Associations of menopausal vasomotor symptoms with fracture incidence
Carolyn J Crandall1, Aaron Aragaki, Jane A Cauley
1Department of Internal Medicine (C.J.C.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095; Women's Health Initiative Clinical Coordinating Center (A.A.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Division of Preventive Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Center for Health Research NW (E.L.), Kaiser Permanente, Portland, Oregon 97227; Department of Epidemiology (R.W.), University of Iowa College of Public Health, Iowa City, Iowa 52242; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, State University of New York, Buffalo, New York 14214; Public Health Sciences (A.L.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Obstetrics and Gynecology (M.J.O'S.), Miller School of Medicine, University of Miami, Miami, Florida 33136; Department of Epidemiology and Prevention (M.V.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; and Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236.
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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