Faster lumbar spine bone loss in midlife predicts subsequent fracture independent of starting bone mineral density

Context Bone mineral density (BMD) decreases rapidly during the menopause transition (MT), and continues to decline in postmenopause. Objective To examine whether faster BMD loss during the combined MT and early postmenopause is associated with incident fracture, independent of starting BMD, before the MT. Design and Setting The Study of Women’s Health Across the Nation (SWAN), a longitudinal cohort study. Patients or Participants 451 women, initially pre- or early perimenopausal, and transitioned to postmenopause. Main outcome measures Time to first fracture after early postmenopause. Results In Cox proportional hazards regression, adjusted for age, body mass index, race/ethnicity, study site, use of vitamin D and calcium supplements, and use of bone--detrimental or beneficial medications, each SD decrement in lumbar spine (LS) BMD before the MT was associated with a 78% increment in fracture hazard (p=0.007). Each 1% per year faster decline in LS BMD was related to a 56% greater fracture hazard (p=0.04). Rate of LS BMD decline predicted future fracture, independent of starting BMD. Women with a starting LS BMD below the sample median, and a LS BMD decline rate faster than the sample median had a 2.7-fold greater fracture hazard (p=0.03). At the FN, neither starting BMD nor rate of BMD decline was associated with fracture. Conclusions At the LS, starting BMD before the MT and rate of decline during the combined MT and early postmenopause are independent risk factors for fracture. Women with below-median starting LS BMD and faster-than-median LS BMD decline have the greatest fracture risk.

Role of Menopausal Transition and Physical Activity in Loss of Lean and Muscle Mass: A Follow-Up Study in Middle-Aged Finnish Women

In midlife, women experience hormonal changes due to menopausal transition. A decrease especially in estradiol has been hypothesized to cause loss of muscle mass. This study investigated the effect of menopausal transition on changes in lean and muscle mass, from the total body to the muscle fiber level, among 47–55-year-old women. Data were used from the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, where 234 women were followed from perimenopause to early postmenopause. Hormone levels (estradiol and follicle stimulating hormone), total and regional body composition (dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) scans), physical activity level (self-reported and accelerometer-measured) and muscle fiber properties (muscle biopsy) were assessed at baseline and at early postmenopause. Significant decreases were seen in lean body mass (LBM), lean body mass index (LBMI), appendicular lean mass (ALM), appendicular lean mass index (ALMI), leg lean mass and thigh muscle cross-sectional area (CSA). Menopausal status was a significant predictor for all tested muscle mass variables, while physical activity was an additional significant contributor for LBM, ALM, ALMI, leg lean mass and relative muscle CSA. Menopausal transition was associated with loss of muscle mass at multiple anatomical levels, while physical activity was beneficial for the maintenance of skeletal muscle mass.

Abstract MP09: Effect of Estradiol Therapy on Arterial Wall Echomorphology in the Early versus Late Intervention Trial With Estradiol(elite)

Objective: The effect of estradiol therapy (ET) has been evaluated on atherosclerosis progression measured by carotid artery wall thickness. Echogenicity of the arterial wall, a measure of lipid deposition, has not been investigated in relation to ET. Methods: This is a secondary analysis from ELITE. A total of 643 healthy postmenopausal women were randomized within time-since-menopause strata (early (<6 years) and late (>10 years) postmenopause) to daily 1 mg estradiol or placebo. The atherosclerosis outcome for the current analysis is grey scale median (GSM, unitless), a qualitative measure of atherosclerosis based on echogenicity obtained by high resolution ultrasonography of the common carotid arterial wall. Lower GSM values indicate more lipid deposition. GSM and serum concentrations of estradiol (E2) were assessed every 6 months over a median 5-year trial period. Linear mixed effects regression models were used to compare the rate of GSM progression between the randomized groups within time-since-menopause strata. The association of mean on-trial serum E2 levels with GSM progression was also tested using similar mixed effects model. Results: The effect of ET on the annual rate of GSM progression significantly differed between early and late postmenopause strata (p-value for interaction = 0.006). Annual GSM progression rate (95% confidence interval) among women in early postmenopause decreased by -0.30 (-0.63, 0.04) per year among women taking ET compared to -1.41 (-1.77, -1.06) per year among the placebo group (p<0.0001). In contrast, the annual GSM progression rate was not significantly different between ET and placebo among the late postmenopausal women (p=0.37). The positive association between mean on-trial E2 level (pg/ml) and GSM progression rate was stronger and significant among early postmenopausal women (0.008 (0.0007, 0.016)) compared to women in the late postmenopause group (0.003 (-0.006, 0.01)). However, this differential association between E2 level and GSM progression rate was not statistically significant (p-value for interaction = 0.33). Conclusion: Compared to placebo, oral ET significantly reduced progression of lipid deposition in the carotid arterial wall among women in early postmenopause. ET had no such beneficial effect in late postmenopause. Associations between serum estradiol levels and lipid deposition validated those findings. Qualitative assessment of subclinical atherosclerosis (GSM) complements the anatomic assessment by carotid artery intima-media thickness.

