Risk factors for perimenopausal fractures: A prospective study

This prospective study was aimed at determining the risk factors for the de velopment of fractures in perimenopausal women. The study group (I? = 3068) was comprised of a stratified population sample of women aged between 47 a nd 56 years. During the follow-up period of 3.6 years, 257 (8.4%) of the wo men sustained a total of 295 fractures. After adjustment for covariates, th e relative risk (RR) of sustaining a fracture was found to be 1.4 [95% conf idence interval (CI) 1.2-1.6] for a 1 standard deviation (SD) decrease in t he spinal and femoral neck bone mineral density (BMD). Women with a previou s fracture history were found to have an increased risk of fracture [RR 1.7 (95% CI 1.3-2.2)] and those reporting three or more chronic illnesses exhi bited a RR of 1.4 (95% CI 1.0-1.9). Women not using hormone replacement the rapy (HRT) had a RR of 1.5 (95% CI 1.1-2.2) fur all fracture types. When os teoporotic fractures (vertebral, hip, proximal humerus and wrist Fractures; n = 98) were used as an endpoint, the independent risk factors were found to be a low BMD (RR for a 1 SD decrease in both spinal and femoral neck BMD was 1.6, 95% CI 1.3-2.0), a previous fracture history (RR 1.9, 95% CI 1.3- 2.9) and nonuse of HRT (RR 2.2, 95% CI 1.3-4.0). The independent risk facto rs for all other fractures (n = 158) were a low BMD (RR for a 1 SD decrease in the spinal BMD was 1.4, 95% CI 1.2-1.6 and in the femoral neck BMD was 1.3, 95% CI 1.1-1.5), a previous fracture history (RR 1.6, 95% CI 1.1-2.2), smoking (RR 1.8, 95% CI 1.1-2.7) and having had three or more chronic illn esses (RR 1.6, 95% CI 1.1-2.2). Weight, height, age, menopausal status, mat ernal hip fracture, use of alcohol, coffee consumption or dietary calcium i ntake were not independently associated with the development of any particu lar type of fracture. We conclude that the independent risk factors for per imenopausal fractures are a low bone density, previous fracture history, no nuse of HRT, having had three or more chronic illnesses and smoking, the gr adient of risk being similar for spinal and femoral neck BMD measurements i n the perimenopausal population. The risk factors are slightly different fo r perimenopausal osteoporotic than for other types of fractures.