We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination.
Hazard ratios (HRs) for any fracture among 21,711 healthy postmenopausal women enrolled in the Women's Health Initiative Clinical Trial, who were treated with HT, Ca/D, or HT + Ca/D, and who reported age of nonsurgical menopause of <40, 40 to 49, and ≥50 years, were compared.
Women with menopause <40 years had significantly higher HR for fracture than women with menopause 40 to 49 or ≥50 years, regardless of treatment intervention (HR [95% CI]: menopause <40 y vs ≥50 y, 1.36 [1.11-1.67]; menopause <40 y vs 40-49 y, 1.30 [1.06-1.60]).
In the overall Women's Health Initiative Clinical Trial cohort and within each treatment group, women with younger menopause age (<40 y) had a higher risk of any fracture than women reporting older menopause ages. The effect of menopause age on fracture risk was not altered by any of the treatment interventions (HT, Ca/D, HT + Ca/D), suggesting that early age of menopause is an independent contributor to postmenopausal fracture risk.
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1US Food and Drug Administration, Silver Spring, MD
2Center for Biostatistics, The Ohio State University, Columbus, OH
3Department of Medicine, Division of Endocrinology & Metabolism, George Washington University Medical Faculty Associates, Washington, DC
4Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
5Medstar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, MD.
Address correspondence to: Shannon D. Sullivan, MD, PhD, Medical Officer, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993. E-mail: email@example.com
Received 2 May, 2016
Revised 6 September, 2016
Accepted 6 September, 2016
Funding/support: The WHI program is funded by the National Heart, Lung, and Blood Institute, and by the United States Department of Health and Human Services.
Financial disclosure/conflicts of interest: None reported.
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