Anti-Mullerian Hormone and Collagen Type I C-telopeptide Predict Fast, Imminent Bone Loss in Early Perimenopause: SWAN

Albert Shieh; Arun S Karlamangla; Fatma Gossiel; Richard Eastell; Sherri-Ann Burnett-Bowie; Gail A Greendale

doi:10.1210/clinem/dgaf658

Anti-Mullerian Hormone and Collagen Type I C-telopeptide Predict Fast, Imminent Bone Loss in Early Perimenopause: SWAN

J Clin Endocrinol Metab. 2025 Dec 16:dgaf658. doi: 10.1210/clinem/dgaf658. Online ahead of print.

Authors

Albert Shieh¹, Arun S Karlamangla¹, Fatma Gossiel², Richard Eastell², Sherri-Ann Burnett-Bowie³, Gail A Greendale¹

Affiliations

¹ Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
² Division of Clinical Medicine, Mellanby Centre for Musculoskeletal Research, University of Sheffield.
³ Massachusetts General Hospital Endocrine Unit, Harvard Medical School.

PMID: 41399290
DOI: 10.1210/clinem/dgaf658

Abstract

Context: Faster menopause-related bone mineral density (BMD) decline predicts more fractures.

Objective: Examine anti-Mullerian hormone (AMH) and collagen type I C-telopeptide (CTX) as predictors of fast, imminent BMD loss (BMD decline rate, over the next 1-2 years, greater than or equal to the mean, annual menopause rate).

Design: Repeated measures modified Poisson regression estimated the associations of early perimenopausal levels of 1) AMH or CTX (in separate models), or 2) AMH and CTX (in a single model) with fast, imminent BMD loss.

Setting: Study of Women's Health Across the Nation (community-based cohort).

Participants: 436 early perimenopausal women.

Main outcome measures: Fast, imminent BMD loss (at lumbar spine [LS], femoral neck, or total hip [TH]).

Results: In separate models, adjusted for age, BMI, cigarette use, race/ethnicity and study site, lesser AMH or greater CTX individually related to greater fast, imminent BMD loss risk. As predictors in a single model, lesser AMH and greater CTX remained independently associated with fast, imminent BMD loss. Per SD decrement in log transformed AMH, fast BMD decline risk was 45% (LS), 17% (FN) and 26% (TH) greater (each p<0.0001). Per SD increment in log transformed CTX, fast BMD loss risk was 35% (LS), 23% (FN), and 34% (TH) greater (each p<0.0001). Model AUC was greater for models with AMH and CTX versus those for models with AMH or CTX individually (p<0.001 for each BMD site-specific comparison).

Conclusions: Combining AMH and CTX affords stronger prediction of fast, imminent BMD loss than using AMH or CTX individually.

Keywords: Bone turnover markers; bone mineral density; cohort; epidemiology; longitudinal; menopause.

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