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Sowers and colleagues have investigated potential associations between changes in bone resorption during the menopause transition and reproductive hormones, body mass index (BMI) and ethnicity [1]. Urinary type I collagen N-telopeptide (NTX), estradiol, and follicle stimulating hormone (FSH) levels were measured annually for up to 8 years spanning the menopause transition in 918 African-American, Chinese, Japanese, or Caucasian women. Urinary NTX began to increase sharply about 2 years before the final menstrual period (FMP), reaching its peak level about 1–1.5 years after the FMP. NTX levels declined modestly from 2–6 years after the FMP but remained about 20% higher than before the menopause transition. The sharp rise in FSH occurred in conjunction with a sharp decline in estradiol and shortly after FSH levels began to increase rapidly. The mean increase in urinary NTX across the menopause transition was greatest in women with BMI < 25 kg/m[+]2[/+] and smallest in women with BMI > 30 kg/m[+]2[/+]. Increases in NTX were greatest in Japanese women and smallest in African-Americans. These differences were attenuated, but not eliminated, when analyses were adjusted for covariates, particularly BMI. During the menopause transition, a decline in ovarian function beginning about 2 years before the FMP is followed by an increase in bone resorption and subsequently by bone loss. The magnitude of the increase in bone resorption is inversely associated with BMI. Ethnic differences in changes in bone resorption are attenuated, but not eliminated, by adjustment for BMI. Ethnic differences in BMI, and corresponding ethnic differences in bone resorption, appear to account for much of the ethnic variation in perimenopausal bone loss.


  • Alka Kumar
    Gynaecologist and Wellness Consultant, Secretary Indian Menopause Society, Nagpur Chapter India, Director of Shalaka Hospital and Menopause Clinic, Nagpur, India


  1. Sowers MR, Zheng H, Greendale GA, et al. Changes in bone resorption across the menopause transition: effects of reproductive hormones, body size, and ethnicity. J Clin Endocrinol Metab 2013;98:2854-63.
  2. Sowers MF, Zheng H, McConnell D, et al. Follicle stimulating hormone and its rate of change in defining menopause transition stages. J Clin Endocrinol Metab 2008;93:3958-64
  3. Paula FJ, Rosen CJ. Obesity, diabetes mellitus and last but not least, osteoporosis. Arq Bras Endocrinol Metabol 2010;54:150-7.
  4. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 2007;92:1640-6.
  5. Akune T, Ohba S, Kamekura S, et al. PPARgamma insufficiency enhances osteogenesis through osteoblast formation from bone marrow progenitors. J Clin Invest 2004;113:84655.
  6. Pei L, Tontonoz P. Fats loss is bones gain. J Clin Invest 2004;113:8056.
  7. Kameda T, Mano H, Yuasa T, et al. Estrogen inhibits bone resorption by directly  +6inducing apoptosis of the bone-resorbing osteoclasts. J Exp Med 1997;186:48995.
  8. Zargar AH, Ahmad S, Masoodi SR, et al. Vitamin D status in apparently healthy adults in Kashmir Valley of Indian Subcontinent. Postgrad Med J 2007;83:713-16.
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