Anti-Mullerian hormone may estimate magnitude of menopausal bone loss

BOSTON — A new assay that can quantify anti-Mullerian hormone in pg/mL may help clinicians predict bone loss in women undergoing menopause, according to a presenter here.

Perspective from Nanette Santoro, MD

“Until recently we didn’t have assays sensitive enough to measure levels of [anti-Mullerian hormone (AMH)] around the time of the menopause transition,” Arun S. Karlamangla, MD, PhD, professor of medicine at the David Geffen School of Medicine at UCLA in Los Angeles, said during a press conference. “We’re interested in …can the level of anti-Mullerian hormone predict whether or not a woman is losing bone and will this provide us information that is not already available with measurements of follicular-stimulating hormone or estrogen levels.”

Arun Karlamanga

Karlamangla and colleagues analyzed data from 474 women enrolled in the Study of Women’s Health Across the Nation. Participants were aged 42 to 52 years at baseline in 1996, and were pre- or perimenopausal with an intact uterus and at least one ovary; none were taking sex steroid hormones. Researchers annually collected and stored morning fasting blood samples during the early follicular phase whenever possible as well as bone mineral density measurements from the lumbar spine and femoral neck. Serum AMH was measured using a high-sensitivity monoclonal ELISA (Ansh Labs) from frozen blood samples for all women with a natural menopause and dateable final menstrual period.

Using AMH and BMD measurements taken between 2 and 4 years before and again between 3 and 4 years after the final menstrual period, researchers assessed the correlation of hormone levels with annualized rate of BMD reduction during the transition to menopause.

Inter-quartile range for AMH was 11 to 146 pg/mL. Median annual rate of BMD decline at the lumbar spine was 1.3% and 1% in the femoral neck. After adjusting for age, BMI, smoking and race/ethnicity, researchers found that each four-fold decrement in AMH level was associated with 0.15% per year increased rate of decline in BMD at the lumbar spine (P < .001) and 0.13% per year at the femoral neck BMD (P = .005), and these associations persisted after further adjustment for time since final menstrual period and serum levels of estradiol and FSH. Each four-fold decrement in AMH level was also associated with an increase in the odds of losing BMD more rapidly than the median rate by 18% at the spine (P = .02) and by 17% at the femoral neck (P = .02).

“AMH levels in the blood strongly predict the rate of BMD decline in the rapid phase of the menopause [and] the information provided by AMH is independent of estrogen or FSH,” Karlamangla said. “The measurement of AMH levels in the serum of women in the menopausal transition may help identify the women who will lose bone the fastest.”– by Jill Rollet

Reference:

Author. OR01-3. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2016; Boston.

Disclosure: Karlamangla reports no relevant financial disclosures.

Perspective

Nanette Santoro, MD

In clinical practice, this is a big issue because it is currently recommended that you don’t measure bone density in women until they are 65 [years old], and universal screening is recommended at that age. All of us who see women patients in the menopausal years worry, “Am I missing someone.” Those fast losers are critical to identify because if we don’t ever look at them until they’re 65 [years old], it’s too late. Being able to apply some kind of biochemical test — where we can say, “You may be a fast loser; let’s get a bone density on you earlier” — would be of tremendous benefit because current screening tools do not pick these people up.

Nanette Santoro, MD

University of Colorado School of Medicine

Aurora, CO

Disclosures: Santoro reports no relevant financial disclosures.