Abstract
It is well known that the adoption of preventive measures for osteoporosis may contribute to minimizing its impact as a result of bone fractures. However, there are well-recognized risk factors involved in the onset of osteoporosis that are not possible to modify. Better knowledge of these non-modifiable factors could aid prevention in subjects at high risk of fractures. The aim of this study was to evaluate the likely association between gynecological, reproductive and family history of hip fracture with the incidence of vertebral and nonvertebral osteoporotic fractures in women older than 50. We studied 255 women aged 50 and over, randomly selected from a Spanish population that had participated in a study of prevalence of vertebral fractures (EVOS study). This cohort was prospectively followed for 8 years by means of four postal questionnaires, in order to find out the incidence of nonvertebral fractures. Concerning the incidence of vertebral fractures, participants were invited to repeat the lumbar spine X-rays 4 years after the initial study. A total of 31 women had incident osteoporotic fractures. The analysis of gynecological variables showed that an increase in the age at menarche was a risk factor for all incident osteoporotic fractures [OR=1.57 (1.04–2.37)]. The presence of amenorrhea at any age during the fertile period was associated with higher incidence of all osteoporotic fractures [OR=6.30 (1.61–24.70]. Among all the reproductive variables analyzed (pregnancy, number of live births and breast-feeding) only pregnancy was an important protective factor in preventing incident Colles fracture [OR=0.15 (0.03–0.62)]. A family history of hip fracture was associated with a higher incidence of all osteoporotic fractures [OR=3.59 (1.01–12.79)]. In summary, a late age at menarche, the presence of amenorrhea and having close relatives with hip fracture were all risk factors which, independently of bone mineral density (BMD) and age, were associated with higher incidence of all osteoporotic fractures. Pregnancy was an important protective factor for the incidence of Colles fractures.
Similar content being viewed by others
References
Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S; discussion 17S–19S
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773
Cooper GS, Sandler DP (1997) Long-term effects of reproductive-age menstrual cycle patterns on peri- and postmenopausal fracture risk. Am J Epidemiol 145:804–809
Roy DK, O’Neill TW, Finn JD, Lunt M, Silman AJ, Felsenberg D, Armbrecht G, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Dequeker J, Diaz MN, Eastell R, Yershova OB, Felsch B, Gowin W, Havelka S, Hoszowski K, Ismail AA, Jajic I, Janott I, Johnell O, Kanis JA, Kragl G, Lopez Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Gennari C, Pols HA, Poor G, Raspe HH, Reid DM, Reisinger W, Scheidt-Nave C, Stepan JJ, Todd CJ, Weber K, Woolf AD, Reeve J (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26
Dunne F, Walters B, Marshall T, Heath DA (1993) Pregnancy associated osteoporosis. Clin Endocrinol (Oxf) 39:487–490
Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563
Michaelsson K, Baron JA, Farahmand BY, Ljunghall S (2001) Influence of parity and lactation on hip fracture risk. Am J Epidemiol 153:1166–1172
O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018
Naves M, Diaz-Lopez JB, Gomez C, Rodriguez-Rebollar A, Rodriguez-Garcia M, Cannata-Andia JB (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–524
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
O’Neill TW, Silman AJ, Naves Diaz M, Cooper C, Kanis J, Felsenberg D (1997) Influence of hormonal and reproductive factors on the risk of vertebral deformity in European women. European Vertebral Osteoporosis Study Group. Osteoporos Int 7:72–78
Warren MP, Brooks-Gunn J, Fox RP, Holderness CC, Hyle EP, Hamilton WG (2002) Osteopenia in exercise-associated amenorrhea using ballet dancers as a model: a longitudinal study. J Clin Endocrinol Metab 87:3162–3168
Paschalis EP, Boskey AL, Kassem M, Eriksen EF (2003) Effect of hormone replacement therapy on bone quality in early postmenopausal women. J Bone Miner Res 18:955–959
Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2:16–25
Hoffman S, Grisso JA, Kelsey JL, Gammon MD, O’Brien LA (1993) Parity, lactation and hip fracture. Osteoporos Int 3:171–176
Cumming RG, Nevitt MC, Cummings SR (1997) Epidemiology of hip fractures. Epidemiol Rev 19:244–257
Fox KM, Magaziner J, Sherwin R, Scott JC, Plato CC, Nevitt M, Cummings S (1993) Reproductive correlates of bone mass in elderly women. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 8:901–908
Mallmin H, Ljunghall S, Persson I, Bergstrom R (1994) Risk factors for fractures of the distal forearm: a population-based case-control study. Osteoporos Int 4:298–304
Sowers M (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060
Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci (Lond) 94:405–412
Cure-Cure C, Cure-Ramirez P, Teran E, Lopez-Jaramillo P (2002) Bone-mass peak in multiparity and reduced risk of bone-fractures in menopause. Int J Gynaecol Obstet 76:285–291
Carranza-Lira S, Mera JP (2002) Influence of number of pregnancies and total breast-feeding time on bone mineral density. Int J Fertil Womens Med 47:169–171
Cumming RG, Klineberg RJ (1993) Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 22:684–691
Fujiwara S, Kasagi F, Yamada M, Kodama K (1997) Risk factors for hip fracture in a Japanese cohort. J Bone Miner Res 12:998–1004
Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 32:78–85
Acknowledgments
This study has been partially supported by the European Vertebral Osteoporosis Study (EVOS), European Community (1991–1993); by the European Prospective Osteoporosis Study (EPOS), European Community; BIOMED 93–95, BMHI—CT 092–0182, (1993 −1997); by Fondo de Investigaciones Sanitarias (FIS 94/1901-E); and by Fundación Renal Iñigo Alvarez de Toledo (Spain). The authors wish to thank Iñigo Santamaria for his help in the preparation of the manuscript and Francesca Pieraccini as language consultant
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Naves, M., Díaz-López, J.B., Gómez, C. et al. Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50. Osteoporos Int 16, 2013–2017 (2005). https://doi.org/10.1007/s00198-005-1983-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-005-1983-4