Early menopause linked to higher risk of osteoporosis, fracture and mortality

The Swedish study looked at the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis.

In 1977, 390 white north European women aged 48 were recruited in the Malmo Perimenopausal Study, an observational study where women were followed from age 48 onwards.

The women were divided into two categories; women who started the menopause before 47 and women who started the menopause at age 47 or later.

The women's bone mineral density (BMD) was measured. At the age of 77, all eligible women were re-measured for BMD. At this point, 298 women were still alive while 92 had died. One hundred out of the 298 women still alive had relocated or declined further participation, leaving 198 women to attend the follow-up measurement.

The study found that at the age of 77, 56% of women with early menopause had osteoporosis, in comparison with 30% of women with late menopause.

Women who started the menopause early were also found to have a higher risk of fragility fracture and of mortality. The mortality rate was 52.4% in the early menopause group compared to 35.2% in the late menopause group. The fracture incidence rate was 44.3% in the early menopause group compared to 30.7% in the late menopause group.

Ola Svejme, orthopaedic surgeon at the Skåne University Hospital, Malmo, Sweden and main author of the paper said:

"The results of this study suggest that early menopause is a significant risk factor for osteoporosis, fragility fracture and mortality in a long-term perspective. To our knowledge, this is the first prospective study with a follow-up period of more than three decades."

BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:

"The study's strength is the length of time the women were observed.

"The higher mortality rate in women with an early menopause needs to be explored further as many other factors could affect this such as medication, nutrition, smoking and alcohol consumption."

More information: Svejme O, Ahlborg H, Nilsson J, Karlsson M. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03324.x

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