The Role of Follicle-Stimulating Hormone in Bone Loss During Menopause Transition: A Narrative Review

For many years, menopause-related bone loss has been attributed solely to declining estrogen levels. Recently it has been suggested that bone loss accelerates during perimenopause, often preceding declines in estradiol (E2), proposing that follicle-stimulating hormone (FSH), the levels of which are high during late perimenopause, may play a role in skeletal deterioration independently of E2. The aim of this narrative review was to present aspects of bone health throughout the menopause transition with a focus on the relationship between FSH and bone-related outcomes. Epidemiological studies evaluating bone mineral density (BMD) and bone turnover markers (BTMs) were analyzed. Higher FSH levels were associated with reduced BMD, particularly at the spine and hip, as well as enhanced bone remodeling activity. In several longitudinal studies, FSH was found to be a more reliable predictor of bone loss than estrogen. In conclusion, FSH may serve as an early marker of perimenopausal bone health deterioration by identifying women at risk for bone loss and allowing for more personalized prevention strategies; however, further research is needed before its clinical use.