Johannesdottir F, Putman MS, Burnett-Bowie SAM, et al. - Lower BMD and worse bone microarchitecture in White women partly explain higher fracture risk in White vs Black women. Postmenopausal Black and White women were compared with respect to the rates of decline in bone density, microarchitecture and strength.

• Postmenopausal Black (n = 80) and White (n = 137) women participating in the Study of Women's Health Across the Nation (SWAN) were investigated using high-resolution peripheral quantitative computed tomography (HR-pQCT) for longitudinal changes in peripheral volumetric bone mineral density (vBMD), microarchitecture and strength at the distal radius and tibia over 6.7 years.

• The greatest decline in total and trabecular vBMD at the radius was observed among women with the lowest baseline body weight independent of race and other clinical covariates.

• Rates of bone loss were higher, particularly at the tibia, among women who lost weight over the follow-up period vs those who maintained or gained weight.

• There appeared protective effects of higher baseline total body fat mass against bone loss at both radius and tibia.

• Overall, the lower risk of fracture among postmenopausal Black women is not because of slower rates of bone deterioration.

• Postmenopausal women should avoid lower body weight and excessive weight loss in order to prevent rapid bone loss and subsequent fractures.