Anti-Mullerian hormone and collagen type I C-telopeptide predict fast, imminent bone loss in early perimenopause: SWAN

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, ≥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

A total of 436 early perimenopausal women.

Main Outcome Measures

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

Results

In separate models, adjusted for age, body mass index, 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 < .0001). Per SD increment in log-transformed CTX, fast BMD loss risk was 35% (LS), 23% (FN), and 34% (TH) greater (each P < .0001). Model areas under the curve was greater for models with AMH and CTX vs those for models with AMH or CTX individually (P < .001 for each BMD site-specific comparison).

Conclusion

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