Background A previous case-control study demonstrated that untreated early menopause (menopause before 45 years of age) predisposes to a lower bone mineral density (BMD) at the femoral neck and the lumbar spine and that the condition increases ten year risk of sustaining a major osteoporotic fracture (1). However, less has been published on the predictors of fractures within this group of patients.
Objectives This study aims to investigate the predictors of fractures in patients with untreated early menopause.
Methods A cohort of patients attending for a DEXA scan in the North-West of England between June 2004 and July 2013 who were diagnosed with untreated early menopause was identified. These patients were divided into two groups: women with a history of post-menopausal fragility fracture and women with no history of fragility fracture. Characteristics of these two groups were compared using the chi squared test for categorical variables and stduents T test for continuous variables. Logistic models were used to describe the associations between known risk factors of fracture (FRAX risk factors and BMD, adjusting for the time from menopause).
Results A total of 2,171 females with untreated early menopause were included in the study. The mean age was 63.56 (±SD12.57). The mean age at menopause was 41.12 (±SD3.85) and the mean years from menopause was 22.44 (±SD12.54). Of those women, 1308 (60.25%) had no fractures and 863 (39.75%) had a fracture. The age at scan of patients with a fracture (66.79±11.50) was significantly different from the age of patients without a fracture (61.43±12.70), p-value 0.000. The mean years from menopause was significantly different in the fracture group (25.84±11.70) as compared to the group without fractures (20.19±12.58), p-value 0.000. The body mass index, age at menopause, history of smoking, rheumatoid arthritis as well as alcohol use were not significantly different between the two groups. The mean femoral neck BMD was significantly lower in females with fracture than those with no fracture: 0.79g/cm2 vs. 0.84g/cm3, respectively, p-value 0.000. The mean lumbar BMD was significantly lower in fracture patients as compared to patients without fractures: 0.97g/cm2 vs. 1.04g/cm2, respectively, p-value 0.000. Prevalence of steroid use was relatively higher in patients without fractures as compared to those with fractures: 22.63% and 17.61% respectively, p-value 0.005. Logistic regression analysis, adjusted for age at scan and years from menopause, revealed a significant association between having a fracture and steroid use OR0.70 (95% CI 0.55, 0.88) as well as between having a fracture and having lower BMD in the lumbar spine OR 0.24 (95% CI 0.13, 0.47).
Conclusions This study demonstrates that steroid use and low lumbar BMD, but not other FRAX predictors, are associated with fracture in patients with an early untreated menopause. These observations can guide measures on enhancing bone health in this patient group.
J. Al-Asiry et al. The effect on lumbar spine and femoral neck bone mineral density of untreated early menopause: a case-control study. Ann Rheum Dis 2011;70(Suppl3):232
Disclosure of Interest None declared