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Fractures Between the Ages of 20 and 50 Years Increase Women's Risk of Subsequent Fractures
Fiona Wu, FRACP;
Barbara Mason, BSc;
Anne Horne, MBChB;
Ruth Ames, NZCS;
Judith Clearwater, BSc;
Michael Liu, MBChB;
Margaret C. Evans, BSc;
Gregory D. Gamble, MSc;
Ian R. Reid, MD
Arch Intern Med. 2002;162:33-36.
Background Perimenopausal and postmenopausal fractures are well-recognized, strong,
independent predictors of subsequent fractures. However, it is unknown whether
premenopausal fractures are predictive of postmenopausal fractures.
Objective To determine whether self-reported fractures sustained before the age
of 50 years are associated with fractures after this age.
Subjects and Methods Cross-sectional study of 1284 women (mean ± SD age, 73 ±
4 years) who were 10 or more years' postmenopausal and who were recruited
from electoral rolls in Auckland, New Zealand. Detailed information on their
fracture, medical, menstrual, alcohol, and smoking histories was obtained
using a standardized questionnaire.
Results Nine percent of the women reported fractures before the age of 20 years;
7%, between the ages of 20 and 50 years; and 29%,after the age of 50 years.
Fractures sustained between the ages of 20 and 50 years were associated with
a 74% increase in the risk of fractures after the age of 50 years (odds ratio,
1.74; 95% confidence interval, 1.12-2.70), while fractures occurring before
the age of 20 years were not (odds ratio, 1.01; confidence interval, 0.66-1.56).
Multivariate analysis showed that after bone density, age, maternal history
of hip fractures, age at menopause, weight, history of hormone replacement
therapy, and smoking and alcohol histories were adjusted for, a history of
fractures between the ages of 20 and 50 years remained a significant independent
predictor of risk of fractures after the age of 50 years (risk ratio, 1.83;
confidence interval, 1.12-2.76).
Conclusions Any fracture (unrelated to motor vehicle accidents) sustained between
the ages of 20 and 50 years is associated with increased risk of fractures
after the age of 50 years. Therefore, this is an important clinical risk factor
that points to the need for bone density measurement, consideration of lifestyle
modification, and antiosteoporosis therapies in these women.
From the Department of Medicine, University of Auckland, Auckland,
New Zealand.
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