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The prevalence of vertebral fractures among Indian perimenopausal women and its association with ovarian biomarkers



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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Author information




CK: data curation and writing of original draft. CK and KEC: data analysis, methodology, writing and editing of original draft. FJ, HSA, NT: review and editing of manuscript. NK: conceptualization, methodology, review and editing of manuscript. AJ: conceptualization, Assay of biochemical parameters and review of manuscript. TVP: conceptualization, Methodology, Formal Analysis and Review and Editing.

Corresponding author

Correspondence to Kripa Elizabeth Cherian.

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The authors declare no conflict of interest and have not received any funding for this study.

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Ethical approval was obtained from the Institutional Review Board.

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Written informed consent was obtained from all participants.

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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).

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  • AMH
  • FSH
  • Perimenopausal women
  • Trabecular bone score
  • Vertebral fractures