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Carolyn J. Crandall, Aaron Aragaki, Jane A. Cauley, JoAnn E. Manson, Erin LeBlanc, Robert Wallace, Jean Wactawski-Wende, Andrea LaCroix, Mary Jo O'Sullivan, Mara Vitolins, Nelson B. Watts, Associations of Menopausal Vasomotor Symptoms with Fracture Incidence, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 2, 1 February 2015, Pages 524–534, https://doi.org/10.1210/jc.2014-3062
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Abstract
Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown.
This study aimed to examine associations of baseline VMS with fracture incidence and BMD.
This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993–2005).
Forty United States clinical centers.
We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50–79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study.
None.
We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9).
After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20–2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm2 lower femoral neck BMD (95% CI, −0.025–−0.005) and 0.016 g/cm2 lower lumbar spine BMD (95% CI, −0.032–−0.004).
Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.
