Early menopause increases risk of fractures, despite calcium, vitamin D, or hormone therapy

Women with a younger age at menopause—less than 40 years—have a higher risk of fracture compared with those who experience menopause at an older age, despite treatment with calcium or vitamin D supplementation, hormone therapy (HT), or any combination of these, according to results from a new analysis of data from the Women’s Health Initiative (WHI) study, published online in the journal Menopause.

Previously, data from the WHI showed that early menopause confers an increased fracture risk in women experiencing early menopause, but these researchers conducted this recent analysis of WHI data to evaluate the efficacy of calcium, vitamin D, and/or HT in mitigating this higher fracture risk in these women.

They included 21,711 healthy postmenopausal women enrolled in the WHI trial with a reported age of nonsurgical menopause of less than 40 years, 40 to 49 years, and 50 years or older, who were treated with HT, calcium or vitamin D supplements, or HT and a combination of these supplements.

Women who experienced menopause before the age of 40 years had a significantly higher hazard ratio for fracture compared with women who experienced it between 40 and 49 years of age (HR: 1.30; 95% CI: 1.06-1.60), and those who experienced it at 50 years or older (HR: 1.36; 95% CI: 1.11-1.67), regardless of treatment interventions.

"This study highlights the need for healthcare providers to take into consideration a woman's age at menopause onset when evaluating patients for fracture risk," said JoAnn Pinkerton, MD, NCMP, executive director of the North American Menopause Society.

These results also highlight the possibility that some women may be candidates for HT at an earlier age.

"Women at risk for bone loss need 1,200 mg of calcium per day, with adequate vitamin D, and encouraged to get as much as possible through diet due to concern that too much supplemental calcium may increase atherosclerotic plaque in women. Women with early menopause should discuss whether they are candidates for hormone therapy with their providers, appropriate amount of calcium, vitamin D, and hormones," she concluded.