Osteoporosis International

, Volume 24, Issue 9, pp 2471–2481

Trajectories of femoral neck strength in relation to the final menstrual period in a multi-ethnic cohort

  • S. Ishii
  • J. A. Cauley
  • G. A. Greendale
  • C. J. Crandall
  • M.-H. Huang
  • M. E. Danielson
  • A. S. Karlamangla
Original Article

DOI: 10.1007/s00198-013-2293-x

Cite this article as:
Ishii, S., Cauley, J.A., Greendale, G.A. et al. Osteoporos Int (2013) 24: 2471. doi:10.1007/s00198-013-2293-x

Abstract

Summary

The purpose of this study was to describe the evolution of femoral neck strength relative to load across the menopause transition. It declined significantly over the 10 years bracketing the final menstrual period, and the rate of decline was modified by body mass index, race/ethnicity, and smoking status.

Introduction

Composite indices of femoral neck strength, which integrate dual energy X-ray absorptiometry (DXA)-derived bone mineral density and bone size with body size, are inversely associated with hip fracture risk. Our objective was to describe longitudinal trajectories of the strength indices across the menopausal transition.

Methods

Data came from the Study of Women’s Health Across the Nation; participants were pre- or early peri-menopausal, ages 42–53 at baseline, and were followed up for 9.1 ± 1.8 years. Composite indices of femoral neck strength in different failure modes (compression, bending, and impact) were created in 921 women who had three or more hip DXA scans and had definable final menstrual period (FMP) dates. We used mixed effects models to fit piecewise linear growth curves to the baseline-normalized strength indices as a function of time to/after the FMP.

Results

Compression and impact strength indices did not decline until 1 year prior to the FMP, and declined rapidly thereafter, with some slowing of decline 1 year after the FMP. Bending strength index increased slightly until 2 years prior to the FMP, then plateaued, and began to decline at the FMP. Mean decline in strength indices over 10 years was 6.9 % (compression), 2.5 % (bending), and 6.8 % (impact). Women with higher body mass index had larger declines in two of the three indices. Other major modifiers of rates of decline were race/ethnicity and smoking status.

Conclusions

Femoral neck strength relative to load declines significantly during the menopausal transition, with declines commencing 1 to 2 years prior to the FMP.

Keywords

Composite strength indicesFinal menstrual periodLongitudinal trajectory across menopauseOsteoporosis

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • S. Ishii
    • 1
  • J. A. Cauley
    • 2
  • G. A. Greendale
    • 3
  • C. J. Crandall
    • 4
  • M.-H. Huang
    • 3
  • M. E. Danielson
    • 5
  • A. S. Karlamangla
    • 3
  1. 1.Department of Geriatric Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
  2. 2.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of Medicine/Division of GeriatricsDavid Geffen School of Medicine at UCLALos AngelesUSA
  4. 4.Department of Medicine/Division of General Internal Medicine and Health Services ResearchDavid Geffen School of Medicine at UCLALos AngelesUSA
  5. 5.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA