Does menopause have an independent effect on bone health?
The decline in BMD accelerates in the late perimenopausal and early postmenopausal periods in women. What remains somewhat controversial is whether the menopause-induced increase in bone resorption diminishes after a few years or persists into old age. In this regard, observational studies of women aged 65 years and older indicate that the rate of bone loss continues to increase with age, particularly in the hip region. This is corroborated by observations that serum markers of bone turnover increase at menopause and remain elevated into older age. Recent studies in animals implicate both the decrease in estrogens and the increase in follicle-stimulating hormone (FSH) as mechanisms underlying bone loss with the menopausal transition. Inhibition of FSH activity prevented ovariectomy-induced bone loss in these animal models. However, whether the increase in FSH with menopause contributes to the decline in bone mass in women remains unclear.