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56 Current Topics in Menopause Prior et al. occur prior to the onset of irregular cycles and may be a result of higher rather than lower levels of estrogen [6]. In addition, some women report difficulty with hot flushes and night sweats (vasomotor symptoms, VMS) before the onset of irregular cycles in the menopause transition, indicating that there is more to perimenopausal VMS than simply low estrogen levels. For the purposes of this chapter, we propose that women in their mid-30s to midor-late 40s with regular menstrual cycles, who begin experiencing a characteristic collection of changes such as new night sweats, new or increased breast tenderness or increased menstrual flow be referred to as “perimenopausal” (Table 1). After starting with the background to current terminology about women’s midlife reproductive transition, we will explore the endocrine, bone and other changes that occur during the perimenopause and the menopause transition Table 1: Midlife women with regular menstrual cycles may be considered to be in perimenopause if they experience any three of the following experience changes (reprinted with permission from [18]): 1. 2. 3. 4. 5. 6. 7. 8. 9. New onset heavy and/or longer flow Shorter menstrual cycles (
84 Current Topics in Menopause, 2013, 84-105 CHAPTER 4 Bone Remodelling in Menopause: Biological and Pathological Aspects Manuel Muñoz-Torres * and Antonia García-Martín Bone Metabolic Unit, Endocrinology Division, University Hospital San Cecilio, Granada, Spain Abstract: Bone is a metabolically active tissue that undergoes continuous regeneration, which provides the skeleton its regenerative and functional adaptation capacity. Although there have been significant advances in the understanding of the mechanism remodelling process in recent years, there is still much to learn on many aspects. The regulation of bone remodelling is a complex process that it integrates different stimuli such as mechanical factors, hormones, cytokines and growth factors. In younger individuals, the bone mass remains practically unchanged, while menopause, aging and some diseases alter bone balance. The main effect of menopause on the skeleton is increased bone resorption resulting in bone loss, which also influences the decrease in intestinal and renal absorption of calcium. The estrogen deficiency plays an important role in the changes of bone mass and calcium metabolism. The bone loss begins in the perimenopausal period but persist until the end of life and it is the main cause of osteoporotic fractures in older women. Keywords: Menopause, bone remodelling, bone mass, osteoporosis, osteoporotic fractures, osteoblast, osteoclast, osteocyte, bone turnover markers, estrogen, aging. BONE REMODELING Send Orders of Reprints at bspsaif@emirates.net.ae The skeleton is metabolically active and constantly remodeling. Bone remodeling is a closely regulated process resulting in the coordinated resorption and formation of skeletal tissue throughout life. The fact that most of the skeleton consists of remodeled bone led to the concept of bone structural units (BSU), also called bone multicellular units (BMU), composed of the three cell types present in the bone. In normal adults, bone resorption and bone formation are tightly *Address correspondence to Manuel Muñoz-Torres: Bone Metabolic Unit, Endocrinology Division, University Hospital San Cecilio, Granada, Spain; Tel/Fax: +34958023966; E-mail: mmt@mamuto.es Volodymyr Dvornyk (Ed) All rights reserved-© 2013 <strong>Bentham</strong> <strong>Science</strong> Publishers
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