Trabecular Bone Score Declines During the Menopause Transition: The Study of Women’s Health Across the Nation (SWAN)

Abstract

Abstract Context Rapid bone density loss starts during the menopause transition (MT). Whether other components of bone strength deteriorate before the final menstrual period (FMP) remains uncertain. Objective To discern whether trabecular bone score (TBS) declines during the MT. Design An 18-year longitudinal analysis from the Study of Women’s Health Across Nation. Setting Community-based cohort. Participants A total of 243 black, 164 Japanese, and 298 white, initially pre- or early perimenopausal women, who experienced their FMP. Main Outcome Measures TBS, an indicator of bone strength. Results Multivariable mixed effects regressions fitted piecewise linear models to repeated measures of TBS as a function of time before or after the FMP; covariates were age at FMP, race/ethnicity, and body mass index. Prior to 1.5 years before the FMP, in the referent individual (a white woman with age at FMP of 52.2 years and body mass index of 28.0 kg/m2), TBS evidenced no change (slope 0.12% per year, P = 0.2991). TBS loss began 1.5 years before the FMP, declining by 1.16% annually (P < 0.0001). Starting 2 years after the FMP, annual rate of TBS loss lessened to 0.89% (P < 0.0001). In the 5 years before through the 5 years after the FMP, in the referent individual, total TBS decline was 6.3% (P < 0.0001), but black participants’ total TBS loss was 4.90% (P = 0.0008, difference in black and white 10-year change). Results for Japanese did not differ from those of white women. Conclusions The occurrence of an MT-related decline in TBS supports the thesis that this period is particularly damaging to skeletal integrity.