{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:26:57Z","timestamp":1781072817897,"version":"3.54.1"},"reference-count":38,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2018,5,18]],"date-time":"2018-05-18T00:00:00Z","timestamp":1526601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Amenorrhea is important for women\u2019s bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaMos) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30\u201360 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD.<\/jats:p>","DOI":"10.3390\/ijerph15051023","type":"journal-article","created":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T04:07:30Z","timestamp":1526875650000},"page":"1023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Adult Premenopausal Bone Health Related to Reproductive Characteristics\u2014Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos)"],"prefix":"10.3390","volume":"15","author":[{"given":"Azita","family":"Goshtasebi","sequence":"first","affiliation":[{"name":"Centre for Menstrual Cycle and Ovulation Research; University of British Columbia, Vancouver, BC V5Z 1M9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5499-2661","authenticated-orcid":false,"given":"Claudie","family":"Berger","sequence":"additional","affiliation":[{"name":"Canadian Multicentre Osteoporosis Study, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8701-7152","authenticated-orcid":false,"given":"Susan I.","family":"Barr","sequence":"additional","affiliation":[{"name":"Centre for Menstrual Cycle and Ovulation Research; University of British Columbia, Vancouver, BC V5Z 1M9, Canada"},{"name":"Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-9993","authenticated-orcid":false,"given":"Christopher S.","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Medicine (Endocrinology and Metabolism), Obstetrics &amp; Gynecology, and BioMedical Sciences, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanveer","family":"Towheed","sequence":"additional","affiliation":[{"name":"Medicine and Public Health, Queens University, Kingston, ON, K7L 3N6 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Shawn","family":"Davison","sequence":"additional","affiliation":[{"name":"A Priori Medical Sciences Inc., Victoria, BC V8R 3E3 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3232-0597","authenticated-orcid":false,"given":"Jerilynn C.","family":"Prior","sequence":"additional","affiliation":[{"name":"Centre for Menstrual Cycle and Ovulation Research; University of British Columbia, Vancouver, BC V5Z 1M9, Canada"},{"name":"Department of Medicine, Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, BC V5Z 1M9, Canada"},{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"BC Women\u2019s Health Research Institute, Vancouver, BC V6H 2N9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1093\/humrep\/13.8.2252","article-title":"Relationship of the menstrual cycle pattern in 14\u201317 year old old adolescents with gynaecological age, body mass index and historical parameters","volume":"13","author":"Voorhorst","year":"1998","journal-title":"Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/j.1471-0528.1992.tb13762.x","article-title":"Length and variation in the menstrual cycle\u2014A cross-sectional study from a Danish county","volume":"99","author":"Munster","year":"1992","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Prior, J.C., Naess, M., Langhammer, A., and Forsmo, S. (2015). Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles\u2014A Population-Based Cohort from HUNT3, Norway. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0134473"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.jadohealth.2008.07.017","article-title":"Age at Menarche in the Canadian Population: Secular Trends and Relationship to Adulthood BMI","volume":"43","author":"Harris","year":"2008","journal-title":"J. Adolesc. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1093\/aje\/kwm237","article-title":"Association of low age at menarche with increased all-cause mortality: A 37-year follow-up of 61,319 Norwegian women","volume":"166","author":"Jacobsen","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1007\/s00198-004-1640-3","article-title":"Body mass index as a predictor of fracture risk: A meta-analysis","volume":"16","author":"Kanis","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/jbmr.2017","article-title":"A meta-analysis of the association of fracture risk and body mass index in women","volume":"29","author":"Johansson","year":"2014","journal-title":"J. Bone Miner. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1093\/aje\/153.3.251","article-title":"Menstrual history and risk of hip fractures in postmenopausal women. The Iowa Women\u2019s Health Study","volume":"153","author":"Nicodemus","year":"2001","journal-title":"Am. J. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1017\/S0714980800009934","article-title":"The Canadian Multicentre Osteoporosis Study (CaMos): Background, rationale, methods","volume":"18","author":"Kreiger","year":"1999","journal-title":"Can. J. Aging"},{"key":"ref_10","first-page":"1023","article-title":"Oral contraceptive agent use and bone mineral density in premenopausal women: Cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study","volume":"165","author":"Prior","year":"2001","journal-title":"Can. Med. Assoc. J."},{"key":"ref_11","unstructured":"(2018, February 21). Wikipedia. Available online: https:\/\/en.wikipedia.org\/wiki\/Demographics_of_Canada#Ethnic_origin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00198-009-0966-2","article-title":"Direct-to-participant feedback and awareness of bone mineral density testing results in a population-based sample of mid-aged Canadians","volume":"21","author":"Kingwell","year":"2010","journal-title":"Osteoporos. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1002\/jbmr.5650091002","article-title":"Universal standardization for dual-x-ray absorptiometry: Patient and phantom cross-calibration results","volume":"9","author":"Genant","year":"1994","journal-title":"J. Bone Miner. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1002\/jbmr.95","article-title":"Peak bone mass from longitudinal data: Implications for the prevalence, pathophysiology, and diagnosis of osteoporosis","volume":"25","author":"Berger","year":"2010","journal-title":"J. Bone Miner. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s001980070050","article-title":"Estimation of prevalence of low bone density in Canadian women and men using a population-specific DEXA reference standard: The Canadian Multicentre Osteoporosis Study (CaMos)","volume":"11","author":"Tenenhouse","year":"2000","journal-title":"Osteoporos. Int."