Bones are not dead issue - they are alive and continue to form and undergo apoptosis. They have receptors for estrogen (E; E-receptors). When E is low, cytokine levels are affected and as a result, more osteoclasts are formed than die out. The increase in osteoclast number and activity result in increased bone resorption hence lower bone density (called osteoporosis) for those in menopause or perimenopause.

Thank you Dr Vicente, for your comments.

The earlier in life that menopause occurs, the lower the bone density will be later in life. Low bone density is associated with a higher fracture rate, and several studies show a relationship between early menopause, oophorectomy, and an increase in osteoporotic fractures.

Early menopause is a risk factor for osteoporosis. Women with an early menopause should have bone density testing performed within 10 years of menopause so that osteopenia or osteoporosis will be diagnosed early and appropriate anti-resorptive therapy initiated.

Body weight is an important determinant of the rates of BMD loss during the menopause transition.

Women lose about 50% of their trabecular bone and 30% of their cortical bone during the course of their lifetime, about half of which is lost during the first 10 yr after the menopause. Approximately 40% of all postmenopausal women will eventually experience fractures. In 2001, the National Osteoporosis Foundation estimated that the annual cost of health care and lost productivity related to osteoporosis was $17 billion.

Despite the public health importance of postmenopausal osteoporosis, there are important gaps in our knowledge of the effect of the menopause transition on the skeletal system. Although bone loss accelerates after menses cease it is not clear either when bone loss begins or what the rates of bone loss are at various stages of the menopause transition. It is important to determine when bone loss accelerates so that women and their health care providers can make informed decisions regarding the appropriate time to screen for osteoporosis and to consider therapy to prevent bone loss. There is considerable variation in rates of bone loss among women, with some women experiencing rapid bone loss during the menopause transition and others experiencing little or no bone loss. The basis for this variation is poorly understood. Identifying factors that are associated with rapid or slow rates of bone loss during the menopause transition could assist clinicians in making decisions that will optimize skeletal health in midlife women.

The Study of Women’s Health Across the Nation (SWAN) is a seven-center, longitudinal cohort study of the menopause transition in a community-based sample of women from multiple ethnic groups. Bone mineral density (BMD) of the lumbar spine and proximal femur has been measured annually in women at five SWAN sites. SWAN is the first large-scale, multiethnic, longitudinal cohort study to assess BMD across the entire menopause transition. Thus, SWAN provides a unique opportunity to characterize changes in BMD across the menopause transition and to assess factors that influence those changes.

Very impressive, and detailed information. I believe your comments will help much understanding especially the influence of early menopause and its proper care and management. Many thanks Dr Astrit  for your so nice comments.