title: Associations of menopausal vasomotor symptoms with fracture incidence.
abstract: BACKGROUND
  Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown.
  
  
  OBJECTIVE
  This study aimed to examine associations of baseline VMS with fracture incidence and BMD.
  
  
  METHODS
  This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005).
  
  
  METHODS
  Forty United States clinical centers.
  
  
  METHODS
  We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50-79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study.
  
  
  METHODS
  None.
  
  
  METHODS
  We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9).
  
  
  RESULTS
  After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20-2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004).
  
  
  CONCLUSIONS
  Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.
authors.affiliation: Department of Internal Medicine (C.J.C.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095; Women's Health Initiative Clinical Coordinating Center (A.A.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Division of Preventive Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Center for Health Research NW (E.L.), Kaiser Permanente, Portland, Oregon 97227; Department of Epidemiology (R.W.), University of Iowa College of Public Health, Iowa City, Iowa 52242; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, State University of New York, Buffalo, New York 14214; Public Health Sciences (A.L.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Obstetrics and Gynecology (M.J.O'S.), Miller School of Medicine, University of Miami, Miami, Florida 33136; Department of Epidemiology and Prevention (M.V.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; and Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.forename: Aaron
authors.initials: A
authors.lastname: Aragaki
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Erin
authors.initials: E
authors.lastname: LeBlanc
authors.forename: Robert
authors.initials: R
authors.lastname: Wallace
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Andrea
authors.initials: A
authors.lastname: LaCroix
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Mara
authors.initials: M
authors.lastname: Vitolins
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology*; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000503:physiopathology; D019584:Hot Flashes / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008593:Menopause; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000453:epidemiology* / Q000503:physiopathology; D013546:Sweating / Q000502:physiology*; D014481:United States / Q000453:epidemiology; D014666:Vasomotor System / Q000503:physiopathology*