title: Increased incident hip fractures in postmenopausal women with moderate to severe pelvic organ prolapse.
abstract: OBJECTIVE
  The aim of this study was to examine the association between fracture and pelvic organ prolapse (POP) in postmenopausal women enrolled in the Women's Health Initiative Estrogen Plus Progestin trial.
  
  
  METHODS
  POP was assessed as cystocele, rectocele, or uterine prolapse and was graded as either "absent to mild" or "moderate to severe." Cox proportional hazard analyses (adjusting for age, body mass index, race, asthma, emphysema, thyroid disease, family history of fracture, regular menses, age at menopause, nulliparity, history of hormone therapy [HT], history of falls, socioeconomic status, calcium, and vitamin D supplementation and physical activity) explored the relationships between moderate to severe POP and incident bone fractures.
  
  
  RESULTS
  Moderate- to severe-grade POP was identified in almost 8% of women (n = 1,192). During a follow-up duration of 7.41 (2.18) years (mean [SD]), 2,156 incident fractures were observed; the most common fracture site was the lower arm (n = 615; 28.51%) followed by the hip (n = 205; 9.51%). Adjusted analyses confirmed moderate to severe POP (of any type) as an independent risk factor for incident hip fractures (hazard ratio [HR], 1.83; 95% CI, 1.16-2.89; P = 0.010). On analyses stratified by assigned treatment (HT vs placebo), moderate to severe rectocele emerged as an independent predictor of incident spine (HR, 2.61; 95% CI, 1.04-6.56; P = 0.042) and lower arm fractures (HR, 1.87; 95% CI, 1.06-3.29; P = 0.030) in the placebo group.
  
  
  CONCLUSIONS
  We identify moderate to severe POP (any type) in postmenopausal women as a risk factor for hip fracture; moderate to severe rectocele holds an additional risk of spine and lower arm fractures in women not taking HT.
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology & Infertility, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. lubnapal@hotmail.com
authors: Lubna
authors: L
authors: Pal
authors: Susan M
authors: SM
authors: Hailpern
authors: Nanette F
authors: NF
authors: Santoro
authors: Ruth
authors: R
authors: Freeman
authors: David
authors: D
authors: Barad
authors: Simon
authors: S
authors: Kipersztok
authors: Vanessa M
authors: VM
authors: Barnabei
authors: Sylvia
authors: S
authors: Wassertheil-Smoller
mesh_terms: D000368:Aged; D052858:Cystocele / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D056887:Pelvic Organ Prolapse / Q000453:epidemiology*; D017698:Postmenopause; D011885:Radius Fractures / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D020047:Rectocele / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000453:epidemiology; D014458:Ulna Fractures / Q000453:epidemiology