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Bone loss and bone size after menopause.

Henrik G Ahlborg1, Olof Johnell, Charles H Turner

  • 1Department of Orthopedics, Malmö University Hospital, Malmö, Sweden. henrik.ahlborg@skane.se

The New England Journal of Medicine
|July 25, 2003
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Postmenopausal bone loss is linked to increased periosteal apposition, which helps maintain bone strength. A strength index, considering bone density and size, may better predict fracture risk than density alone.

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Area of Science:

  • Bone biology and skeletal health
  • Postmenopausal health and osteoporosis research
  • Biomechanical analysis of bone strength

Background:

  • Bone loss accelerates after menopause, impacting skeletal integrity.
  • Bone strength is influenced by both bone density and structural characteristics like bone size.
  • The relationship between periosteal apposition, bone size changes, and fracture risk prediction remains unclear.

Purpose of the Study:

  • To investigate whether bone size increases due to periosteal apposition post-menopause.
  • To determine if a strength index, incorporating bone density and size, predicts fracture risk more effectively than bone density alone.

Main Methods:

  • Longitudinal study of 108 women followed for 15 years post-menopause.
  • Bone mass and skeletal structure of the distal radius assessed using single-photon absorptiometry.
  • Recorded postmenopausal serum estradiol levels and distal radius fractures.

Main Results:

  • Mean annual decrease in bone mineral density was 1.9%.
  • Medullary and periosteal bone diameters increased annually by 1.1% and 0.7%, respectively.
  • A 1-SD decrease in the strength index was associated with a 3.8-fold increased risk of distal radius fracture.

Conclusions:

  • Increased periosteal apposition partially offsets bone strength loss after menopause.
  • A strength index combining bone density and size shows promise as a predictor of fracture risk.