Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study.
BACKGROUND
Because menopausal estrogen is related to the development of osteoporosis, we investigated the potential associations of the estrogen-related events of menarche, pregnancy, and menopause with fracture risk in a population-based, prospective study of older women.


METHODS
The Leisure World Cohort was established in the early 1980s when residents of a California retirement community, including 8877 women, completed a health survey. Incident fractures of the hip (n = 1220), wrist (n = 463), and spine (n = 613) incurred over two decades were identified from four follow-up questionnaires, hospital discharge records, and (for hip fracture) death certificates. Hazard ratios (HR) adjusted for age and other potential confounders were calculated using proportional hazards regression.


RESULTS
Late age at menarche was associated with decreased hip fracture risk (HR = 0.84, 95% CI 0.72-0.98, for age > or = 14 vs. < or = 12 years) but was unrelated to fractures at other sites. Hip fracture risk was also reduced in women who had been pregnant (HR = 0.83, 95% CI 0.72- 0.95). Women who reported menopause at age 45+ had a lower risk of wrist fracture compared with those with menopause at age < or = 44 (HR = 0.74, 95% CI 0.58-0.95 for ages 45-54; HR = 0.71, 95% CI 0.49-1.04 for ages 55+). Although fracture risks did not differ between ever and never users of menopausal estrogen, recency since last use was related to wrist fractures (HR = 1.09, 95% CI 1.03-1.16 for each 5 years since last years).


CONCLUSIONS
The estrogen-related events of menarche, pregnancy, and menopause were not associated with osteoporotic fracture risk in a consistent manner. Other factors related to these events may be influencing development of osteoporosis and the likelihood of sustaining a fracture in older women.
Paganini-Hill
Annlia
A
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. annliahi@usc.edu
Atchison
Kathryn A
KA
Gornbein
Jeffery A
JA
Nattiv
Aurelia
A
Service
Susan K
SK
White
Stuart C
SC
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006304:Health Status; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D008572:Menarche; D016017:Odds Ratio; D017584:Reproductive History; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014954:Wrist Injuries / Q000453:epidemiology