},{"key":"ref_16","first-page":"4325","article-title":"Re-naming pcos\u2014Suggest anovulatory androgen excess","volume":"98","author":"Prior","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1210\/jcem-67-5-937","article-title":"Effect of excess endogenous androgens on bone density in young women","volume":"67","author":"Buchanan","year":"1988","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","first-page":"646","article-title":"High bone density in hyperandrogenic women: Effect of gonadotropin-releasing hormone agonist alone or in conjunction with estrogen-progestin replacement","volume":"81","author":"Simberg","year":"1996","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/BF00571330","article-title":"Bone mineral density in hyperandrogenic amenorrhoea","volume":"52","author":"Prezelj","year":"1993","journal-title":"Calcif. Tissue Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJM199011013231801","article-title":"Spinal bone loss and ovulatory disturbances","volume":"323","author":"Prior","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/epirev\/mxt012","article-title":"Negative Spinal Bone Mineral Density Changes and Subclinical Ovulatory Disturbances\u2014Prospective Data in Healthy Premenopausal Women With Regular Menstrual Cycles","volume":"36","author":"Li","year":"2014","journal-title":"Epidemiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00198-006-0210-2","article-title":"Menstrual cycle lengths and bone mineral density: A cross-sectional, population-based study in rural Chinese women ages 30\u201349 years","volume":"18","author":"Ouyang","year":"2007","journal-title":"Osteoporos. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1093\/aje\/kwf049","article-title":"Natural history of bone loss over 6 years among premenopausal and early postmenopausal women","volume":"156","author":"Bainbridge","year":"2002","journal-title":"Am. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.bone.2005.01.014","article-title":"Genetic and environmental determinants of bone mineral density in Chinese women","volume":"36","author":"Lau","year":"2005","journal-title":"Bone"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/aje\/kwf061","article-title":"Correlates of forearm bone mineral density in young Norwegian women: The Nord-Trondelag Health Study","volume":"156","author":"Hawker","year":"2002","journal-title":"Am. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11657-014-0185-0","article-title":"The Tromso Study: Fit Futures: A study of Norwegian adolescents\u2019 lifestyle and bone health","volume":"9","author":"Winther","year":"2014","journal-title":"Arch. Osteoporos."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4174","DOI":"10.1210\/jc.2012-2561","article-title":"Fractures in healthy females followed from childhood to early adulthood are associated with later menarcheal age and with impaired bone microstructure at peak bone mass","volume":"97","author":"Chevalley","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","first-page":"2709","article-title":"Effects of estrogen exposure and reproductive factors on bone mineral density and osteoporotic fractures","volume":"80","author":"Nguyen","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s001980170133","article-title":"How do reproductive and lifestyle factors influence bone density in distal and ultradistal radius of early postmenopausal women? The Nord-Trondelag Health Survey, Norway","volume":"12","author":"Forsmo","year":"2001","journal-title":"Osteoporos. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1152\/physrev.00027.2015","article-title":"Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery","volume":"96","author":"Kovacs","year":"2016","journal-title":"Physiol. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/AOG.0000000000002096","article-title":"Associations of Parity, Breastfeeding, and Fractures in the Women\u2019s Health Observational Study","volume":"130","author":"Crandall","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1359\/jbmr.2000.15.10.2011","article-title":"More broken bones: A 4-year double cohort study of young girls with and without distal forearm fractures","volume":"15","author":"Goulding","year":"2000","journal-title":"J. Bone Miner. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1359\/jbmr.080815","article-title":"Deleterious effect of late menarche on distal tibia microstructure in healthy 20-year-old and premenopausal middle-aged women","volume":"24","author":"Chevalley","year":"2009","journal-title":"J. Bone Miner. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/BF01623777","article-title":"Association between weight cycling history and bone mineral density in premenopausal women","volume":"7","author":"Fogelholm","year":"1997","journal-title":"Osteoporos. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s001980050077","article-title":"Weight variability, weight change and the incidence of hip fractures: A prospective study of 39000 middle-aged Norwegians","volume":"8","author":"Meyer","year":"1998","journal-title":"Osteoporos. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3291","DOI":"10.1210\/jc.2009-2497","article-title":"A prospective exploration of cognitive dietary restraint, subclinical ovulatory disturbances, cortisol and change in bone density over two years in healthy young women","volume":"95","author":"Bedford","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1093\/humrep\/deh381","article-title":"Indicators for the total duration of premenopausal endogenous estrogen exposure in relation to BMD","volume":"19","author":"Hagemans","year":"2004","journal-title":"Hum. Reprod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.1365-2796.1997.tb00024.x","article-title":"Bone mass and risk factors for bone loss in perimenopausal Danish women","volume":"242","author":"Brot","year":"1997","journal-title":"J. Intern. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/5\/1023\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:04:53Z","timestamp":1760195093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/5\/1023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,18]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,5]]}},"alternative-id":["ijerph15051023"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15051023","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,18]]}}}