Department of Obstetrics and Gynaecology, Skåne University Hospital, Klinikgatan 12, 221 85, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Musculoskelet Disord. 2022 Aug 16;23(1):779. doi: 10.1186/s12891-022-05744-5.
To identify factors related to reproductive history and weight change associated with first incident fracture in middle-aged women.
In total, 18,326 women from the Malmö Diet and Cancer study were included in this prospective population-based cohort study. Participants were included 1991-1996 and followed to 2016. Using data from the National Patient Registry, linked with every participants' unique personal identification number, any first fracture affecting spine, thoracic cage, upper and lower extremities was identified. The association of baseline factors with incident fracture risk was analyzed using Cox regression models.
For participating women, median age 56.0 years, the multivariable Cox regression analysis observed that early menopause (40-44 years) (hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.03-1.27) but not premature menopause < 40 years (HR 1.06, 95% CI 0.91-1.24) was associated with future fracture risk. Self-reported weight loss since age 20 was also associated with future fracture risk (HR 1.39, 95% CI 1.17-1.65) whereas a daily alcohol consumption in the third quartile (5.36-11.42 g/day) compared to the lowest quartile (0-0.80 g/day) was associated with decreased future fracture risk (HR 0.88, 95% CI 0.81-0.96). The multivariable Cox regression analysis also observed that increasing age and weight at baseline, current smoking, a positive history of previous fracture and family history of fractures were associated with increased fracture risk whereas an increasing BMI was associated with a decreased fracture risk. No association to parity or period of lactation was observed nor ever-use of oral contraceptives and menopausal hormone therapy.
This study shows that early menopause between 40 to 45 years and self-reported weight loss since age of 20 are relevant factors associated with increased fracture risk in middle-aged women. These factors were independent of traditional predictors of fracture risk among women and may be considered in preventive initiatives.
Clinicaltrials.gov with identifier: NCT04151732, since Nov 5th 2018.
确定与中年女性首次骨折相关的生殖史和体重变化的因素。
本前瞻性人群队列研究共纳入 18326 名来自马尔默饮食与癌症研究的女性。参与者于 1991-1996 年入组，并随访至 2016 年。使用国家患者登记处的数据，并与每位参与者的唯一个人识别号码相关联，以确定任何影响脊柱、胸廊、上下肢的首次骨折。使用 Cox 回归模型分析基线因素与骨折风险的相关性。
对于参加研究的女性，中位年龄为 56.0 岁，多变量 Cox 回归分析发现，早期绝经（40-44 岁）（风险比（HR）1.14，95%置信区间（CI）1.03-1.27），而不是早绝经（<40 岁）（HR 1.06，95%CI 0.91-1.24）与未来骨折风险相关。自 20 岁以来的体重减轻也与未来骨折风险相关（HR 1.39，95%CI 1.17-1.65），而与最低四分位数（0-0.80g/d）相比，第三四分位数（5.36-11.42g/d）的每日酒精摄入量与未来骨折风险降低相关（HR 0.88，95%CI 0.81-0.96）。多变量 Cox 回归分析还发现，年龄和基线体重增加、当前吸烟、既往骨折病史和骨折家族史与骨折风险增加相关，而 BMI 增加与骨折风险降低相关。未观察到与生育次数或哺乳期有关，也未观察到使用口服避孕药和绝经激素治疗的情况。
本研究表明，40-45 岁之间的早期绝经和自 20 岁以来的体重减轻是与中年女性骨折风险增加相关的重要因素。这些因素独立于女性骨折风险的传统预测因素，可在预防措施中考虑。
Clinicaltrials.gov，标识符：NCT04151732，自 2018 年 11 月 5 日起。