The Association between Fast Increase in Bone Turnover During the Menopause Transition and Subsequent Fracture

Context Bone turnover increases rapidly during the menopause transition (MT) and plateaus above premenopausal levels in early postmenopause. It is uncertain whether higher bone turnover is associated with fracture in midlife women with near-normal bone mineral density (BMD). Objective Examine whether faster increases in bone turnover during the MT (2 years before to 2 years after the final menstrual period [FMP]), and greater bone turnover during early postmenopause (≥2 years after the FMP) are risk factors for subsequent fracture, accounting for BMD. Design and Setting The Study of Women’s Health Across the Nation, a longitudinal cohort study of the MT. Participants A total of 484 women (initially pre- or early perimenopausal, who transitioned to postmenopause) with bone turnover (urine collagen type I N-telopeptide), BMD, and fracture data. Main Outcome Measure Incident fracture after the MT. Results Adjusting for age, race/ethnicity, fracture before the MT, cigarette use, body mass index, and study site in Cox proportional hazards regression, each SD increment in the rate of increase in bone turnover during the MT was associated with 24% greater hazard of incident fracture in postmenopause (P = .008). Accounting for the same covariates, each SD increment in bone turnover during early postmenopause was associated with a 27% greater hazard of fracture (P = .01). Associations remained significant after controlling for MT rate of change and early postmenopausal level of BMD. Conclusion Faster increases in bone turnover during the MT and greater bone turnover in early postmenopause forecast future fractures.

Menopausal hormone therapy and heart disease prevention: desired or valid?

Cardiovascular diseases are the main cause of death for women in older age groups. For many decades, specialists have tried to prevent their development by the use of estrogen. The review of the literature presents current data on the effect of menopausal hormone therapy (MHT) on the risk of cardiovascular complications. The results of the main randomized clinical and observational studies in this area, conducted over several decades, are discussed. We described the concept of “window of opportunities”, in accordance with which an improvement in cardiovascular prognosis can be expected only at the onset of MHT in women under the age of 60 years in early postmenopause (menopause duration <10 years). There are experimental and clinical data explaining the different effects of estrogen on the cardiovascular prognosis in women of various age groups and different duration of postmenopause. The recommendations given in the review on the use of MHT are based on modern international guidelines.

Experience of using MHT combined with dipyridamole in patients in the early postmenopause

This article presents the evaluation of efficacy of low-dose dipyridamole used to prevent thrombotic complications during menopausal therapy in women in the early postmenopause.

Analysis of Antioxidant Consumption, Body Mass Index and the Waist-Hip Ratio in Early Postmenopause

Oxidative stress is present in early postmenopause. Antioxidants, present in food, avoid or limit the damage caused by free radicals. The aim of this study was to analyze whether the consumption of vitamin A, vitamin C, and Selenium was adequate in postmenopausal women and its relationship with levels of malondialdehyde. A descriptive, cross-sectional prospective clinical study was carried out with 132 women (45–55 years old) in postmenopause. The body mass index (BMI) and the waist-to-hip ratio (WHR) were calculated. The participants were surveyed about their food consumption for seven days. The plasmatic concentration of malondialdehyde was quantified by the methyl-phenyl-indole method. The women were grouped according to their BMI. All groups showed similar consumption of proteins, lipids, and carbohydrates, which exceeded the daily recommended level. According to the WHR, 87% had android fat distribution. Selenium, vitamin C, and vitamin A intake were below the daily recommended/suggested levels. The greater the BMI, the higher the plasmatic concentration of malondialdehyde in the patients. It was observed an elevated caloric intake, android fat distribution, and a greater BMI was accompanied by a lower consumption of antioxidants and an increased level of malondialdehyde.