title: Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women.
abstract: OBJECTIVE
  To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women.
  
  
  METHODS
  Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The significance level was set at p<0.05.
  
  
  RESULTS
  The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.07; 95% CI: 1.06;1.08), time since menopause (OR=2.16; 95% CI: 1.49;3.14), previous fracture (OR=2.62; 95% CI: 2.08;3.29) and current smoking (OR=1.45; 95% CI: 1.13;1.85). BMI (OR=0.88; 95% CI: 0.86;0.89), regular physical activity (OR=0.78; 95% CI: 0.65;0.94) and hormone replacement therapy (OR=0.43; 95% CI: 0.33;0.56) had a protective effect on bone mass. Risk factors significantly associated with osteoporotic fractures were age (OR=1.05; 95% CI: 1.04;1.06), time since menopause (OR=4.12; 95% CI: 1.79;9.48), familial history of hip fracture (OR=3.59; 95% CI: 2.88;4.47) and low BMD (OR=2.28; 95% CI: 1.85;2.82).
  
  
  CONCLUSIONS
  Advanced age, menopause, low-trauma fracture and current smoking are major risk factors associated with low BMD and osteoporotic fracture. The clinical use of these parameters to identify women at higher risk for fractures might be a reasonable strategy to improve the management of osteoporosis.
authors.affiliation: Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. mpinheiro@uol.com.br
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Pinheiro
authors.forename: Edgard T dos
authors.initials: ET
authors.lastname: Reis Neto
authors.forename: Flávia S
authors.initials: FS
authors.lastname: Machado
authors.forename: Felipe
authors.initials: F
authors.lastname: Omura
authors.forename: Jeane H K
authors.initials: JH
authors.lastname: Yang
authors.forename: Jacob
authors.initials: J
authors.lastname: Szejnfeld
authors.forename: Vera L
authors.initials: VL
authors.lastname: Szejnfeld
mesh_terms: D015519:Bone Density; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014505:Urban Population