There is dearth of data on prevalent vertebral fractures in perimenopausal women in India and limited literature on the utility of FSH, AMH and estradiol in evaluating bone health them. The objective was to study the prevalence of vertebral fractures (VF) and to assess the utility of FSH, estradiol and AMH in predicting them in Indian perimenopausal women
Materials and methods
It was a cross-sectional study. Perimenopausal women aged 40–49 years underwent assessment for prevalent vertebral fractures, bone mineral density (BMD) and trabecular bone score (TBS). Utility of serum FSH, estradiol and AMH in predicting prevalent vertebral fractures was also assessed.
A total of 300 perimenopausal women with mean (SD) age of 43.2 (2.8) years was recruited and 18% had moderate–severe VF. Mean (SD) serum AMH was lower in perimenopausal women with VF as compared to those without fractures [0.752 (0.594) vs 1.023 (0.704) P = 0.006]. AMH showed significant positive correlation with TBS (r = 0.3; P < 0.001) and BMD at the femoral neck (r = 0.2; P < 0.001) and lumbar spine (r = 0.3; P < 0.001).On ROC analysis, AMH demonstrated good performance in predicting prevalent VF with an AUC of 0.800 (95% CI 0.705–0.880) and a sensitivity of 85% and specificity of 60% at a cut-off of 1.12 ng/mL. On an exploratory multivariate logistic regression analysis, AMH significantly predicted prevalent fractures with an adjusted OR (OR) of 1.85 (95% CI: 1.03–3.00; P = 0.04). The performance of FSH and estradiol in predicting prevalent fractures was sub-optimal.
About one-fifth of the study subjects had prevalent vertebral fractures. AMH may be a menstrual cycle independent biomarker and may reflect bone loss in perimenopausal women. Further prospective studies are needed to validate these findings.
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Johnell O, Kanis JA, Odén A et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42. https://doi.org/10.1007/s00198-003-1490-4
Wong CC, McGirt MJ (2013) Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc 6:205–214. https://doi.org/10.2147/JMDH.S31659
Shetty S, John B, Mohan S, Paul TV (2020) Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis. Arch Osteoporos 15:25. https://doi.org/10.1007/s11657-020-0688-9
Tella SH, Gallagher JC (2014) Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol 142:155–170. https://doi.org/10.1016/j.jsbmb.2013.09.008
Sowers MR, Zheng H, McConnell D, Nan B, Harlow SD, Randolph JF (2008) Estradiol rates of change in relation to the final menstrual period in a population-based cohort of women. J Clin Endocrinol Metab 93:3847–3852. https://doi.org/10.1210/jc.2008-1056
Wang J, Zhang W, Yu C et al (2015) Follicle-stimulating hormone increases the risk of postmenopausal osteoporosis by stimulating osteoclast differentiation. PLoS One 10:e0134986. https://doi.org/10.1371/journal.pone.0134986
Santoro N, Roeca C, Peters BA, Neal-Perry G (2021) The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab 106:1–15. https://doi.org/10.1210/clinem/dgaa764
Yan Y, Chen W, Wang J et al (2020) Serum anti-Müllerian hormone levels are associated with low bone mineral density in premenopausal women. Biomarkers 25:693–700. https://doi.org/10.1080/1354750X.2020.1833083
Ahuja M (2016) Age of menopause and determinants of menopause age: a PAN India survey by IMS. J Midlife Health 7:126–131. https://doi.org/10.4103/0976-7800.191012
Yang J, Cosman F, Stone PW, Li M, Nieves JW (2020) Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective? Osteoporos Int 31:2321–2335. https://doi.org/10.1007/s00198-020-05588-6
Hans D, Šteňová E, Lamy O (2017) The trabecular bone score (TBS) complements DXA and the FRAX as a fracture risk assessment tool in routine clinical practice. Curr Osteoporos Rep 15:521–531. https://doi.org/10.1007/s11914-017-0410-z
Rajan R, Cherian KE, Kapoor N, Paul TV (2020) Trabecular bone score-an emerging tool in the management of osteoporosis. Indian J Endocrinol Metab 24:237–243. https://doi.org/10.4103/ijem.IJEM_147_20
Rajan R, Paul J, Cherian KE, Asha HS, Kapoor N, Paul TV (2020) FRAX® with or without BMD and TBS predicts fragility fractures in community-dwelling rural southern Indian postmenopausal women. Arch Osteoporos 15:82. https://doi.org/10.1007/s11657-020-00756-x
Saini AK, Dawe EJC, Thompson SM, Rosson JW (2017) Vitamin D and calcium supplementation in elderly patients suffering fragility fractures; the road not taken. Open Orthop J 11:1230–1235. https://doi.org/10.2174/1874325001711011230
Kim SH, Choi HS, Rhee Y, Kim KJ, Lim S-K (2011) Prevalent vertebral fractures predict subsequent radiographic vertebral fractures in postmenopausal Korean women receiving antiresorptive agent. Osteoporos Int 22:781–787. https://doi.org/10.1007/s00198-010-1298-y
Shuhart CR, Yeap SS, Anderson PA et al (2019) Executive summary of the 2019 ISCD position development conference on monitoring treatment, DXA cross-calibration and least significant change, spinal cord injury, peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics. J Clin Densitom. 22: 453–471. https://doi.org/10.1016/j.jocd.2019.07.001
Genant HK (1997) Assessment of vertebral fractures in osteoporosis research. J Rheumatol 24:1212–1214
Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289. https://doi.org/10.1007/s00198-005-2010-5
Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 91:4215–4222. https://doi.org/10.1210/jc.2006-1178
Hosmer WD, Genant HK, Browner WS (2002) Fractures before menopause: a red flag for physicians. Osteoporos Int 13:337–341. https://doi.org/10.1007/s001980200035
Wu F, Mason B, Horne A et al (2002) Fractures between the ages of 20 and 50 years increase women’s risk of subsequent fractures. Arch Intern Med 162:33–36. https://doi.org/10.1001/archinte.162.1.33
Ferrari S, Bianchi ML, Eisman JA et al (2012) Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 23:2735–2748. https://doi.org/10.1007/s00198-012-2030-x
Martínez-Morillo M, Grados D, Holgado S (2012) Premenopausal osteoporosis: how to treat? Reumatol Clin 8:93–97. https://doi.org/10.1016/j.reuma.2011.05.011
Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierrez C, Crandall CJ, Karlamangla AS (2019) Estradiol and follicle-stimulating hormone as predictors of onset of menopause transition-related bone loss in pre- and perimenopausal women. J Bone Miner Res 34:2246–2253. https://doi.org/10.1002/jbmr.3856
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The authors declare no conflict of interest and have not received any funding for this study.
Ethical approval was obtained from the Institutional Review Board.
Written informed consent was obtained from all participants.
The datasets generated and analyzed in the present study are not publicly available, but may be obtained from the corresponding author on reasonable request.
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Kuriakose, C., Cherian, K.E., Jebasingh, F. et al. The prevalence of vertebral fractures among Indian perimenopausal women and its association with ovarian biomarkers. J Bone Miner Metab (2021). https://doi.org/10.1007/s00774-021-01266-7
- Perimenopausal women
- Trabecular bone score
- Vertebral fractures