Hormonal Changes During Menopause and Their Impact on Bone Health: Insights from Orthopedic and Reproductive Medicine

Background Menopause is characterized by profound hormonal alterations, including a decline in estradiol and progesterone with compensatory rises in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These changes have been implicated in the pathogenesis of bone loss and osteoporosis, yet their precise contribution in the South Asian population remains underexplored. This study aimed to investigate the relationship between hormonal changes during menopause and their impact on bone health, with integrated perspectives from orthopedic and reproductive medicine. Methods A retrospective study was conducted at the University of Lahore, Lahore, Pakistan, utilizing medical records of postmenopausal women aged 45-65 years over a 12-month period. A total of 180 participants with complete hormonal and bone health data were included through purposive sampling. Data collected included demographic characteristics, menopausal duration, lifestyle factors, serum hormone levels (estradiol, progesterone, FSH, LH), biochemical markers (serum calcium, vitamin D, alkaline phosphatase), and bone mineral density (BMD) assessed via dual-energy X-ray absorptiometry (DEXA). Statistical analyses included t-tests, chi-square tests, Pearson's correlation, and multivariate linear regression, with p < 0.05 considered significant. Results Women with menopause ≥5 years exhibited significantly lower estradiol (21.4 ± 8.6 pg/mL vs. 36.8 ± 12.4 pg/mL, p < 0.001) and higher FSH (68.7 ± 12.5 mIU/mL vs. 51.6 ± 9.4 mIU/mL, p < 0.001). Lumbar spine BMD was markedly reduced in this group (0.81 ± 0.13 g/cm² vs. 0.94 ± 0.11 g/cm², p < 0.001), with higher rates of osteopenia (49.1%) and osteoporosis (25.5%). Biochemical markers showed lower calcium and vitamin D, alongside elevated alkaline phosphatase. Correlation analysis demonstrated a positive association between estradiol and BMD (r = 0.46, p < 0.001) and a negative association with FSH (r = -0.39, p < 0.001). Multivariate regression identified estradiol as the strongest positive predictor and FSH as the strongest negative predictor of BMD, independent of age, BMI, and lifestyle factors. Conclusion Hormonal shifts during menopause, particularly reduced estradiol and elevated FSH, exert a dominant influence on bone health deterioration, surpassing the effects of age, BMI, and lifestyle. Early identification and targeted interventions addressing endocrine changes may be crucial for mitigating osteoporosis risk in postmenopausal women.