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Women had a 59 percent greater risk of bone fracture as they aged when they had above-normal levels of N-telopeptide (NTX)—the byproduct of bones breaking down—in their urine, compared with women who had low NTX levels.

When women with high NTX levels also had a low spinal bone density measurement, their risk of fracture increased nearly three-fold.

The study, published in the journal Menopause, is the first to look for signs of bone breakdown in younger, premenopausal women in an effort to determine if such signs can predict the risk that these women will suffer fractures as they age.

“Bone fractures—particularly in the hip, wrist, and back—have serious consequences, including disability and death,” says Jane Cauley, professor of epidemiology at the University of Pittsburgh and the study’s lead author. “Knowing a woman’s risk of fracture can help doctors determine the best course of action to protect her bones as she enters menopause, a time when estrogen deficiency negatively affects skeletal health.”

By the time a woman turns 50, her risk of a fracture at some point in the remainder of her life is estimated to be at least 40 percent. Fractures are more common for these women than heart attacks, strokes, and breast cancer combined.

During menopause, bone remodeling increases, leading to an imbalance between bone formation and bone resorption, or the process by which bones are broken down and their minerals are returned to the blood. This remodeling persists for several years and is associated with an increased rate of bone loss, making it easier for bones to fracture.

Cauley and her colleagues used data from 2,305 premenopausal or perimenopausal women aged 42 to 52 collected over an average of 7.6 years as part of the Study of Women’s Health Across the Nation (SWAN). Participants were from Boston, Detroit, Los Angeles, Pittsburgh, and Oakland, California.

SWAN examines the physical, biological, psychological, and social health of women during their middle years. The goal is to help scientists, health care providers, and women learn how mid-life experiences affect health and quality of life during aging.

Collaborating on the study are additional researchers from the University of Pittsburgh, University of California Los Angeles, Massachusetts General Hospital, Kaiser Permanente Northern California, and the University of Michigan.

This research was supported in part by the National Institutes of Health, Department of Health and Human Services, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health.

More news from the University of Pittsburgh: www.news.pitt.edu/