title: Long-term fracture risk among women with proven endometriosis.
abstract: OBJECTIVE
  To determine whether women with pelvic endometriosis are at increased fracture risk.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Population-based investigation using the data resources of the Rochester Epidemiology Project.
  
  
  METHODS
  From Olmsted County, Minnesota, 987 women with endometriosis that was first surgically visualized or histologically proven in 1970-1989.
  
  
  METHODS
  None, observational study.
  
  
  METHODS
  Follow-up for fractures through complete inpatient and outpatient community medical records.
  
  
  RESULTS
  In 17,408 person-years of follow-up, 256 women experienced 449 different fractures. The cumulative incidence after 20 years (30.8%) was not elevated relative to that expected (30.6%). The independent predictors of any fracture included age (hazard ratio [HR] per 10 years: 1.61; 95% confidence interval [CI] 1.42-1.84]), corticosteroid use (HR: 2.78; 95% CI 1.48-5.24), prior hip, spine, or forearm fracture (HR: 1.82; 95% CI 1.10-3.02), and use of the selective estrogen receptor modulators, tamoxifen or raloxifene (HR: 4.34; 95% CI 2.14-8.81); physical activity was protective (HR: 0.40; 95% CI 0.18-0.88). There was no significant influence on fracture risk of surgery or other medical treatments for endometriosis.
  
  
  CONCLUSIONS
  Despite reported adverse effects of treatment on bone density, there was no overall increase in long-term fracture risk in this unselected cohort of women with proven endometriosis.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. melton.j@mayo.edu <melton.j@mayo.edu>
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Good
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Achenbach
authors.forename: Ann L
authors.initials: AL
authors.lastname: Oberg
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004715:Endometriosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016387:Women's Health