title: Fractures between the ages of 20 and 50 years increase women's risk of subsequent fractures.
abstract: BACKGROUND
  Perimenopausal and postmenopausal fractures are well-recognized, strong, independent predictors of subsequent fractures. However, it is unknown whether premenopausal fractures are predictive of postmenopausal fractures.
  
  
  OBJECTIVE
  To determine whether self-reported fractures sustained before the age of 50 years are associated with fractures after this age.
  
  
  METHODS
  Cross-sectional study of 1284 women (mean +/- SD age, 73 +/- 4 years) who were 10 or more years' postmenopausal and who were recruited from electoral rolls in Auckland, New Zealand. Detailed information on their fracture, medical, menstrual, alcohol, and smoking histories was obtained using a standardized questionnaire.
  
  
  RESULTS
  Nine percent of the women reported fractures before the age of 20 years; 7%, between the ages of 20 and 50 years; and 29%,after the age of 50 years. Fractures sustained between the ages of 20 and 50 years were associated with a 74% increase in the risk of fractures after the age of 50 years (odds ratio, 1.74; 95% confidence interval, 1.12-2.70), while fractures occurring before the age of 20 years were not (odds ratio, 1.01; confidence interval, 0.66-1.56). Multivariate analysis showed that after bone density, age, maternal history of hip fractures, age at menopause, weight, history of hormone replacement therapy, and smoking and alcohol histories were adjusted for, a history of fractures between the ages of 20 and 50 years remained a significant independent predictor of risk of fractures after the age of 50 years (risk ratio, 1.83; confidence interval, 1.12-2.76).
  
  
  CONCLUSIONS
  Any fracture (unrelated to motor vehicle accidents) sustained between the ages of 20 and 50 years is associated with increased risk of fractures after the age of 50 years. Therefore, this is an important clinical risk factor that points to the need for bone density measurement, consideration of lifestyle modification, and antiosteoporosis therapies in these women.
authors.affiliation: Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: Wu
authors.forename: Barbara
authors.initials: B
authors.lastname: Mason
authors.forename: Anne
authors.initials: A
authors.lastname: Horne
authors.forename: Ruth
authors.initials: R
authors.lastname: Ames
authors.forename: Judith
authors.initials: J
authors.lastname: Clearwater
authors.forename: Michael
authors.initials: M
authors.lastname: Liu
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Evans
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
mesh_terms: D000367:Age Factors; D000368:Aged; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015999:Multivariate Analysis; D016017:Odds Ratio; D017698:Postmenopause; D011237:Predictive Value of Tests; D017697:Premenopause; D012008:Recurrence; D012307:Risk Factors