Crandall CJ, Aragaki A, Cauley JA, Manson JE, LeBlanc E, Wallace R, Wactawski-Wende J, LaCroix A, O'Sullivan MJ, Vitolins M, Watts NB. Associations of menopausal vasomotor symptoms with fracture incidence.
J Clin Endocrinol Metab 2015;
100:524-34. [PMID:
25522264 PMCID:
PMC4318890 DOI:
10.1210/jc.2014-3062]
[Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT
Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown.
OBJECTIVE
This study aimed to examine associations of baseline VMS with fracture incidence and BMD.
DESIGN
This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005).
SETTING
Forty United States clinical centers.
PARTICIPANTS
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.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9).
RESULTS
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/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004).
CONCLUSIONS
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.
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