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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2021
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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. |
format | Online Article Text |
id | pubmed-7788464 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
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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