Rd. Chapurlat et al., Longitudinal study of bone loss in pre- and perimenopausal women: Evidencefor bone loss in perimenopausal women, OSTEOPOR IN, 11(6), 2000, pp. 493-498
Bone loss before and around the time of menopause is not well characterized
by longitudinal studies. We measured bone mineral density at various skele
tal sites - total body, femoral neck, trochanter, anteroposterior (AP) and
lateral spine, and forearm with dual-energy X-ray absorptiometry in a large
prospective cohort of 272 untreated pre- and perimenopausal women aged 31-
59 years, at I year intervals for 3 years. Sex steroids and the following m
arkers of bone remodeling were measured: serum osteocalcin (OC), procollage
n I carboxyterminal extension peptide, bone alkaline phosphatase (BAP) and
urinary crosslinks (CTX and NTX). Seventy-six women were classified as peri
menopausal and 196 as premenopausal, Over the 3 years, premenopausal women
had no significant bone loss at any site and a small but significant increa
se in bone mineral density at the trochanter, total hip, AP spine and radiu
s. Perimenopausal women significantly lost bone from cancellous and cortica
l sites, i.e,, the femoral neck, trochanter and lumbar spine. In perimenopa
usal women with increased follicle stimulating hormone, the rate of bone lo
ss at the femoral neck correlated negatively with OC and BAP. In perimenopa
usal women, serum estradiol levels decreased during the 3 years of follow-u
p and bone loss from the trochanter and the AP spine was correlated with se
rum estradiol after 3 years. In conclusion, among premenopausal women there
is no bone loss. In contrast, there is a rapid and diffuse bone loss in pe
rimenopausal women, related to decreased estrogen secretion. Bone markers m
ay be useful to identify these women losing bone.