P043 The different roles of FRAX risk factors as predictors of fragility fractures in peri-menopausal vs post-menopausal patients: results from a large population-based cohort study
Authors: Song Kaiyang , Bukhari Marwan 
Published: April 2024

Background/Aims

The marked rise in the prevalence of fragility fractures affecting both women undergoing the transition to menopause (i.e. peri-menopause), and post-menopausal women, confers a significant burden on patients’ health and quality of life. The risk factors for fractures in post-menopausal women have been previously well-explored, and tend to align with the FRAX variables. However, there is less consensus regarding the fracture risk factors in peri-menopausal women. We compare the association between FRAX risk factors and fractures across peri-menopausal and post-menopausal women, selected from the same large population-based cohort.

Methods

Female patients referred for a DXA scan at the Royal Lancaster Infirmary between 2004-2011 provided information relating to any previous fragility fracture(s), FRAX risk factors, and menopause status (i.e. not post-menopausal vs post-menopausal) through a questionnaire. Patients aged 41 to 51 (median menopause age in UK) who had not undergone the menopause, as per their questionnaire response, were categorised as ‘peri-menopausal’. Logistic regression modelling, which included adjustment for potential confounders, was performed using r(version 4.3.1).

Results

Our study included 23388 patients, including 3785 peri-menopausal patients and 20774 post-menopausal patients, with a mean age of 47.5 (SD:3.0) and 66.1 (SD:10.4) respectively. The prevalence of fragility fractures was greater in the post-menopausal than peri-menopausal cohort (42.8% vs 25.5% respectively; p &lt; 0.001). Across post-menopausal patients, following adjustment for the other FRAX risk factors, significant predictors of increased fracture risk were age (odds ratio (OR): 1.04 (95% CI:1.03-1.04, p &lt; 0.001), smoking (OR:1.16 (CI:1.09-1.23, p &lt; 0.001), alcohol (OR:1.54, CI:1.36-1.74, p &lt; 0.001), and a family history of fracture(s) (OR:1.21 (CI:1.13-1.29, p &lt; 0.001). Comparatively, across peri-menopausal patients, only alcohol (OR:1.57, CI:1.08-2.26, p = 0.016) and smoking (OR:1.22 (CI:1.00-1.48, p = 0.045) positively predicted fracture risk. Corticosteroid use was associated with a reduced fracture risk across both post-menopausal (OR:0.84, CI:0.79-0.90, p &lt; 0.001) and peri-menopausal (OR:0.79, CI: 0.64-0.97, p = 0.024) cohorts.

Conclusion

Different FRAX risk factors predict fracture occurrence across post-menopausal and peri-menopausal patients; notably, only smoking and alcohol consumption predict an increased fracture risk in the latter group. Interestingly, corticosteroids were associated with a reduced risk of fractures across both groups. This finding may be elucidated by the fact that low-dose corticosteroids can exert an anti-inflammatory effect, and may protect bone cells. However, our finding is limited by the fact that the indication, dose and duration of corticosteroids were unknown. More generally, our study is limited by the fact that patients’ peri-menopausal status was not clinically confirmed, but inferred based on patients’ age and self-reported menopause status. Our results suggest that the FRAX risk factors, which were derived from analysis of predominantly 50-80 year old patients, may require adjustment for peri-menopausal patients (many of whom are aged &lt;50). Future studies should assess whether our conclusions apply to specific fracture sites, and are replicated across more demographically diverse patient populations.

Disclosure

K. Song: None. M. Bukhari: None.