Osteoporosis International

, Volume 24, Issue 9, pp 2471–2481 | Cite as

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



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.


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.


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.


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.


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


Composite strength indices Final menstrual period Longitudinal trajectory across menopause Osteoporosis 



The SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH) (grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). The Hip Strength Through the Menopausal Transition has grant support from the NIA (AG026463). Additional support for this project provided by NIA through P30-AG028748. Dr. Ishii was supported by VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center and VA Advanced Geriatrics Fellowship. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, VA, or the NIH.

Clinical Centers

University of Michigan, Ann Arbor—Siobán Harlow, PI 2011–present, MaryFran Sowers, PI 1994–2011; Massachusetts General Hospital, Boston, MA—Joel Finkelstein, PI 1999–present; Robert Neer, PI 1994–1999; Rush University, Rush University Medical Center, Chicago, IL—Howard Kravitz, PI 2009–present; Lynda Powell, PI 1994–2009; University of California, Davis/Kaiser—Ellen Gold, PI; University of California, Los Angeles—Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY—Carol Derby, PI 2011–present, Rachel Wildman, PI 2010–2011; Nanette Santoro, PI 2004–2010; University of Medicine and Dentistry—New Jersey Medical School, Newark—Gerson Weiss, PI 1994–2004; and the University of Pittsburgh, Pittsburgh, PA—Karen Matthews, PI.

NIH Program Office

National Institute on Aging, Bethesda, MD—Winifred Rossi 2012; Sherry Sherman 1994–2012; Marcia Ory 1994–2001; and National Institute of Nursing Research, Bethesda, MD—Program Officers.

Central Laboratory

University of Michigan, Ann Arbor—Daniel McConnell (Central Ligand Assay Satellite Services).

Coordinating Center

University of Pittsburgh, Pittsburgh, PA—Kim Sutton-Tyrrell, Co-PI 2001–present; Maria Mori Brooks Co-PI 2012; New England Research Institutes, Watertown, MA—Sonja McKinlay, PI 1995–2001.

Steering Committee

Susan Johnson, Current Chair

Chris Gallagher, Former Chair

We thank the study staff at each site and all the women who participated in SWAN.

Conflicts of interest



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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

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