occurred in the first 15 years since menopause, suggesting estrogen decrease may be a risk factor for lumbar disc degeneration.

Evaluation of the Efficacy and Safety of Bazedoxifene/Conjugated Estrogens for Secondary Outcomes Including Vasomotor Symptoms in Postmenopausal Women by Years Since Menopause in the Selective Estrogens, Menopause and Response to Therapy (SMART) Trials

Bazedoxifene/conjugated estrogens (BZA/CE), a novel tissue-selective estrogen complex (TSEC), has been evaluated in the Selective estrogens, Menopause And Response to Therapy (SMART) trials. Secondary outcomes from these trials were evaluated to determine whether the effects of BZA/CE are influenced by years since menopause (YSM). SMART-1 and SMART-2 were randomized, double-blind, placebo (PBO)-controlled phase 3 trials in nonhysterectomized postmenopausal women. Outcomes were evaluated for women <5 or ≥5 YSM in SMART-1 (BZA 20 mg/CE 0.45 mg, n=433; BZA 20 mg/CE 0.625 mg, n=414; PBO, n=427) and SMART-2 (BZA 20 mg/CE 0.45 mg, n=127; BZA 20 mg/CE 0.625 mg, n=128; PBO, n=63). Hot-flush frequency and severity, health-related quality of life (HRQoL), sleep, treatment satisfaction, cumulative amenorrhea, and breast pain were assessed for each study individually, using defined statistical analysis protocols. For <5 and ≥5 YSM subgroups, BZA 20 mg/CE 0.45 and 0.625 mg showed significant decreases in hot-flush frequency and severity at 3 months compared with PBO (p<0.05 for both). Both BZA/CE doses showed significant improvements compared with PBO in HRQoL scores, sleep parameters, and satisfaction with treatment at 3 months irrespective of YSM (p≤0.05 vs. PBO for all). Similar to PBO, BZA/CE showed high proportions of cumulative amenorrhea (SMART-1) and low incidences of breast pain (SMART-1 and SMART-2) for women <5 and ≥5 YSM. The positive effects of BZA/CE on secondary outcomes were consistent among women <5 or ≥5 YSM.

Relationship between body composition and bone mineral density of the lumbar spine and proximal femur: influence of years since menopause

Objectives. To investigate the relationship between the body composition and regional bone mineral density (BMD) in postmenopausal women according to years since menopause (YSM).Methods. A total of 167 postmenopausal women with a mean age of 62.91 ± 5.09 years participated in this cross-sectional study. The average YSM was 11.96 ± 6.28 years. We used the DXA Lunar Prodigy Primo™ device to assess the body composition parameters [body fat mass (BFM) and lean body mass (LBM)] and the BMD of the lumbar spine, proximal femur and total body.Results. The LBM was a stronger predictor of the proximal femur BMD than BFM in 1–10 YSM category, whereas the BFM was a stronger predictor of the proximal femur BMD than LBM in 11–20 and 21–30 YSM categories. The BMD of the lumbar spine showed a similar trend. A significant relationship was found between BMD of L1–L4 and LBM in 1–10 YSM category (r = 0.26; p < 0.05). BFM was significantly associated with BMD of L1–L4 in 11–20 YSM category (r = 0.25; p < 0.05). Significant relationships were found between total femur BMD and LBM in 1–10 YSM (r = 0.27; p < 0.05) and 11–20 YSM category (r = 0.25; p < 0.05). BFM was significantly associated with total femur BMD only in 11–20 YSM category (r = 0.40; p < 0.05).Conclusion. The relationships between BMD and body composition are dependent on YSM and vary between selected segments.

“Trabecular Bone Score” (TBS): An indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism

BackgroundPatients with primary hyperparathyroidism (PHPT) generally show reduced bone mineral density (BMD) at cortical sites with relatively preserved trabecular bone. However, the increased fracture risk at all skeletal sites suggests that areal BMD probably is not effective in capturing all the determinants of bone strength. “Trabecular Bone Score” (TBS) has been recently proposed as an indirect measure of bone micro-architecture. Our study was aimed to investigate TBS in patients with PHPT. MethodsSeventy-three Caucasian postmenopausal women with PHPT and 74 age-matched healthy women (C) were studied. In all participants BMD at lumbar spine (LS) and at femoral sites (Neck-FN and total hip-TH) was measured by DXA and, in 67 patients and 34 C, also at the distal 1/3 of the radius (R). TBS was measured in the region of LS-BMD. Spine X ray was assessed in all patients. ResultsMean TBS values were significantly reduced in PHPT (1.19±0.10) compared to C (1.24±0.09, p<0.01). Patients and controls did not differ for age, years since menopause (YSM), BMI, 25(OH)D serum levels, creatinine clearance, LS-BMD and FN-BMD. On the contrary, mean BMD values at both TH and R were significantly lower in PHPT patients compared to controls (p<0.01 and p<0.0001, respectively). In PHPT with vertebral fractures (VF+, n=29) TBS was significantly lower than in those without fracture (VF−, n=44)(1.14±0.10 vs. 1.22±0.10, respectively; p<0.01), whose TBS values did not differ from C. Mean TBS values in patients with (n=18) and without (n=55) non-vertebral fractures did not significantly differ (1.16±0.09 vs. 1.20±0.11). The presence of vertebral fractures was independently associated with the reduction of TBS (OR=0.003, 95% CI=0–0.534, p=0.028) and with YSM (OR=1.076, 95% CI=1.017–1.139, p=0.011), but not with age, the reduction of LS-BMD and the increase of BMI. The combination of YSM > 10years plus TBS < 1.2 was associated with a significant risk of VF (OR=11.73, 95% CI 2.43–66.55, p<0.001). A TBS value <1.2 showed a better performance in individuating VF (sensibility 79.3%, specificity 61.4%, positive predictive value 57.5%, and negative predictive value 81.8%) in respect to YSM > 10years. ConclusionsTBS seems to indirectly reflect an alteration of bone micro-architecture in postmenopausal women with PHPT.

