Perimenopausal Screening Laboratory Tests
For a perimenopausal woman with potential osteoporosis and cardiovascular disease risks, order a lipid panel and consider DXA screening if she is age 60-64 with risk factors (low body weight <70 kg, previous fracture, glucocorticoid use, or family history), but routine DXA screening should wait until age 65 unless these specific risk factors are present. 1, 2
Osteoporosis Screening Approach
Age-Based DXA Screening Algorithm
Age 65 and older: All postmenopausal women should undergo routine DXA screening of the hip and lumbar spine regardless of risk factors 1, 2
Age 60-64 with risk factors: DXA screening is recommended as the benefits are comparable to routine screening in older women 1
Age <60 without risk factors: No routine DXA screening is recommended 1
Key Risk Factors That Trigger Earlier Screening
Low body weight (<70 kg) is the single best predictor of low bone mineral density and should prompt screening 1
Previous fragility fracture at any age warrants immediate screening 1
Long-term glucocorticoid therapy is a strong indication for screening 1
Medical conditions including hyperparathyroidism, hypogonadism, and chronic inflammatory diseases 1
Family history of osteoporosis (though less evidence supports this as a sole trigger) 1
No current estrogen therapy use increases risk 1
Cardiovascular Disease Screening
Essential Laboratory Tests
Lipid panel is critical as dyslipidemia is associated with both cardiovascular disease and low bone mineral density 3, 4
Elevated LDL and low HDL cholesterol are associated with both atherosclerosis and low bone mineral density, making this a dual-purpose screening test 3
The link between dyslipidemia and bone health reflects shared pathophysiological mechanisms including inflammation and oxidative stress 3, 4
Additional CVD Risk Assessment
Fasting glucose or HbA1c should be checked as diabetes is a shared risk factor for both osteoporosis and cardiovascular disease 3, 4
Blood pressure measurement is essential as hypertension contributes to both conditions 4
Laboratory Tests NOT Routinely Recommended
FSH and inhibin B levels should NOT be used to diagnose perimenopause itself, as menstrual history and age are sufficient for clinical diagnosis 5
While FSH has a positive likelihood ratio of 3.06 for perimenopause, no single test is accurate enough to rule in or rule out perimenopausal status 5
Clinicians should diagnose perimenopause based on menstrual history (irregular periods or 3-11 months of amenorrhea) and age without relying on laboratory results 5
Common Pitfalls to Avoid
Don't screen too early: Avoid DXA screening in women under age 60 without specific risk factors, as routine screening is not recommended 1
Don't ignore the cardiovascular-bone connection: Recognize that osteoporosis and cardiovascular disease share common risk factors and pathophysiology, making comprehensive screening important 3, 4
Don't order FSH to "confirm" perimenopause: Self-assessment and menstrual history are more useful than laboratory tests for diagnosing the menopausal transition 5
Don't forget race/ethnicity considerations: African-American women have higher average bone mineral density than white women and may be less likely to benefit from screening 2
Follow-Up Testing Intervals
For normal bone density or mild osteopenia: Repeat DXA in 2-3 years 1
For osteoporosis or patients on treatment: Repeat DXA in 1-2 years to monitor treatment effectiveness 1
A minimum of 2 years is needed to reliably measure changes in bone mineral density due to testing precision limitations 1, 2