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

J Clin Endocrinol Metab. 2020 Apr 1;105(4):e1872-e1882. doi: 10.1210/clinem/dgz056.


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.

Keywords: cohort; epidemiology; longitudinal; menopause; trabecular bone score.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Body Mass Index*
  • Bone Density*
  • Cancellous Bone / physiopathology*
  • Ethnic Groups
  • Female
  • Follow-Up Studies
  • Fractures, Bone / epidemiology*
  • Humans
  • Longitudinal Studies
  • Menopause*
  • Menstruation
  • Middle Aged
  • Prognosis
  • United States / epidemiology
  • Women's Health