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Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea

IMPORTANCE: Although estrogen level is positively associated with bone mineral density, there are limited data on the risk of fractures after menopause. OBJECTIVE: To investigate whether female reproductive factors are associated with fractures among postmenopausal women. DESIGN, SETTING, AND PARTIC...

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Autores principales: Yoo, Jung Eun, Shin, Dong Wook, Han, Kyungdo, Kim, Dahye, Yoon, Ji Won, Lee, Dong-Yun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788464/
https://www.ncbi.nlm.nih.gov/pubmed/33404618
http://dx.doi.org/10.1001/jamanetworkopen.2020.30405
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author Yoo, Jung Eun
Shin, Dong Wook
Han, Kyungdo
Kim, Dahye
Yoon, Ji Won
Lee, Dong-Yun
author_facet Yoo, Jung Eun
Shin, Dong Wook
Han, Kyungdo
Kim, Dahye
Yoon, Ji Won
Lee, Dong-Yun
author_sort Yoo, Jung Eun
collection PubMed
description IMPORTANCE: Although estrogen level is positively associated with bone mineral density, there are limited data on the risk of fractures after menopause. OBJECTIVE: To investigate whether female reproductive factors are associated with fractures among postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used data from the Korean National Health Insurance Service database on 1 272 115 postmenopausal women without previous fracture who underwent both cardiovascular and breast and/or cervical cancer screening from January 1 to December 31, 2009. Outcome data were obtained through December 31, 2018. EXPOSURES: Information was obtained about reproductive factors (age at menarche, age at menopause, parity, breastfeeding, and exogenous hormone use) by self-administered questionnaire. MAIN OUTCOMES AND MEASURES: Incidence of any fractures and site-specific fractures (vertebral, hip, and others). RESULTS: Among the 1 272 115 participants, mean (SD) age was 61.0 (8.1) years. Compared with earlier age at menarche (≤12 years), later age at menarche (≥17 years) was associated with a higher risk of any fracture (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.17-1.31) and vertebral fracture (aHR, 1.42; 95% CI, 1.28-1.58). Compared with earlier age at menopause (<40 years), later age at menopause (≥55 years) was associated with a lower risk of any fracture (aHR, 0.89; 95% CI, 0.86-0.93), vertebral fracture (aHR, 0.77; 95% CI, 0.73-0.81), and hip fracture (aHR, 0.88; 95% CI, 0.78-1.00). Longer reproductive span (≥40 years) was associated with lower risk of fractures compared with shorter reproductive span (<30 years) (any fracture: aHR, 0.86; 95% CI, 0.84-0.88; vertebral fracture: aHR, 0.73; 95% CI, 0.71-0.76; and hip fracture: aHR, 0.87; 95% CI, 0.80-0.95). Parous women had a lower risk of any fracture than nulliparous women (aHR, 0.96; 95% CI, 0.92-0.99). Although breastfeeding for 12 months or longer was associated with a higher risk of any fractures (aHR, 1.05; 95% CI, 1.03-1.08) and vertebral fractures (aHR, 1.22; 95% CI, 1.17-1.27), it was associated with a lower risk of hip fracture (aHR, 0.84; 95% CI, 0.76-0.93). Hormone therapy for 5 years or longer was associated with lower risk of any factures (aHR, 0.85; 95% CI, 0.83-0.88), while use of oral contraceptives for 1 year or longer was associated with a higher risk of any fractures (aHR, 1.03; 95% CI, 1.01-1.05). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that female reproductive factors are independent risk factors for fracture, with a higher risk associated with shorter lifetime endogenous estrogen exposure. Interventions to reduce fracture risk may be needed for women at high risk, including those without osteoporosis.
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spelling pubmed-77884642021-01-15 Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea Yoo, Jung Eun Shin, Dong Wook Han, Kyungdo Kim, Dahye Yoon, Ji Won Lee, Dong-Yun JAMA Netw Open Original Investigation IMPORTANCE: Although estrogen level is positively associated with bone mineral density, there are limited data on the risk of fractures after menopause. OBJECTIVE: To investigate whether female reproductive factors are associated with fractures among postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used data from the Korean National Health Insurance Service database on 1 272 115 postmenopausal women without previous fracture who underwent both cardiovascular and breast and/or cervical cancer screening from January 1 to December 31, 2009. Outcome data were obtained through December 31, 2018. EXPOSURES: Information was obtained about reproductive factors (age at menarche, age at menopause, parity, breastfeeding, and exogenous hormone use) by self-administered questionnaire. MAIN OUTCOMES AND MEASURES: Incidence of any fractures and site-specific fractures (vertebral, hip, and others). RESULTS: Among the 1 272 115 participants, mean (SD) age was 61.0 (8.1) years. Compared with earlier age at menarche (≤12 years), later age at menarche (≥17 years) was associated with a higher risk of any fracture (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.17-1.31) and vertebral fracture (aHR, 1.42; 95% CI, 1.28-1.58). Compared with earlier age at menopause (<40 years), later age at menopause (≥55 years) was associated with a lower risk of any fracture (aHR, 0.89; 95% CI, 0.86-0.93), vertebral fracture (aHR, 0.77; 95% CI, 0.73-0.81), and hip fracture (aHR, 0.88; 95% CI, 0.78-1.00). Longer reproductive span (≥40 years) was associated with lower risk of fractures compared with shorter reproductive span (<30 years) (any fracture: aHR, 0.86; 95% CI, 0.84-0.88; vertebral fracture: aHR, 0.73; 95% CI, 0.71-0.76; and hip fracture: aHR, 0.87; 95% CI, 0.80-0.95). Parous women had a lower risk of any fracture than nulliparous women (aHR, 0.96; 95% CI, 0.92-0.99). Although breastfeeding for 12 months or longer was associated with a higher risk of any fractures (aHR, 1.05; 95% CI, 1.03-1.08) and vertebral fractures (aHR, 1.22; 95% CI, 1.17-1.27), it was associated with a lower risk of hip fracture (aHR, 0.84; 95% CI, 0.76-0.93). Hormone therapy for 5 years or longer was associated with lower risk of any factures (aHR, 0.85; 95% CI, 0.83-0.88), while use of oral contraceptives for 1 year or longer was associated with a higher risk of any fractures (aHR, 1.03; 95% CI, 1.01-1.05). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that female reproductive factors are independent risk factors for fracture, with a higher risk associated with shorter lifetime endogenous estrogen exposure. Interventions to reduce fracture risk may be needed for women at high risk, including those without osteoporosis. American Medical Association 2021-01-06 /pmc/articles/PMC7788464/ /pubmed/33404618 http://dx.doi.org/10.1001/jamanetworkopen.2020.30405 Text en Copyright 2021 Yoo JE et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Yoo, Jung Eun
Shin, Dong Wook
Han, Kyungdo
Kim, Dahye
Yoon, Ji Won
Lee, Dong-Yun
Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title_full Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title_fullStr Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title_full_unstemmed Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title_short Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea
title_sort association of female reproductive factors with incidence of fracture among postmenopausal women in korea
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788464/
https://www.ncbi.nlm.nih.gov/pubmed/33404618
http://dx.doi.org/10.1001/jamanetworkopen.2020.30405
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