Risks of perimenopausal fractures‐a prospective population‐based study

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Abstract
Objective. To examine the associations between potential risk factors and fractures in perimenopausal women.Subjects. A total of 3140 women (mean age 53.4±2.8 (s.d.) years) were followed‐up for 2.4 years after axial bone densitometry (lumbar spine and femoral neck) with regard to the occurrence of fractures.Results. In all, 5.6% of the women sustained a fracture. There were 169 low energy fractures (falling on a level surface) in 157 women after the exclusion of 18 fractures caused by a high energy trauma. The wrist was the most frequent site of fracture (n=46). Lumbar bone mineral density was 5.8% lower and femoral bone mineral density 4.6% lower among fracture cases compared with non‐fracture cases (p < 0.0001). History of a fracture during 1980–1989 elevated the risk of all fractures 2.83‐fold (95% confidence interval (CI) 1.95–4.10) and the risk of a first wrist fracture 2.25‐fold (95% CI 1.10–4.62). The amount of weekly alcohol intake was higher among fracture cases than among non‐fracture cases yielding an age‐adjusted odds ratio (OR) of 1.45 (95% CI 1.05–2.02). Past or present use of hormone replacement therapy was protective against fractures (age‐adjusted OR 0.70, 95% CI 0.50–0.96). If bilateral oophorectomy had been carried out under the age of 45 years, the risk of fracture was 3.64‐fold (95% CI 1.01–13.04) compared with women operated upon after the age of 45 years. Age at menarche, parity, lactation and smoking history did not differ between the fracture and non‐fracture groups.Conclusions. A former history of fractures, low baseline bone mineral density (BMD) and use of alcohol are predisposing factors associated with perimenopausal fractures, while hormone replacement therapy is protective in this respect.