Early Menopause Ups Risk for Osteoporotic Fractures, Death

Women who experience early menopause are almost twice as likely to have osteoporosis and are at greater risk for fracture and death than women who experience menopause later in life, according to results of a 34-year study conducted in Sweden.¹ In 1977, 390 women who were 48 years old were recruited for the study. Incidence of fragility fractures, mortality, and prevalence of osteoporosis were measured when the remaining 198 participants were 77 years old; mortality rate and fractures were recorded until age 82 years. Early menopause was defined as occurring before age 47 years.

Women in the early menopause group were nearly twice as likely as women in the late menopause group to have osteoporosis (56% vs 30%, respectively). In addition, the early menopause group had higher rates of mortality (52%) and fractures (44%) compared with those for the late menopause group (mortality, 35%; fractures, 31%).

The link between early menopause and increased risk of osteoporosis has long been established. Although this study confirms this association, it does not elucidate a causal nexus for this association. Many factors affect bone density-nutrition, smoking history, weight, alcohol consumption, exercise, estrogen levels, genetics, medication use-but the extent to which each factor plays a role is unclear.

Estrogen does offer some protection against loss of bone density, but the hormone should not be considered an effective tool for prevention of osteoporotic fractures.² The best management strategies for postmenopausal women are identifying those at risk for fracture and then reducing modifiable risk factors through dietary and lifestyle changes and pharmacological therapy if indicated.³ 

Pertinent Points:

- Osteoporosis is more likely to occur in women with early menopause (56%) than in women with late menopause (30%).
- Women with early menopause had a mortality rate of 52%, compared with a mortality rate of 35% for women who experienced menopause later in life.
- Fracture rates are higher for women with early menopause than for those with late menopause (44% vs 31%, respectively).

References:

References
1. Svejme O, Ahlborg H, Nilsson JA, Karlsson M. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG. 2012;DOI:10.1111/j.1471-0528.2012.033324.x. [Epub ahead of print.]
2. Orwoll ES, Nelson HD. Does estrogen adequately protect postmenopausal women against osteoporosis: an iconoclastic perspective. J Clin Endocrinol Metab. 1999;84:1872-1874.
3. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17:25-54.