title: Age of menopause and fracture risk in postmenopausal women randomized to calcium + vitamin D, hormone therapy, or the combination: results from the Women's Health Initiative Clinical Trials.
abstract: We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination.
  
  
  
  Hazard ratios (HRs) for any fracture among 21,711 healthy postmenopausal women enrolled in the Women's Health Initiative Clinical Trial, who were treated with HT, Ca/D, or HT + Ca/D, and who reported age of nonsurgical menopause of <40, 40 to 49, and ≥50 years, were compared.
  
  
  
  Women with menopause <40 years had significantly higher HR for fracture than women with menopause 40 to 49 or ≥50 years, regardless of treatment intervention (HR [95% CI]: menopause <40 y vs ≥50 y, 1.36 [1.11-1.67]; menopause <40 y vs 40-49 y, 1.30 [1.06-1.60]).
  
  
  
  In the overall Women's Health Initiative Clinical Trial cohort and within each treatment group, women with younger menopause age (<40 y) had a higher risk of any fracture than women reporting older menopause ages. The effect of menopause age on fracture risk was not altered by any of the treatment interventions (HT, Ca/D, HT + Ca/D), suggesting that early age of menopause is an independent contributor to postmenopausal fracture risk.
authors: 1US Food and Drug Administration, Silver Spring, MD 2Center for Biostatistics, The Ohio State University, Columbus, OH 3Department of Medicine, Division of Endocrinology & Metabolism, George Washington University Medical Faculty Associates, Washington, DC 4Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 5Medstar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, MD.
authors: Shannon D
authors: SD
authors: Sullivan
authors: Amy
authors: A
authors: Lehman
authors: Nisha K
authors: NK
authors: Nathan
authors: Cynthia A
authors: CA
authors: Thomson
authors: Barbara V
authors: BV
authors: Howard
mesh_terms: D000328:Adult; D000367:Age Factors; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use; D016387:Women's Health
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium