title: The relative effect of endogenous estradiol and androgens on menopausal bone loss: a longitudinal study.
abstract: OBJECTIVE
  The aim of this study was to assess the relative strength of the association of endogenous estradiol and androgens with bone loss at the lumbar spine and femoral neck during the menopausal transition.
  
  
  METHODS
  A longitudinal study of a population-based cohort of 159 Australian-born women who at baseline had a mean age of 50.0 years (SD=2.4) and had menstruated in the prior 3 months. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck on up to three occasions.
  
  
  RESULTS
  Of the 159 participants, 50 had two BMD measurements and 109 had a third measure. The mean time between the first and final measures for the whole group was 39 months and at the time of the final measures 49% of the participants had become postmenopausal. The mean percentage change/year in lumbar spine BMD was -0.9% (95% CI, -1.1 to -0.6) and at the femoral neck, -0.5% (95% CI, -0.7 to -0.2). A highly significant association with estradiol at the final time point was found, whereas the contribution of estradiol at baseline was negligible. The variance explained by estradiol levels was 19% and 11% for change in BMD at the LS and FN, respectively. Excluding baseline estradiol values and using the average of change in BMD at the LS and FN, the final regression equation estimated that an estradiol level of 330 pmol/l (95% CI, 274 to 386) and 245 pmol/l (95% CI, 194 to 296) is required for preservation of LS and FN BMD, respectively. A stepwise linear regression model was used to assess the effect of age, BMI, estradiol, testosterone, DHEAS, SHBG, and free testosterone index on changes in BMD and found that only the final estradiol level had a significant association with change in BMD.
  
  
  CONCLUSIONS
  Endogenous estradiol was the only hormone among those investigated to have a significant effect on bone mineral density during the menopausal transition.
authors.affiliation: Office for Gender and Health, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Charles Connibere Building, Melbourne, Victoria, Australia. janetrg@unimelb.edu.au
authors.forename: Janet R
authors.initials: JR
authors.lastname: Guthrie
authors.forename: Philippe
authors.initials: P
authors.lastname: Lehert
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dennerstein
authors.forename: Henry G
authors.initials: HG
authors.lastname: Burger
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.forename: John D
authors.initials: JD
authors.lastname: Wark
mesh_terms: D015519:Bone Density / Q000502:physiology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood / Q000502:physiology*; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000503:physiopathology*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood / Q000502:physiology*
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate