Long-term fracture risk among women with proven endometriosis.
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.
Melton
L Joseph
LJ
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>
Leibson
Cynthia L
CL
Good
Andrew E
AE
Achenbach
Sara J
SJ
Oberg
Ann L
AL
Khosla
Sundeep
S
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