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Title: Menopause-Related Appendicular Bone Loss is Mainly Cortical and Results in Increased Cortical Porosity
Austin Authors: Bjørnerem, Åshild;Wang, Xiaofang;Bui, Minh;Ghasem-Zadeh, Ali ;Hopper, John L;Zebaze, Roger M D;Seeman, Ego 
Affiliation: Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Endocrine Centre, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: 2018 2017-12-08
Publication information: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2018; 33(4): 598-605
Abstract: After menopause, remodeling becomes unbalanced and rapid. Each of the many remodeling transactions deposits less bone than it resorbed, producing microstructural deterioration. Trabecular bone is said to be lost more rapidly than cortical bone. However, because 80% of the skeleton is cortical, we hypothesized that most menopause-related bone loss and changes in bone microstructure are cortical, not trabecular in origin, and are the result of intracortical remodeling. Distal tibial and distal radial microstructure were quantified during 3.1 years (range, 1.5 to 4.5 years) of follow-up using high-resolution peripheral quantitative computed tomography and StrAx software in 199 monozygotic and 125 dizygotic twin pairs aged 25 to 75 years in Melbourne, Australia. The annual increases in tibial cortical porosity accelerated, being 0.44%, 0.80%, and 1.40% in women remaining premenopausal, transitioning to perimenopause, and from perimenopausal to postmenopause, respectively. Porosity increased in the compact-appearing, outer, and inner transitional zones of the cortex (all p < 0.001). The annual decrease in trabecular bone volume/tissue volume (BV/TV) also accelerated, being 0.17%, 0.26%, and 0.31%, respectively. Little bone loss was observed before menopause. The reduction in BV/TV was due to a decrease in trabecular number (p < 0.001). The greatest bone loss, 7.7 mg hydroxyapatite (HA) annually, occurred in women transitioning from perimenopausal to postmenopause and of this, 6.1 mg HA (80%) was cortical. Results were similar for the distal radius. Despite microarchitectural changes, no significant bone loss was observed before menopause. Over 90% of appendicular bone loss occurs during and after menopause, over 80% is cortical, and this may explain why 80% of fractures are appendicular. © 2017 American Society for Bone and Mineral Research.
DOI: 10.1002/jbmr.3333
ORCID: 0000-0002-9692-048X
PubMed URL: 29218771
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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