Trabecular bone score and bone remodelling markers identify perimenopausal women at high risk of bone loss.

CONTEXT: Bone loss is accelerated in the late perimenopause and early menopause. The date of the final menstrual period cannot be stated until 1 year after it has ended, and at that time, most of the rapid bone loss phase will have elapsed. Therefore, early detection of bone loss is crucial. OBJECTIVES: To evaluate the utility of bone turnover markers (BTM) to identify the women who are more likely to lose more bone mass during the transition to menopause and quantify the loss of bone quality measured by trabecular bone score (TBS). DESIGN, PATIENTS AND SETTING: Sixty-four healthy premenopausal women, mean age between 44 and 57 years old, were enrolled and followed up for 5 years. Clinical features, lifestyle, bone densitometry, TBS and BTM (CTX, P1NP and osteocalcin) were measured at baseline and follow-up. RESULTS: All women had densitometrically normal bone at the time of enrolment. After 5 years, 48.4% had normal bone mineral density, 45.8% low bone mass and 6.3% osteoporosis. Women with osteopenia/osteoporosis at follow-up had higher CTX and P1NP at enrolment compared with women with densitometrically normal bone. The areas under the curve for the prediction of low bone mass or osteoporosis were 0.69 (P = 0.011) for P1NP, 0.69 for CTX (P = 0.013) and 0.77 (P 0.001) for OC. A significant correlation was found between P1NP increase after 5 years and the decrease in lumbar bone density (r = -0.383, P = 0.002). At baseline, 7 (10.9%) women had deteriorated microarchitecture (TBS < 1.3). Three of these women developed osteoporosis and four osteopenia at follow-up. CONCLUSIONS: Women with higher P1NP and CTX and lower TBS at baseline had lower BMD in the transition to menopause suggesting these novel tools could have potential use in identifying women at high risk of rapidly decreasing bone mass.

Traditional and novel bone remodeling markers in premenopausal and postmenopausal women.

CONTEXT: Bone turnover markers (BTMs) may identify changes in bone remodeling within a relatively short time interval before changes in bone mineral density can be detected. New markers such as osteoprotegerin, receptor activator of nuclear factor-κB ligand, and sclerostin have emerged, but there is little information about their potential use in clinical practice. OBJECTIVES: The aim of this study was to analyze the ability of several BTMs to predict bone loss in pre- and postmenopausal women and to monitor the efficacy of treatment in osteoporotic women. DESIGN, PATIENTS, AND SETTING: We performed an observational prospective study in pre- and postmenopausal ambulatory women (n = 72 and n = 152, respectively). INTERVENTION: Postmenopausal women with osteoporosis (n = 18) were treated with risedronate and calcium. Women filled out a questionnaire and underwent bone mineral density measurement using dual-energy x-ray absorptiometry at the time of enrollment and after 1 year of follow-up. BTMs were measured at baseline, at 6 months, and after 1 year. RESULTS: Increased levels of N-terminal propeptide of type 1 procollagen (P1NP) and ß-type I collagen telopeptides (CTXs) were associated with low bone mineral density in the premenopausal (P = .02 and P = .04, respectively) and postmenopausal (P = .03 and P = .02) groups. The best analytical performance to diagnose osteoporosis was for ß-CTX, osteocalcin, and P1NP, with areas under the curve of 0.70 (P = .005), 0.64 (P = .048), and 0.71 (P = .003). A significant decrease was found in P1NP, osteocalcin, tartrate-resistant acid phosphatase-5b, ß-CTX, and bone alkaline phosphatase after 1 year of treatment (all P < .05). CONCLUSIONS: Our data suggest that measurement of ß-CTX and P1NP shows adequate analytical performance and could potentially be included in algorithms for the screening of osteoporosis. Furthermore, these two markers, along with osteocalcin and tartrate-resistant acid phosphatase-5b, are useful to monitor the response to risedronate.