Geburtshilfe Frauenheilkd 2006; 66 - PO_E_02_03
DOI: 10.1055/s-2006-952555

Influence of pattern of menopausal transition on the amount of trabecular bone loss and fracture rate

M Haseitl 1, S Fillenberg 1, D Müller 2, J Rattenhuber 1, VR Seifert-Klauss 1
  • 1Frauenklinik der Technischen Universität München, Klinikum Rechts der Isar, München
  • 2Institut für Röntgendiagnostik der TU München, München

Introduction: Bone density is lower in postmenopausal than in premenopausal women. Recent longitudinal data on perimenopausal bone density changes show that accelerated bone loss begins well before menopause. This study investigated the dynamics of endocrine changes leading to postmenopausal osteopenia and the time point at which accelarated bone loss begins in untreated women during their perimenopausal years.

Methods: 34 pre-, peri- and early postmenopausal women without prior hormone replacement therapy were propectively followed by measuring lumbar spine (L1-L3) trabecular bone density with quantitative computed tomography (QCT) at baseline, two, six and nine years. Fractures were categorized as a) radiographic vertebral (RV), b) fracture without adequate trauma (NAT) and c) clinical fracture after adequate trauma (AT).

Results: Six different patterns of menopausal transition were identified in our sample by coding for pre-, peri- or postmenopause at the timepoints: baseline, 2 and 6 years. Trabecular bone loss in the groups not reaching postmenopause during the first six years of observation was ≤ 50% of the maximum bone loss observed during this time. The perimenopausal phase with estrogen levels still within the normal range was associated with the greatest reduction of trabecular bone mineral density, reaching 6.3mg/ml loss annually in the lumbar spine. By comparison, the average rate of loss was slower in the early postmenopause; total bone loss differed by pattern of menopausal transition (One-way ANOVA: p<0,05). Fracture rates were highest in women with prolonged perimenopause, and more type RV and NAT fractures were noted in women who did not reach postmenopause before year six of follow-up.

Conclusion: In this study, perimenopausal women suffered more fractures without adequate trauma, while postmenopausal women had more clinical fractures following adequate trauma. Larger studies are needed to validate our findings.