Are severe menopause symptoms a bellwether of bone health?

Women with more severe vasomotor symptoms (VMS) and night sweats may be at risk of having poorer bone health, according to a prospective observational study based on data from the Women’s Health Initiative (WHI).

More than 27,000 women aged 50 to 79 from two WHI cohorts were represented: 23,573 who had not used menopausal hormone therapy and 4,867 from the bone mineral density (BMD) cohort. Mean follow-up was 8.2 years (1993-2005). The researchers measured baseline VMS and incident adjudicated fractures, and BMD at baseline and the first, third, sixth, and ninth annual visits. 

After adjusting for variables such as body mass index, race/ethnicity, smoking, education, and age at baseline, the hazard ratio for hip fracture among women with baseline moderate to severe VMS versus those with no VMS was 1.78 (95% confidence interval [CI] 1.20 – 2.65, P = .01), No association was found between vertebral fracture and VMS. Over the course of follow-up, severity of VMS was inversely associated with BMD (P = .004 for femoral neck, P = .045 for lumbar spine).

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In repeated measures models, when compared with women who reported no VMS symptoms, those who reported moderate to severe VMS had 0.015 g/cm² lower femoral neck BMD (95% CI, 0.025 – 0.005) and 0.016 g/cm² lower lumbar spine BMD (95% CI, 0.032 – 0.004).

The study was limited in that the incidence of fracture in the cohort was low and the general health of WHI participants was better than similarly aged women in the general population. In addition, VMS information was self-reported and assessed at only a baseline visit. BMD data were only available for 4867 participants, meaning that the researchers could not adjust for BMD in the fracture models. An insufficient number of hip fracture events occurred, preventing a more in-depth look at the joint effects of hot flash severity and night sweat severity, along with their corresponding interactions.

The investigators concluded that women who had moderate to severe VMS have increased rates of hip fracture and lower BMD. They believe that further study of the mechanisms underlying the association could aid development of preventive strategies for women who are at risk.

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