Spontaneous postmenopausal bone loss in different skeletal areas--followed up for 15 years

We examined the spontaneous bone loss in two populations of healthy postmenopausal women, who were followed for 9.5 and 14.5 years without any treatment influencing the calcium metabolism. The bone mass was measured in different skeletal areas: the distal forearm, the lumbar spine, the proximal femur, and the total skeleton. The spontaneous bone loss in the distal forearm, the lumbar spine, and the total skeleton was fitted to an exponential model as a function of years since menopause. The overall bone loss averaged 20-25% of premenopausal bone mass 16 years after menopause. The patterns of bone loss were, however, different for the axial and the peripheral skeleton. Thus, the bone loss in the distal forearm approached a more linear model with a more consistent bone loss throughout the observation period. In contrast, the lumbar spine showed no significant loss 8 years after menopause. This arrest in bone loss could not be explained by the presence of degenerative changes in the lumbar spine and/or aortic calcifications, although these changes significantly contributed to 14% increased bone mineral density (p < 0.001). We conclude that bone loss averages 20-25% over the initial 16 years of menopause regardless of skeletal site and that patterns of bone loss are different in the axial and peripheral skeleton.