Bone health in perimenopausal women can be predicted by elevated levels of FSH

摘要

Introduction: Loss of bone mass due to the menopause has been widely attributed to the effects of low estrogen. However, the onset of bone loss begins before any symptoms of menopause may appear, when estrogen levels are within the normal range but follicle-stimulating hormone (FSH) levels are raised. We report two cases of bone symptoms in the presence of abnormally elevated FSH and normal estrogen levels. Methods: Both patients, aged 38 and 41, presented to the fertility clinic because of failure to conceive over the past year. They had a history of irregular periods with normal blood loss. On interview, both reported a recent onset of bone aches and pains and an increase in vasomotor symptoms, including sweating and hot flushes. Nothing was notable on examination" A female hormone blood profile was then carried out on day 3 of the menstrual cycle and serial FSH levels were taken over the following three cycles. Results: Serum FSH was found to be elevated on all occasions (range, 20-35 u/L) for both women. Oestradiol levels were within the normal range. In order to further investigate the bone symptoms, a DEXA scan was then performed, showing suboptimal bone density consistent with osteopenia in both patients (T-score between — I and —2.5).Conclusions: Our results display an association between elevated FSH levels and bone density, in the presence of normal estrogen levels. We propose that the very high FSH levels have direct effects on bone resorption during the perimenopausal stage. This may allow the prediction of bone health in women approaching the menopause by measuring their serum FSH. Therefore, earlier interventions to halt the development and progression of bone loss in women with raised FSH can be implemented, which will prove extremely beneficial.