Skip to main content

Advertisement

Log in

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

Osteoporosis International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  2. Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B (2011) Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int 22:2575–2586

    Article  PubMed  CAS  Google Scholar 

  3. Sowers MR, Zheng H, Jannausch ML, McConnell D, Nan B, Harlow S, Randolph JF Jr (2010) Amount of bone loss in relation to time around the final menstrual period and follicle-stimulating hormone staging of the transmenopause. J Clin Endocrinol Metab 95:2155–2162

    Article  PubMed  CAS  Google Scholar 

  4. Recker R, Lappe J, Davies K, Heaney R (2000) Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 15:1965–1973

    Article  PubMed  CAS  Google Scholar 

  5. Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ, Lee JS, Karlamangla AS (2011) Bone mineral density loss in relation to the final menstrual period in a multi-ethnic cohort: results from the study of Women’s Health Across the Nation (SWAN). J Bone Miner Res. doi:10.1002/jbmr.534

  6. Reeve J, Walton J, Russell LJ et al (1999) Determinants of the first decade of bone loss after menopause at spine, hip and radius. QJM 92:261–273

    Article  PubMed  CAS  Google Scholar 

  7. Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. BMJ 303:961–964

    Article  PubMed  CAS  Google Scholar 

  8. Heaney RP, Barger-Lux MJ, Davies KM, Ryan RA, Johnson ML, Gong G (1997) Bone dimensional change with age: interactions of genetic, hormonal, and body size variables. Osteoporos Int 7:426–431

    Article  PubMed  CAS  Google Scholar 

  9. Ahlborg HG, Nguyen ND, Nguyen TV, Center JR, Eisman JA (2005) Contribution of hip strength indices to hip fracture risk in elderly men and women. J Bone Miner Res 20:1820–1827

    Article  PubMed  Google Scholar 

  10. Finkelstein JS, Brockwell SE, Mehta V et al (2008) Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab 93:861–868

    Article  PubMed  CAS  Google Scholar 

  11. Karlamangla AS, Barrett-Connor E, Young J, Greendale GA (2004) Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int 15:62–70

    Article  PubMed  Google Scholar 

  12. Ishii S, Greendale GA, Cauley JA, Crandall CJ, Huang MH, Danielson ME, Karlamangla AS (2012) Fracture risk assessment without race/ethnicity information. J Clin Endocrinol Metab. doi:10.1210/jc.2012-1997

  13. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444

    Article  PubMed  CAS  Google Scholar 

  14. Ishii S, Cauley JA, Crandall CJ, Srikanthan P, Greendale GA, Huang MH, Danielson ME, Karlamangla AS (2012) Diabetes and femoral neck strength: findings from the Hip Strength Across the Menopausal Transition Study. J Clin Endocrinol Metab 97:190–197

    Article  PubMed  CAS  Google Scholar 

  15. Sowers M, Crawford S, Sternfeld B et al (2000) Design, survey, sampling and recruitment methods of SWAN: a multi-center, multi-ethnic, community based cohort study of women and the menopausal transition. Academic, San Diego

    Google Scholar 

  16. Baecke JA, Burema J, Frijters JE (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942

    PubMed  CAS  Google Scholar 

  17. Sternfeld B, Ainsworth BE, Quesenberry CP (1999) Physical activity patterns in a diverse population of women. Prev Med 28:313–323

    Article  PubMed  CAS  Google Scholar 

  18. Ishii S, Cauley JA, Greendale GA, Danielson ME, Safaei Nili N, Karlamangla A (2012) Ethnic differences in composite indices of femoral neck strength. Osteoporos Int 23:1381–1390

    Article  PubMed  CAS  Google Scholar 

  19. Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structure analysis. Curr Osteoporos Rep 5:49–55

    Article  PubMed  Google Scholar 

  20. Szulc P, Seeman E, Duboeuf F, Sornay-Rendu E, Delmas PD (2006) Bone fragility: failure of periosteal apposition to compensate for increased endocortical resorption in postmenopausal women. J Bone Miner Res 21:1856–1863

