title: Risks of perimenopausal fractures--a prospective population-based study.
abstract: OBJECTIVE
  To examine the associations between potential risk factors and fractures in perimenopausal women.
  
  
  METHODS
  A total of 3,140 women (mean age 53.4 +/- 2.8 (s.d.) years) were followed-up for 2.4 years after axial bone densitometry (lumbar spine and femoral neck) with regard to the occurrence of fractures.
  
  
  RESULTS
  In all, 5.6% of the women sustained a fracture. There were 169 low energy fractures (falling on a level surface) in 157 women after the exclusion of 18 fractures caused by a high energy trauma. The wrist was the most frequent site of fracture (n = 46). Lumbar bone mineral density was 5.8% lower and femoral bone mineral density 4.6% lower among fracture cases compared with non-fracture cases (p < 0.0001). History of a fracture during 1980-1989 elevated the risk of all fractures 2.83-fold (95% confidence interval (CI) 1.95-4.10) and the risk of a first wrist fracture 2.25-fold (95% CI 1.10-4.62). The amount of weekly alcohol intake was higher among fracture cases than among non-fracture cases yielding an age-adjusted odds ratio (OR) of 1.45 (95% CI 1.05-2.02). Past or present use of hormone replacement therapy was protective against fractures (age-adjusted OR 0.70, 95% CI 0.50-0.96). If bilateral oophorectomy had been carried out under the age of 45 years, the risk of fracture was 3.64-fold (95% CI 1.01-13.04) compared with women operated upon after the age of 45 years. Age at menarche, parity, lactation and smoking history did not differ between the fracture and non-fracture groups.
  
  
  CONCLUSIONS
  A former history of fractures, low baseline bone mineral density (BMD) and use of alcohol are predisposing factors associated with perimenopausal fractures, while hormone replacement therapy is protective in this respect.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Kuopio, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: H
authors.initials: H
authors.lastname: Kröger
authors.forename: R
authors.initials: R
authors.lastname: Honkanen
authors.forename: E
authors.initials: E
authors.lastname: Puntila
authors.forename: J
authors.initials: J
authors.lastname: Huopio
authors.forename: S
authors.initials: S
authors.lastname: Saarikoski
authors.forename: E
authors.initials: E
authors.lastname: Alhava
mesh_terms: D000428:Alcohol Drinking; D015519:Bone Density; D015914:Estrogen Replacement Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D050723:Fractures, Bone / Q000453:epidemiology; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D011159:Population Surveillance; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors