Anti-Mullerian Hormone and Collagen Type I C-telopeptide Predict Fast, Imminent Bone Loss in Early Perimenopause: SWAN.

Abstract

Faster menopause-related bone mineral density (BMD) decline predicts more fractures. 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, greater than or equal to the mean, annual menopause rate). 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. Study of Women's Health Across the Nation (community-based cohort). 436 early perimenopausal women. Fast, imminent BMD loss (at lumbar spine [LS], femoral neck, or total hip [TH]). In separate models, adjusted for age, BMI, 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<0.0001). Per SD increment in log transformed CTX, fast BMD loss risk was 35% (LS), 23% (FN), and 34% (TH) greater (each p<0.0001). Model AUC was greater for models with AMH and CTX versus those for models with AMH or CTX individually (p<0.001 for each BMD site-specific comparison). Combining AMH and CTX affords stronger prediction of fast, imminent BMD loss than using AMH or CTX individually.