title: Fracture Rates and Bone Density Among Postmenopausal Veteran and Non-Veteran Women From the Women's Health Initiative.
abstract: OBJECTIVE
  Postmenopausal osteoporosis can impact quality-of-life even prefracture. To determine whether osteoporosis should be a greater concern in women Veterans versus non-Veterans, we compared fracture rates and bone mineral density (BMD) for Veterans and non-Veterans using Women's Health Initiative data.
  
  
  METHODS
  In this cohort study, participants were women aged 50-79 years. Outcomes were hip, central body, and limb fractures occurring during up to 19 years of follow-up and hip, spine, and whole body BMD collected three times over a 6-year period in a participant subsample. Covariates comprised risk factors for fracture, including fall history and other components of the World Health Organization Fracture Risk Assessment Tool (FRAX). Cox Proportional Hazards models were used to examine fracture rates for Veterans compared with non-Veterans.
  
  
  RESULTS
  Of 161,808 women, 145,521 self-identified as Veteran (n = 3,719) or non-Veteran (n = 141,802). Baseline FRAX scores showed that Veterans had higher 10-year probabilities for any major fracture (13.3 vs 10.2; p < .01) and hip fracture (4.1 vs 2.2; p < .01) compared with non-Veterans. The age-adjusted rate of hip fracture per 1,000 person-years for Veterans was 3.3 versus 2.4 for non-Veterans (p < .01). After adjustment, the hazards ratio for hip fracture was 1.24 (95% confidence interval 1.03-1.49) for Veterans versus non-Veterans. Hazards ratios at other anatomic sites did not differ by Veteran status. Mean BMD at baseline and at Years 3 and 6 also did not differ by Veteran status at any site.
  
  
  CONCLUSIONS
  Women Veterans had an increased hip fracture rate not explained by differences in well-recognized fracture risk factors.
authors.affiliation: VA Salt Lake City Healthcare System, Utah. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City. Joanne.LaFleur@va.gov.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Eileen
authors.initials: E
authors.lastname: Rillamas-Sun
authors.affiliation: Durham Center for Health Services Research and Durham Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, North Carolina. Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.affiliation: VA Salt Lake City Healthcare System, Utah. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Knippenberg
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minnesota. Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: School of Pharmacy, University of Washington, Seattle.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015519:Bone Density; D016022:Case-Control Studies; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D013131:Spine / Q000000981:diagnostic imaging; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Cohort; Fracture; Osteoporosis; Postmenopausal osteoporosis; Risk factors; Veterans