EXECUTIVE SUMMARY
Researchers have developed an index to predict which women may experience faster bone loss across the menopause transition.
- Such a tool may prove helpful. Estimates indicate that as many as 50% of Americans older than 50 years will be at risk for osteoporotic fractures during their lifetimes.
- Osteoporosis has a fivefold greater prevalence in women than in men. In the United States, although women have only twice the fracture rate of men, they sustain 80% of hip fractures because older women far outnumber older men.
- Because gender and age are the factors most associated with the disease, the U.S. Preventive Services Task Force recommends screening for women who are age 65 and older.
Researchers have developed an index to predict which women may experience faster bone loss across the menopause transition.1 Such a tool may prove helpful. Estimates indicate that as many as 50% of Americans older than 50 years will be at risk for osteoporotic fractures during their lifetimes.2 Osteoporosis has a fivefold greater prevalence in women than in men. In the United States, although women only have twice the fracture rate of men, they sustain 80% of hip fractures because older women outnumber older men.3
Osteoporosis is a medical condition that causes bone density to diminish and fracture risk to increase. It often is referred to as a “silent” disease because individuals who have it experience few noticeable symptoms. Because gender and age are the factors most associated with the disease, the U.S. Preventive Services Task Force recommends screening for women who are age 65 and older.4
“Whether an individual loses or gains bone mass is dependent on how much bone is being broken down by osteoclasts and being formed by osteoblasts; both processes occur simultaneously,” explains Albert Shieh, MD, fellow physician in the Division of Endocrinology, Diabetes and Hypertension at the David Geffen School of Medicine, University of California, Los Angeles. “At present, we can measure markers of bone breakdown (resorption) and formation.”
Shieh and researchers hypothesized that to better predict how fast bone will be lost, such markers should be combined in an “index” to reflect both processes, rather than being interpreted in isolation. In the current article, the scientists found that new “Bone Balance Index” predicted future bone loss across the menopause transition better than the bone resorption marker alone, Shieh notes.The scientists combined measurements of bone breakdown and bone formation in what they termed the “Bone Balance Index” to determine each individual’s net bone balance before the final menstrual period.
To create the index, the researchers looked at data from the Study of Women’s Health Across the Nation, a longitudinal, multicenter study of some 3,000 women in midlife from five racial/ethnic groups. The 685 women who participated in the current research were between the ages of 42 and 52, premenopausal or in early perimenopause when they enrolled in the study, and had their final menstrual periods during the follow-up portion of the study.
Urine and blood samples were taken from study participants to measure for bone turnover markers, the proteins that reflect bone breakdown and bone formation. Participants also had their bone mineral density measured every year during the study.
The scientists found that the Index was a stronger predictor of bone loss from two years before the final menstrual period to three to four years later — a time when bone density typically declines — than a measurement of bone breakdown alone.1
This approach to assessing bone health may help identify which women are at risk of losing vertebral bone mineral density across the menopause transition, notes Shieh. However, more studies are needed to test whether the index is useful for predicting bone loss after the menopause transition and if it is useful for predicting fractures, he states.
Bone health measures should begin early in life, according to Contraceptive Technology. Weight-bearing exercise in moderation is important to initiate the skeletal modeling and remodeling process. Clinicians should advise on the importance of smoking cessation, as well as moderation in alcohol use.5
Bone mineral density testing is recommended for all women ages 65 years and older, with consideration for earlier testing in women with clinical risk factors for fracture, including low body weight, history of prior fracture, family history of osteoporosis, smoking, excessive alcohol intake, or long-term use of high-risk medications such as glucocorticoids.6
The Institute of Medicine recommends that adults age 19 to 70 get 600 IU (international units) of vitamin D a day. For calcium, the amount needed depends on age and sex. All adults ages 19-50 should get 1,000 mg; the recommendation for adult men ages 51-70 is 1,000 mg, while adult women in the same age bracket are advised to take 1,200 mg.7 (The National Institutes of Health has a handout on calcium and vitamin D. Access it at http://bit.ly/29w3l7z.)
REFERENCES
- Shieh A, Han W, Ishii S, et al. Quantifying the balance between total bone formation and total bone resorption: An index of net bone formation. J Clin Endocrinol Metab 2016; 101(7):2802-2809.
- Office of the Surgeon General, U.S. Department of Health and Human Services (HHS). Bone Health and Osteoporosis: A Report of the Surgeon General. HHS; Rockville, MD: 2004.
- American College of Obstetricians and Gynecologists. Osteoporosis. Practice Bulletin. Obstet Gynecol 2012; 120(3):718-734.
- U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2011; 154(5):356-364.
- Nelson AL. Perimenopause, menopause, and postmenopause: Health promotion strategies. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
- Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010; 17(1):25-54.
- National Institutes of Health. Calcium & Vitamin D: Important At Every Age. Accessed at http://bit.ly/29w3l7z.
