{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:17:01Z","timestamp":1790626621685,"version":"4.1.0"},"reference-count":57,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T00:00:00Z","timestamp":1619481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["NR004061"],"award-info":[{"award-number":["NR004061"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012505"],"award-info":[{"award-number":["AG012505"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012535"],"award-info":[{"award-number":["AG012535"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012531"],"award-info":[{"award-number":["AG012531"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012539"],"award-info":[{"award-number":["AG012539"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012546"],"award-info":[{"award-number":["AG012546"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012553"],"award-info":[{"award-number":["AG012553"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012554"],"award-info":[{"award-number":["AG012554"]}]},{"name":"NIH Office of Research on Women\u2019s Health","award":["AG012495"],"award-info":[{"award-number":["AG012495"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Bone mineral density (BMD) decreases rapidly during menopause transition (MT), and continues to decline in postmenopause.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This work aims to examine whether faster BMD loss during the combined MT and early postmenopause is associated with incident fracture, independent of starting BMD, before the MT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Study of Women\u2019s Health Across the Nation, a longitudinal cohort study, included 451 women, initially premenopausal or early perimenopausal, and those transitioned to postmenopause. Main outcome measures included time to first fracture after early postmenopause.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In Cox proportional hazards regression, adjusted for age, body mass index, race\/ethnicity, study site, use of vitamin D and calcium supplements, and use of bone-detrimental or -beneficial medications, each SD decrement in lumbar spine (LS) BMD before MT was associated with a 78% increment in fracture hazard (P\u2005=\u2005.007). Each 1% per year faster decline in LS BMD was related to a 56% greater fracture hazard (P\u2005=\u2005.04). Rate of LS BMD decline predicted future fracture, independent of starting BMD. Women with a starting LS BMD below the sample median, and an LS BMD decline rate faster than the sample median had a 2.7-fold greater fracture hazard (P\u2005=\u2005.03). At the femoral neck, neither starting BMD nor rate of BMD decline was associated with fracture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>At the LS, starting BMD before the MT and rate of decline during the combined MT and early postmenopause are independent risk factors for fracture. Women with a below-median starting LS BMD and a faster-than-median LS BMD decline have the greatest fracture risk.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab279","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T08:35:19Z","timestamp":1619512519000},"page":"e2491-e2501","source":"Crossref","is-referenced-by-count":23,"title":["Faster Lumbar Spine Bone Loss in Midlife Predicts Subsequent Fracture Independent of Starting Bone Mineral Density"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0695-7976","authenticated-orcid":false,"given":"Albert","family":"Shieh","sequence":"first","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun S","family":"Karlamangla","sequence":"additional","affiliation":[{"name":"Department of Medicine, David 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