Kaiser Permanente, Center for Health Research, Portland, OR, USA.
Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA.
J Bone Miner Res. 2022 Jul;37(7):1260-1269. doi: 10.1002/jbmr.4613. Epub 2022 Jun 19.
We aimed to evaluate the relationship between cumulative endogenous estrogen exposure and fracture risk in 150,682 postmenopausal women (aged 50 to 79 years at baseline) who participated in the Women's Health Initiative. We hypothesized that characteristics indicating lower cumulative endogenous estrogen exposure would be associated with increased fracture risk. We determined ages at menarche and menopause as well as history of irregular menses from baseline questionnaires and calculated years of endogenous estrogen exposure from ages at menarche and menopause. Incident clinical fractures were self-reported over an average 16.7 years of follow-up. We used multivariable proportional hazards models to assess the associations between the estrogen-related variables and incidence of any clinical fracture. In fully adjusted models, those with the fewest years of endogenous estrogen exposure (<30) had an 11% higher risk of developing central body fractures and a 9% higher risk of lower extremity fractures than women with 36 to 40 years of endogenous estrogen exposure (the reference category). In contrast, women with the most years of endogenous estrogen exposure (more than 45 years) had a 9% lower risk of lower extremity fractures than the reference category. Women with irregular (not monthly) menstrual cycles were 7% to 8% more likely to experience lower extremity fractures than women with regular monthly cycles. Our findings support the hypothesis that characteristics signifying lower cumulative endogenous estrogen exposure are associated with higher fracture risk. © 2022 American Society for Bone and Mineral Research (ASBMR).
我们旨在评估 150682 名绝经后妇女（基线时年龄在 50 至 79 岁）的累积内源性雌激素暴露与骨折风险之间的关系。我们假设，表明较低的累积内源性雌激素暴露的特征与增加的骨折风险相关。我们从基线问卷中确定了初潮和绝经年龄以及不规则月经史，并根据初潮和绝经年龄计算了内源性雌激素暴露的年数。在平均 16.7 年的随访中，通过自我报告确定了临床骨折的发生情况。我们使用多变量比例风险模型来评估雌激素相关变量与任何临床骨折发生之间的关联。在完全调整的模型中，与内源性雌激素暴露时间最短（<30 年）的女性相比，暴露时间为 36 至 40 年的女性发生中央身体骨折的风险高 11%，发生下肢骨折的风险高 9%（参考类别）。相比之下，内源性雌激素暴露时间最长（超过 45 年）的女性发生下肢骨折的风险比参考类别低 9%。月经周期不规律（非每月）的女性发生下肢骨折的风险比月经周期规律的女性高 7%至 8%。我们的研究结果支持了这样的假设，即表明较低的累积内源性雌激素暴露的特征与较高的骨折风险相关。 © 2022 美国骨骼与矿物质研究协会（ASBMR）。
