MedWire News: Research shows that women experience a sharp rise in their risk for hip fracture between their sixth and eight decades, regardless of menopausal factors.
"Our findings show that age is far more important than factors relating to menopause in determining the risk of hip fracture," comment lead author Emily Banks (The Australian National University, Canberra, Australian Capital Territory) and team.
"Hence, clinical decisions around hip fracture prevention should be based on age, and age-related factors, such as frailty, low body mass index, sensory impairment, and comorbidity, rather than on age at menopause."
The team examined data from 561,609 participants of the UK Million Women Study of 1996–2001, including 3.4 million person-years of follow-up, at an average of 6.2 years per participant. The women could all provide complete menopause information and had never used hormone replacement therapy, with 75% postmenopausal at baseline.
Overall, 0.3% of women were admitted to hospital with a first hip fracture during follow-up.
Women aged 50–54 years who were postmenopausal had a significantly higher risk for hip fracture than their premenopausal counterparts, with a relative risk (RR) of 2.22, after adjusting for confounders such as age, smoking, socioeconomic status, parity, use of hormonal contraceptives, and comorbidity.
However, the risk for hip fracture after the menopause increased significantly and sharply with age, with a seven-fold increase in the 5-year rate in women aged 70–74 years versus those aged 50–54 years (0.82 vs 0.11 cases per 100 women).
In contrast, age at time of menopause had little impact on risk, with RRs of just 1.22 and 1.08 for women who underwent menopause before the age of 45 years or from 45–49 years versus 50 years or older.
Finally, the risk for hip fracture was not significantly affected by whether menopause was natural or surgical.
The researchers conclude in the journal PLoS Medicine: “Our findings show that at around the time of menopause, when hip fractures are relatively uncommon, postmenopausal women have a higher incidence of such fractures than premenopausal women.
“However, after the menopause the incidence of hip fracture increases rapidly with age and fracture rates are determined far more by women's actual ages than by factors relating to the menopause.”
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