A high rate of premenopausal bone breakdown increases fracture risk

If you’re a woman “of a certain age,” you’ve probably already heard the fairy tale that women’s bones crumble at menopause. I’ve said many times that thin bones don’t have to be weak bones, and women with osteoporosis or osteopenia in midlife won’t necessarily have a high risk of fracture, but it’s still wise to look at your fracture risk factors — including bone loss — and take action. The question is, how would a woman approaching menopause (but not yet past it) find out if she’s losing bone at a rapid pace, which could be a red flag for heightened fracture risk after menopause?

We know from research that the rate of bone breakdown as measured by markers of bone resorption such as the NTx test correlates with rate of bone loss in menopausal women. But are these markers of bone resorption helpful in predicting which perimenopausal women might fracture later in life? A new study from the University of Pittsburgh suggests this might be the case.

Looking at 2,406 premenopausal women over a period of 7.6 years, researcher Dr. Jane Cauley and colleagues found that women who had NTx levels above the median at any of the yearly clinic visits had a statistically significant (55%) increase in fracture risk within the 7.6 years of the study. So a higher-than-average rate of bone breakdown even several years before menopause could well weaken bone. From my work here at the Center for Better Bones, I find it is wise to look at markers of bone resorption well before menopause. As we now know, bone loss begins in the late 20s and early 30s and, given our current lifestyle, accelerated bone breakdown can occur much earlier than commonly recognized.

If you are a woman approaching menopause — or even younger! — and have a family history of osteoporosis or other risk factors, consider taking our Fracture Risk & Bone Health Profile to determine the basis of your osteoporosis risk. Then, look into getting an NTx test to see whether you have higher than the average bone turnover — and if you do, consider taking steps to alkalize your diet, reduce stress, and get bone-building exercise as a way of addressing the concern before it becomes a real problem. (You can look at my article about stopping bone loss in menopause for more ideas.)

An ounce of prevention is worth a pound of cure!



Cauley, J, et al. 2010. Bone resorption and fracture across the menopausal transition: The study of women’s health across the nation (SWAN). ASBMR Meeting, Toronto, Abstract 1093.

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