Anti-Müllerian Hormone May Predict Rapid Bone Mineral Density Loss During Perimenopause

BMD scan
Woman getting a bone density scan
Investigators assessed whether low anti-Müllerian hormone levels are associated with bone loss in women experiencing the menopause transition.

Low levels of anti-Müllerian hormone (AMH) may be a biomarker for significant bone loss during the transition to menopause, according to results of a study published in the Journal of Bone and Mineral Research.

The Study of Women’s Health Across the Nation (SWAN) was a prospective cohort study conducted at 7 sites in the United States. Women (N=2365) aged 42 to 52 years underwent bone mineral density (BMD) evaluations every 1 to 2 years up to 1 year after the final menstrual period. Serum AMH levels were obtained at baseline.

The mean age of the study population was 46 (standard deviation [SD], 3) years; 54% were in premenopause, 45% were in early perimenopause, and 0.1% were in late perimenopause; and 50% were non-Hispanic White, 28% were Black, 12% were Japanese, and 11% were Chinese.

At baseline, mean lumbar spine BMD was 1.08 (SD, 0.14) g/cm2 and femoral neck BMD was 0.85 (SD, 0.14) g/cm2.

Median AMH level during premenopause and perimenopause combined was 106 (interquartile range, 13,362) pg/mL, and median AMH level was below the lower limit of detection during late perimenopause.

Among women in premenopause or early perimenopause, in the fully adjusted model, every 50% decrement in serum AMH level predicted a 0.12% (P <.001) loss of lumbar spine BMD and a 0.11% (P <.001) loss of femoral neck BMD annually. No associations between serum AMH level and BMD were observed among women in late perimenopause.

For every 50% decrement in serum AMH level, a 0.20% (P =.002) ongoing loss of lumbar spine BMD was reported in women in premenopause and a 0.23% (P <.001) and a 0.20% (P <.001) ongoing loss of lumbar spine and femoral neck BMD, respectively, was reported in women in early perimenopause. Among the late perimenopause group, an ongoing loss of 0.50% and 0.37% of lumbar spine and femoral neck BMD, respectively, was observed, but these associations were attenuated after adjusting for follicle-stimulating hormone and inhibin B levels.

A serum AMH level less than 100 pg/mL had a sensitivity for predicting bone loss at either or both sites of 50% among women in premenopause, of 80% among women in early perimenopause, and of 98% among women in late perimenopause.

This study may have been biased, as not all women had natural menopause due to hysterectomy or use of exogenous sex hormones.

These data indicated that a decrement in serum AMH level experienced by women during premenopause or early perimenopause was a predictor of more rapid BMD loss over the next 3 to 4 years.

Disclosure: One study author declared an affiliation with a biotech, pharmaceutical, and/or device company. Please refer to the original article for a full list of disclosures.


Karlamangla AS, Shieh A, Greendale GA, et al. Anti-Mullerian hormone as predictor of future and ongoing bone loss during the menopause transition. J Bone Miner Res. Published online April 4 2022. doi:10.1002/jbmr.4525