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Early menopause may predict future health problems

Robin Wulffson MD's picture
early menopause, osteoporosis, fractures, mortality, hormone replacement, HRT

According to a new study, an early menopause may indicate an increased risk for osteoporosis, fractures, and earlier death. Researchers at Skåne University Hospital, Malmo, Sweden published their findings online on April 25 in BJOG: An International Journal of Obstetrics and Gynaecology. Menopause is a natural event that normally occurs between the ages of 45 and 55. It is the transition period in a woman's life when her ovaries stop producing ova (eggs), her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.

The researchers conducted a prospective study of 390 Caucasian north European women aged 48 years at the start of the study. The women were followed until age 82. At the beginning of the study period, bone mineral density (BMD) was measured by single-photon absorptiometry (SPA) in the distal (lower) forearm and the women’s menopausal status was noted. Menopause was defined according to the World Health Organization (WHO) criterion of a minimum of 12 months of continuous amenorrhea (absence of menses). The subjects were divided into two groups: early menopause (occurring before age 47 years) and late menopause (occurring at age 47 years or later). At age 77, their forearm BMD was re-measured by SPA; in addition, proximal (upper) femur (thigh bone) and lumbar (lower) spine BMD were measured by dual-energy X-ray absorptiometry (DXA). The DXA data was used to determine the prevalence of osteoporosis. Mortality rate and the fracture incidence were recorded up until age 82. Main outcome measures  Incidence of fragility fractures, mortality, prevalence of osteoporosis at age 77.

The researchers found that at follow-up, 15 of 27 (56%) women with early menopause and 52 of 171 (30%) women with late menopause had developed osteoporosis. Therefore, the relative risk (RR) for osteoporosis in the early menopause group was 1.83 (almost twice the risk as that for women in the late menopause group). Women with early menopause were also much more likely to have sustained at least one fragility fracture (RR: 1.68). The mortality rate in the early menopause group was 52.4%, compared with 35.2% in the late menopause group (RR: 1.59).

The authors concluded that menopause before age 47 is associated with increased mortality risk and increased risk of sustaining fragility fractures and of osteoporosis at age 77.

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Limitations of the study included the small sample size and high dropout rate from the bone mass evaluations. Only 51% of the women completed both bone mass assessments (at initial evaluation and at age 77. Because of the lack of repeat bone mass assessment, the BMD data are less reliable than the fracture and mortality data.

Take home message:
The increased mortality in the early menopause group is most likely related to osteoporosis and fractures. Women who suffer a hip fracture must undergo major surgery, which can result in complications including death. Mobility issues following a hip fracture can lead to depression and even suicide.

Poor life style choices such as smoking, excessive alcohol consumption, poor diet, and inadequate exercise increase the risk of an early menopause and osteoporosis. Ethnic variations exist in bone mass. For example, women of African descent have denser bones; thus, they can lose more bone before they are at a high fracture risk. Scandinavian and Asian women have finer bone structure; thus, they are at increased risk for osteoporosis. Of note, is the fact that the study was conducted in Sweden; thus, many of these women were likely to be Scandinavian and at increased risk for the development of osteoporosis.

Women who experience an early menopause and/or have fine bone structure should discuss hormone replacement therapy (HRT) or osteoporosis medication with their healthcare professional. HRT cannot increase bone strength; however, it can reduce bone loss. Conversely, osteoporosis medication can actually increase bone mass. As with most medications, side-effects and adverse effects can occur with either regimen.

BJOG: An International Journal of Obstetrics and Gynaecology.

See also:
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