    Article  PubMed  Google Scholar 

  21. Seeman E (2003) Periosteal bone formation—a neglected determinant of bone strength. N Engl J Med 349:320–323

    Article  PubMed  Google Scholar 

  22. Ahlborg HG, Johnell O, Turner CH, Rannevik G, Karlsson MK (2003) Bone loss and bone size after menopause. N Engl J Med 349:327–334

    Article  PubMed  Google Scholar 

  23. Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the Women’s Health Initiative-Observational study. J Bone Miner Res 24:1369–1379

    Article  PubMed  Google Scholar 

  24. Compston JE, Watts NB, Chapurlat R et al (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124:1043–1050

    Article  PubMed  Google Scholar 

  25. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, Cummings SR (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. Jama 293:2102–2108

    Article  PubMed  CAS  Google Scholar 

  26. Cauley JA, Wu L, Wampler NS, Barnhart JM, Allison M, Chen Z, Jackson R, Robbins J (2007) Clinical risk factors for fractures in multi-ethnic women: the Women’s Health Initiative. J Bone Miner Res 22:1816–1826

    Article  PubMed  Google Scholar 

  27. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. Jama 286:2815–2822

    Article  PubMed  CAS  Google Scholar 

  28. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1997) Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 146:502–509

    Article  PubMed  CAS  Google Scholar 

  29. Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HA (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790

    Article  PubMed  Google Scholar 

  30. Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162

    Article  PubMed  CAS  Google Scholar 

  31. Gerdhem P, Obrant KJ (2002) Effects of cigarette-smoking on bone mass as assessed by dual-energy X-ray absorptiometry and ultrasound. Osteoporos Int 13:932–936

    Article  PubMed  CAS  Google Scholar 

  32. Oncken C, Prestwood K, Kleppinger A, Wang Y, Cooney J, Raisz L (2006) Impact of smoking cessation on bone mineral density in postmenopausal women. J Womens Health (Larchmt) 15:1141–1150

    Article  Google Scholar 

  33. Follet H, Boivin G, Rumelhart C, Meunier PJ (2004) The degree of mineralization is a determinant of bone strength: a study on human calcanei. Bone 34:783–789

    Article  PubMed  CAS  Google Scholar 

  34. Cauley JA, Danielson ME, Gregg EW, Vogt MT, Zmuda J, Bauer DC (1997) Calcaneal ultrasound attenuation in older African-American and Caucasian-American women. Osteoporos Int 7:100–104

    Article  PubMed  CAS  Google Scholar 

  35. Danielson ME, Beck TJ, Karlamangla AS et al (2012) A comparison of DXA and CT based methods for estimating the strength of the femoral neck in post-menopausal women. Osteoporos Int. doi:10.1007/s00198-012-2066-y

  36. Li GW, Chang SX, Xu Z, Chen Y, Bao H, Shi X (2012) Prediction of hip osteoporotic fractures from composite indices of femoral neck strength. Skeletal Radiol. doi:10.1007/s00256-012-1473-7

  37. Yu N, Liu YJ, Pei Y et al (2010) Evaluation of compressive strength index of the femoral neck in Caucasians and Chinese. Calcif Tissue Int 87:324–332

    Article  PubMed  CAS  Google Scholar 

  38. Crandall CJ, Zheng Y, Crawford SL, Thurston RC, Gold EB, Johnston JM, Greendale GA (2009) Presence of vasomotor symptoms is associated with lower bone mineral density: a longitudinal analysis. Menopause 16:239–246

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Ishii.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ishii, S., Cauley, J.A., Greendale, G.A. et al. Trajectories of femoral neck strength in relation to the final menstrual period in a multi-ethnic cohort. Osteoporos Int 24, 2471–2481 (2013). https://doi.org/10.1007/s00198-013-2293-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-013-2293-x

Keywords

Navigation