Estrogen status and heredity are major determinants of premenopausal bone mass

R. Armamento-Villareal, D. T. Villareal, L. V. Avioli, R. Civitelli

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


To analyze their relative effects on premenopausal bone mass, we have studied the impact of lifelong estrogen exposure, assessed by an estrogen score (ES; computed on age at menarche, average length of menstrual cycles since menarche, and use of birth control pills), heredity, and some environmental factors on vertebral bone density (VBD), of 63 premenopausal women (age, 19-40 yr). Compared with women with normal bone density (Z score > -1), subjects with low VBD (Z score < -1) had significantly lower ES (15.1±3.9 vs. 18.7±2.4, P = 0.001), higher age at menarche (13.8±1.7 vs. 12.6±1.4 yr, P = 0.005), and lower serum estradiol (46.9±37 vs. 86.6±57 pg/ml, P = 0.023) and estrone levels (107.4±60 vs. 178.8±9.0 pg/ml, P = 0.05). Likewise, women in the lowest quartile for VBD had significantly lower ES (15.3±4.5 vs. 18.1±2.7, P = 0.006) and higher age at menarche (13.9±1.9 vs. 12.8±.4, P = 0.02) than those in the upper three quartiles. A higher proportion of subjects with irregular menses (52 vs. 23%, P = 0.03) and a positive family history of osteoporosis (86 vs. 61%, P = 0.04) was found in the low VBD group compared with subjects with normal VBD. VBD correlated positively with ES (r = 0.44, P = < 0.001) and negatively with age at menarche (r = -0.30, P = 0.03) by simple linear regression, whereas no correlation was found between VBD and age, body mass index, parity, lactation, physical activity, sunlight exposure, and dietary calcium and vitamin D intakes. The correlation between VBD and ES improved after correcting for the effect of all the other variables by partial correlation analysis (Pearson partial r = 0.57, P < 0.01), which also disclosed a significant contribution of dietary calcium to VBD. However, ES was the only significant independent determinant of VBD, by stepwise multiple regression analysis (R2 = 0.24). Therefore, premenopausal estrogen exposure, and possibly genetic predisposition, rather than environmental factors, are the major determinants for the development of peak bone mass before menopause.

Original languageEnglish
Pages (from-to)2464-2471
Number of pages8
JournalJournal of Clinical Investigation
Issue number6
StatePublished - 1992


  • bone density
  • menarche
  • menopause
  • menstrual cycle
  • osteoporosis


Dive into the research topics of 'Estrogen status and heredity are major determinants of premenopausal bone mass'. Together they form a unique fingerprint.

Cite this