Crandall Carolyn J, Liu Jingmin, Cauley Jane, Newcomb Polly A, Manson JoAnn E, Vitolins Mara Z, Jacobson Lisette T, Rykman Kelli K, Stefanick Marcia L
Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; the Women's Health Initiative Clinical Coordinating Center and the Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington; the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas; the Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa; and the Departments of Medicine and Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
Obstet Gynecol. 2017 Jul;130(1):171-180. doi: 10.1097/AOG.0000000000002096.
OBJECTIVE: To examine associations of several aspects of parity and history of lactation with incident hip fractures and clinical fractures and, in a subset of women, with bone mineral density. METHODS: In this observational study, we analyzed data from 93,676 postmenopausal women participating in the Women's Health Initiative Observational Study and all bone density data from the subset of participants who underwent bone density testing at three clinical centers. At baseline, participants were aged 50-79 years. Using Cox proportional hazards regression analysis, we examined associations of fracture incidence and bone density with several aspects of parity (number of pregnancies, age at first pregnancy lasting 6 months or greater, and number of pregnancies lasting 6 months or greater) and breastfeeding (number of episodes of breastfeeding for at least 1 month, number of children breastfed, age when first breastfed, age when last breastfed, total number of months breastfed). RESULTS: The mean baseline age (standard deviation) of participants was 64 (±7.4) years (mean follow-up 7.9 years). During follow-up, the incident rate of hip fracture was 1.27%. Ten percent of participants were nulligravid. In fully adjusted models, number of pregnancies, parity, age at first birth, number of children breastfed, age at first breastfeeding, age at last breastfeeding, and total duration of breastfeeding were not statistically significantly associated with hip fracture incidence. There were no consistent associations of parity or lactation characteristics with overall clinical fracture risk or bone density. However, compared with never breastfeeding, a history of breastfeeding for at least 1 month was associated with a decreased risk of hip fracture (yes compared with no, hazard ratio 0.84, 95% confidence interval 0.73-0.98). CONCLUSION: Patterns of parity and history of lactation were largely unrelated to fracture risk or bone density.
目的:研究生育次数及哺乳史的多个方面与髋部骨折和临床骨折发生率之间的关联,并在部分女性亚组中研究其与骨密度的关系。 方法:在这项观察性研究中,我们分析了93676名参与女性健康倡议观察性研究的绝经后女性的数据,以及在三个临床中心接受骨密度检测的参与者亚组的所有骨密度数据。基线时,参与者年龄在50 - 79岁之间。我们使用Cox比例风险回归分析,研究骨折发生率和骨密度与生育次数的多个方面(怀孕次数、首次怀孕持续6个月或更长时间的年龄、持续6个月或更长时间的怀孕次数)以及母乳喂养(至少母乳喂养1个月的次数、母乳喂养的子女数、首次母乳喂养的年龄、最后一次母乳喂养的年龄、母乳喂养的总月数)之间的关联。 结果:参与者的平均基线年龄(标准差)为64(±7.4)岁(平均随访7.9年)。随访期间,髋部骨折的发生率为1.27%。10%的参与者从未怀孕。在完全调整模型中,怀孕次数、生育次数、初产年龄、母乳喂养的子女数、首次母乳喂养的年龄、最后一次母乳喂养的年龄以及母乳喂养的总时长与髋部骨折发生率无统计学显著关联。生育次数或哺乳特征与总体临床骨折风险或骨密度之间没有一致的关联。然而,与从未母乳喂养相比,有至少1个月母乳喂养史与髋部骨折风险降低相关(是与否相比,风险比0.84,95%置信区间0.73 - 0.98)。 结论:生育模式和哺乳史在很大程度上与骨折风险或骨密度无关。
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