Biochemical markers for bone turnover predict risk of vertebral fractures in postmenopausal women over 10 years: the Japanese Population-based Osteoporosis (JPOS) Cohort Study

We evaluated how bone turnover might predict vertebral fracture risk in postmenopausal women over 10 years. After adjusting for age and femoral neck bone mineral density, high bone-specific alkaline phosphatase and total and free deoxypyridinoline at baseline predicted increased vertebral fracture risk in women with ≥ 5 years since menopause. The aim was to evaluate the ability of bone turnover markers (BTMs) in predicting vertebral fractures. Participants in the 1996 baseline survey of the JPOS Cohort Study included 522 postmenopausal women, with no diseases or medications affecting bone metabolism. Vertebral fractures were ascertained in three follow-up surveys (1999, 2002, and 2006). Initial fracture events were diagnosed morphometrically. The Poisson regression model was applied to estimate the rate ratio (RR) of the following log-transformed BTM values at baseline: osteocalcin and bone-specific alkaline phosphatase (BAP) in serum and C-terminal cross-linked telopeptide of type I collagen, total deoxypyridinoline (tDPD), and free deoxypyridinoline (fDPD) in urine. Eighty-three fracture events were diagnosed over a median follow-up period of 10.0 years. RR per standard deviation (SD) (95 % confidence interval) for BAP was 4.38 (1.45, 13.21) among 65 subjects with years since menopause (YSM) < 5 years. RRs per SD (95 % confidence interval) for BAP, tDPD, and fDPD were 1.39 (1.12, 1.74), 1.32 (1.05, 1.67), and 1.40 (1.12, 1.76), respectively, after adjusting for age and femoral neck bone mineral density (FN BMD) among 457 subjects with YSM ≥ 5 years. Of the 451 women followed at least once until 2002, RRs per SD for BAP, tDPD, and fDPD adjusted for age and FN BMD over 6 years were not significantly different from those over 10 years. BAP was associated with vertebral fracture risk among early postmenopausal women. BTMs can predict vertebral fractures independently of BMD among late postmenopausal women over a 10-year follow-up period.

The effect of physical loading on calcaneus quantitative ultrasound measurement: a cross-section study

BackgroundPhysical loading leads to a deformation of bone microstructure and may influence quantitative ultrasound (QUS) parameters. This study aims at evaluating the effect of physical loading on bone QUS measurement, and further, on the potential of diagnosing osteoporosis using QUS method under physical loading condition.Methods16 healthy young females (control group) and 45 postmenopausal women (divided into 3 groups according to the years since menopause (YSM)) were studied. QUS parameters were measured at calcaneus under self-weight loading (standing) and no loading (sitting) conditions. Weight-normalized QUS parameter (QUS parameter measured under loading condition divided by the weight of the subject) was proposed to evaluate the influence of loading. T-test, One-Way analysis of variance (one way ANOVA) and receiver operating characteristic (ROC) analysis were applied for analysis.ResultsIn QUS parameters, mainly normalized broadband ultrasound attenuation (nBUA), measured with loading significantly differed from those measured without loading (p < 0.05). The relative changes of weight-normalized QUS parameters on postmenopausal women with respect to premenopausal women under loading condition were larger than those on traditional QUS parameters measured without loading. In ROC analysis, weight-normalized QUS parameters showed their stronger discriminatory ability for menopause.ConclusionsPhysical loading substantially influenced bone QUS measurement (mainly nBUA). Weight-normalized QUS parameters can discriminate menopause more effectively. By considering the high relationship between menopause and osteoporosis, an inference was drawn that adding physical loading during measurement may be a probable way to improve the QUS based osteoporosis diagnosis.

Relative contribution of weight‐bearing and non‐weight‐bearing effect of adipose tissue to bone mineral density in postmenopausal women

To investigate the relative contributions of weight-bearing and non-weight-bearing effects of adipose tissue to bone mineral density (BMD) in postmenopausal women. The subjects were 228 postmenopausal women aged 50-75 years. Age, years since menopause (YSM), height, body weight, and body mass index were recorded. Trunk fat mass, body fat mass, bilateral leg BMD and lean (muscle) mass were measured by whole body scanning with dual-energy X-ray absorptiometry. The relationships of BMD to trunk and body fat mass were investigated using uni- and multivariable analyses. The amount of trunk fat mass and body fat mass were 8.7 ± 3.6 kg and 19.0 ± 5.9 kg, respectively. On Pearson's correlation test, right leg BMD was positively correlated with trunk fat mass (r=0.268, P<0.001) and body fat mass (0.299, P<0.001). On multiple linear regression analysis, trunk fat mass (t-value = 3.500, P<0.001), age (-2.431, P<0.05), and YSM (-2.564, P<0.01) were independent significant predictors of right leg BMD. However, body fat mass was not a predictor of BMD (-0.465, P=0.642). These relationships remained significant after further adjusting for right leg muscle mass. Trunk fat mass rather than body fat mass is a significant predictor of leg BMD at the most weight-bearing site, despite being less than half the amount of body fat mass. Thus, adipose tissue contributes more to BMD through non-weight-bearing effect rather than weight-bearing effect.