Anti-Mullerian Hormone and Collagen Type I C-telopeptide Predict Fast, Imminent Bone Loss in Early Perimenopause: SWAN
Authors' conclusion
Combining AMH and CTX affords stronger prediction of fast, imminent BMD loss than using AMH or CTX individually.
Study context
- Population
- Early perimenopausal women, Study of Women's Health Across the Nation (SWAN)
- Participants
- 436 women
- Exposure
- Early perimenopausal anti-Mullerian hormone (AMH) and CTX levels, separately and combined, as predictors of fast, imminent bone mineral density (BMD) loss
- Outcome
- Fast, imminent BMD loss (BMD decline rate over the next 1-2 years ≥mean annual menopause rate) at lumbar spine (LS), femoral neck (FN) or total hip (TH)
- Follow-up
- Next 1-2 years
Methodological detailscommunity-based cohort, repeated measures modified Poisson regression
- Community-based cohort
- Repeated measures modified Poisson regression
Main finding
As reported in the abstract
Fast, imminent BMD loss (single model with AMH and CTX)
- Per SD decrement in log AMH: greater fast BMD decline risk, LS (P < .0001)
- 45%
- Per SD decrement in log AMH: greater fast BMD decline risk, FN (P < .0001)
- 17%
- Per SD decrement in log AMH: greater fast BMD decline risk, TH (P < .0001)
- 26%
- Per SD increment in log CTX: greater fast BMD loss risk, LS (P < .0001)
- 35%
- Per SD increment in log CTX: greater fast BMD loss risk, FN (P < .0001)
- 23%
- Per SD increment in log CTX: greater fast BMD loss risk, TH (P < .0001)
- 34%
Observational data: associations, not effects.
Further findings
Fast, imminent BMD loss (separate models)
- Lesser AMH or greater CTX individually related to greater fast, imminent BMD loss risk
Model AUC: AMH and CTX combined vs AMH or CTX individually
- AUC greater for combined models (P < .001 for each BMD site-specific comparison)
Original publication
Anti-Mullerian Hormone and Collagen Type I C-telopeptide Predict Fast, Imminent Bone Loss in Early Perimenopause: SWAN. J Clin Endocrinol Metab. Published 16 December 2025. doi:10.
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