Early Menopause and Risk of Fractures–A Preventable Gap

Abstract

Background: Osteoporosis is a chronic disease that results in microarchitectural changes to the bone, thereby reducing its density and increasing the risk of fractures. This retrospective cross-sectional study aimed to examine the link between the risk of major osteoporotic fractures and hip fractures with the age of menopause onset, as well as the impact of menopause duration on fracture incidence.
 Methods: This retrospective cross-sectional study was conducted at the Special Hospital for Rheumatic Diseases, Novi Sad, Serbia. The data required for meeting the study objectives were obtained from patients’ medical records spanning the 2015-2018 period. The sample for the study comprised of 985 postmenopausal women aged ≥ 50 yr who underwent bone mineral densitometry examination and received a FRAX score for major osteoporotic fractures and hip fractures with and without bone mineral density. The obtained FRAX scores were compared across the subjects with respect to the age of menopause onset and menopause duration.
 Results: The group that entered into menopause before the age of 45 had a high risk of hip fracture (OR: 1,652; 95% CI: 1,138 - 2,399; P<.01) and a higher mean FRAX score for hip fracture compared to women in whom menopause started after the age of 45 (Me=1.60 vs. 1.30, P<.004). FRAX scores were also correlated with menopause duration, and the difference between the groups with the longest (over 20 yr) and the shortest (1–10 yr) duration was statistically significant at P<.001.
 Conclusion: As menopause duration could contribute to the prediction of fracture risk, its inclusion in the FRAX algorithm should be considered, while also taking into account the age of menopause onset.

Should the FRAX tool include other variables to assess fragility-related osteoporotic fractures?

“…Hay autores que indican que la herramienta FRAX debería incluir alguna variable ginecológica como la menopausia, tanto la edad a la que se produce como su duración (15). Con los resultados de nuestro estudio no estamos cuestionando la utilidad de FRAX.…”

Associations of parabens and age at natural menopause: National Health and Nutrition Examination Survey

“…The onset of menopause signi es a gradual decline in ovarian function, a reduction in estrogen production, and cessation of reproductive capability [2]. Early menopause was associated with a number of adverse health outcomes, including fractures [3], cardiovascular disease (CVD) [4], diabetes [5], and mortality [6].…”