Bone turnover markers and Trabecular Bone Score (TBS) might be useful tools to identify transmenopausal women who are at greater risk for bone loss, according to study results published in Clinical Endocrinology.

Researchers conducted this study to determine whether bone turnover markers can effectively identify women who are likely to lose more bone mass during late perimenopause and early menopause. They assessed 64 healthy premenopausal women (age 44-57 years) at baseline and at 5-year follow-up for clinical and lifestyle features, bone densitometry, TBS, and bone turnover marker levels (C-terminal telopeptide of type 1 collagen [CTX], N-amino terminal propeptide of type 1 collagen [P1NP], and osteocalcin).

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At baseline, all participants had normal bone density. After 5 years, 35.9% continued to have normal bone density, 57.8% had low bone mass, and 6.3% had osteoporosis. Compared with those who had normal bone density at follow-up, women with osteopenia or osteoporosis had significantly higher baseline bone turnover marker levels.

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Areas under the curve for P1NP, CTX, and osteocalcin in predicting future low bone mass or osteoporosis were 0.69 (P =.011), 0.69 (P =.013), and 0.77 (P =.001), respectively. Furthermore, the researchers discovered a significant correlation between increased 5-year P1NP level and decreased lumbar bone density (r = -0.383; P =.002).

Also of significance, the investigators found that 7 women with deteriorated microarchitecture at baseline (TBS <1.3) went on to have osteoporosis (n = 3) and osteopenia (n = 4), indicating that TBS may help identify women at higher risk.

Limitations to this study included a low number of osteoporosis diagnoses and incident fractures as a result of the short follow-up and relatively small population.

“[T]his study shows that women with higher levels of [bone turnover markers] and lower TBS at the perimenopause have higher risk of presenting low bone mass/osteoporosis in the future,” the researchers said. “Larger studies will have to determine the best turnover markers combination and optimal thresholds required to identify women at risk of rapid bone loss.”


Gutierrez-Buey G, Restituto P, Botella S, et al. Trabecular bone score and bone remodeling markers identify perimenopausal women at high risk of bone loss [published online May 29, 2019]. Clin Endrocrinol (Oxf). doi:10.1111/cen.14042

This article originally appeared on Endocrinology Advisor