Presence of vasomotor symptoms is associated with lower bone mineral density: A longitudinal analysis

Objective: To determine whether women with vasomotor symptoms (VMS) have lower bone mineral density (BMD) than do women without VMS. Methods: We analyzed data from baseline to annual follow-up visit 5 for 2,213 participants in the bone substudy of the Study of Women's Health Across the Nation. At baseline, women were aged 42 to 52 years, had an intact uterus and one or more ovaries, were not using exogenous hormones, were not pregnant or lactating, and were premenopausal or early perimenopausal. Menopausal stage and VMS were assessed by annual questionnaire. Menopausal stages were premenopausal, early perimenopausal, late perimenopausal, and postmenopausal. Using repeated-measures mixed models, we determined the association between VMS (any vs none) and BMD (by dual x-ray absorptiometry) within each menopause status category. Results: After controlling for age, time within each menopausal stage, race/ethnicity, study site, and baseline menopausal stage, postmenopausal women with any VMS had lower lumbar (0.008 g/cm ² lower, P = 0.001) and lower total hip (0.005 g/cm ² lower, P = 0.04) BMD than did postmenopausal women without VMS. Compared with early perimenopausal women without VMS, early perimenopausal women with any VMS had lower femoral neck BMD (0.003 g/cm ² lower, P = 0.0001). Premenopausal women with any VMS had lower femoral neck BMD (0.003 g/cm ² lower, P = 0.03) compared with premenopausal women without VMS. Conclusions: Even in the earliest menopausal transition stages, women with VMS had lower BMD than did women without VMS. Effects varied by anatomical site, being most evident at the lumbar spine and total hip in postmenopausal women and at the femoral neck among premenopausal and early perimenopausal women.