New information on Bone Loss in Menopause — Better Bones

Are you at risk of losing up to 20% of your bone in the years around menopause? Women with accelerated bone loss (called “rapid losers” in a new study) are at higher risk of developing osteoporosis and weaker bones than the average woman. The average woman only loses between 8% and 10% of her bone mass during the three years around menopause.

This new study shows that there is an easy way to find out if you are a person who “rapidly loses” bone so you can take steps to stop it.

Find out if you are a “rapid bone loser”

The researchers focused on using the N-telopeptide cross-link test (a urine test) to help identify women at higher risk for greater and more rapid bone loss. As bone is lost, fragments of certain bone proteins appear in the urine; these are called N-telopeptides (NTx). A woman with more NTx protein fragments in her urine is likely experiencing more rapid bone loss and therefore has a higher risk of excessive menopausal bone loss.

In the study, researchers looked at bone breakdown levels of NTx in about 500 early postmenopausal women who were within 1 to 2 years of having their last period. They found the following:

  • The higher the urinary NTx level, the faster the rate of bone loss during the menopausal transition. This makes sense: a higher rate of bone degradation would likely translate into greater bone loss.
  • A urinary NTx level greater than 65 nM BCE/mM Cr was found to fairly well identify individuals who lose bone rapidly. To put this in context, the average premenopausal NTx level is 36 nM BCE/mM Cr, and I have generally found that postmenopausal women with a level of 50 NTx lose between ½ and 1% of bone mass per year.
  • The association between early postmenopausal NTx and rate of bone loss was stronger at the spine than at the hip. This again makes sense, because the spine is metabolically active trabecular bone, typically losing mass years before the hip.
  • Furthermore, looking back, it was found that elevated urinary NTx in perimenopause was also associated with a higher rate of bone loss during the menopause transition.

menopause table 3

Menopausal bone loss is not evenly distributed during the 10-year transition period (5 years before a woman’s last menstrual period and 5 years after). The greatest bone loss occurs in the 3-year period that begins 1 year before a woman’s last period and ends 2 years after her last period, which is known as “trans menopause.”

What does this research mean to you?

If you notice symptoms of perimenopause, such as irregular periods and hot flashes, or if you recently went through menopause (within a couple of years), a simple test of your urine NTx level can help you identify a tendency toward excessive bone loss.

If you are experiencing excessive bone loss, you can take steps to find out why this may be the case and correct the situation. When I work with individual clients, this is exactly the type of work I do with them.

You can find more information about the simple urine test in my short video and associated manual. You can also order this test online through our online consultation system at our partner laboratory Evexia.

And since you can’t really know when the year before your last period will occur until you’ve actually experienced your last period, it’s a good idea to start a solid Better Bones program right away at the first signs of perimenopause.


Shieh A, et al. Urinary N-telopeptide and rate of bone loss during the transition from menopause to early postmenopause. J Bone Miner Res. 2016;31(11):2057-2064.

Dr. Susan BrownAm Dr. Susan E Brown. I am a clinical nutritionist, medical anthropologist, writer and motivationalist. spokesman. Learn my time-tested 6-step natural approach to bone health at my online courses.

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