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Baseline age and time to major fracture in younger postmenopausal women

Gourlay, Margaret Lee MD, MPH1; Overman, Robert A. MPH2; Fine, Jason P. ScD3; Ensrud, Kristine E. MD, MPH4; Crandall, Carolyn J. MD, MS5; Gass, Margery L. MD6; Robbins, John MD7; Johnson, Karen C. MD, MPH8; LeBlanc, Erin S. MD, MPH9; Womack, Catherine R. MD8; Schousboe, John T. MD, PhD10; LaCroix, Andrea Z. PhD11 for the Women’s Health Initiative Investigators

doi: 10.1097/GME.0000000000000356
Original Articles

Objective This study aims to estimate the incidence of first hip or clinical vertebral fracture or major osteoporotic (hip, clinical vertebral, proximal humerus, or wrist) fracture in postmenopausal women undergoing their first bone mineral density (BMD) test before age 65 years.

Methods We studied 4,068 postmenopausal women, aged 50 to 64 years without hip or clinical vertebral fracture or antifracture treatment at baseline, who were participating in the Women’s Health Initiative BMD cohort study. BMD tests were performed between October 1993 and April 2005, with fracture follow-up through 2012. Outcomes were the time for 1% of women to sustain a hip or clinical vertebral fracture and the time for 3% of women to sustain a major osteoporotic fracture before initiating treatment, adjusting for clinical risk factors and accounting for competing risks. Women without osteoporosis and women with osteoporosis on their first BMD test were analyzed separately.

Results During a maximum of 11.2 years of concurrent BMD and fracture follow-up, the adjusted estimated time for 1% of women to have a hip or clinical vertebral fracture was 12.8 years (95% CI, 8.0-20.4) for women aged 50 to 54 years without baseline osteoporosis, 7.6 years (95% CI, 4.8-12.1) for women aged 60 to 64 years without baseline osteoporosis, and 3.0 years (95% CI, 1.3-7.1) for all women aged 50 to 64 years with baseline osteoporosis. Results for major osteoporotic fracture were similar.

Conclusions Because of very low rates of major osteoporotic fracture, postmenopausal women aged 50 to 64 years without osteoporosis on their first BMD test are unlikely to benefit from frequent rescreening before age 65 years.

From the 1Department of Family Medicine, University of North Carolina, Chapel Hill, NC; 2Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; 3Department of Biostatistics, University of North Carolina, Chapel Hill, NC; 4Department of Medicine, VA Medical Center, Minneapolis, MN; 5Department of Medicine, University of California Los Angeles, Los Angeles, CA; 6The North American Menopause Society, Mayfield Heights, OH; 7University of California at Davis, Sacramento, CA; 8University of Tennessee Health Science Center, Memphis, TN; 9Center for Health Research, Kaiser Permanente Northwest, Portland, OR;10Division of Health Policy and Management, University of Minnesota, Minneapolis, MN; and 11Fred Hutchinson Cancer Research Center, Seattle, WA.

Received July 18, 2014; revised and accepted August 27, 2014.

The funding organizations had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of data; in the preparation, review, or approval of the manuscript; and in the decision to submit the manuscript for publication.

Funding/support: The project described was funded by the National Center for Research Resources (grant K23RR024685) and by the National Center for Advancing Translational Sciences, National Institutes of Health (grant UL1TR000083). The Women’s Health Initiative program was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services (contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C).

Clinical trial registration: NCT00000611 (

Financial disclosure/conflicts of interest: K.E.E. serves as consultant for a data monitoring committee at Merck Sharp and Dohme. J.T.S. received research grant funding from Bone Ultrasound Finland from September 2013 through July 2014. Other financial activities are not related to the submitted work.

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Address correspondence to: Margaret Lee Gourlay, MD, MPH, University of North Carolina, Aycock Bldg, Manning Dr, CB 7595, Chapel Hill, NC 27599-7595. E-mail:

© 2015 by The North American Menopause Society.