P-676 Bone health in Australian women with early menopause: a 23-year longitudinal analysis
Authors: Jones A , Ebeling P , Mishra G , Teede H , Entiocott J , Vincent A 
Published: June 2023

Abstract

Study question
What is the frequency of osteoporosis, fractures, and osteoporosis management in women with early menopause (menopause &lt;45years; EM)? What factors influence osteoporosis, screening, and treatment?

Summary answer
Osteoporosis risk is 80% higher in women with early versus natural age menopause. Despite higher screening and treatment, gaps persist in managing EM bone health.

What is known already
A treatment gap in osteoporosis care exists, with low diagnosis (using dual X-ray absorptiometry, DXA), and primary or secondary fracture prevention. Women with EM have increased rates of osteoporosis. Clinical guidelines recommend screening with DXA and menopause hormone therapy (MHT) for most women with EM to reduce osteoporosis and fracture risk. However, studies suggest osteoporosis knowledge, guideline uptake and management adherence by clinicians and women is limited.

Study design, size, duration
The Australian Longitudinal Study on Women’s Health is a prospective longitudinal study of Australian women. This study uses the cohort of women born between 1946 – 1951, surveyed nine times between 1996 – 2019. Data from Australian administrative health records including the Pharmaceutical Benefits Scheme (PBS) (MHT, Bone specific agents; BSA) and Medicare benefits schedule (DXA) was linked to survey data.

Participants/materials, setting, methods
Respondents with self-reported age of menopause were included. EM defined as above. T-test/chi-square used for comparisons at baseline (p &lt; 0.05 indicates significance). Generalised estimating equations (GEE) for panel data explored longitudinal outcomes of osteoporosis, fractures, DXA rates, MHT use and BSA (in women with osteoporosis/fracture). Univariable regression was performed, and variables retained where p &lt; 0.2, to form the multivariable model, and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robustness of results.

Main results and the role of chance
8,603 women were included: 610 (7.1%) with EM. Mean (SD) baseline age was 47.6 (1.45) years in the entire cohort, and mean (SD) age of menopause was 38.2 (7.95) and 51.3 (3.04) years in women with EM and natural age menopause, respectively (P &lt; 0.001). Overall, 421 (69.0%) women with EM had DXA screening, 305 (50%) had a fracture/osteoporosis, 474 ever used MHT (77.7%) and 142 (46.6%) used BSA.
Using the multivariable model, women with EM had increased risk of osteoporosis (Odds Ratio (OR) 1.80; 95%CI 1.43,2.26), fractures (OR 1.48; 1.18,1.85), MHT use (OR 6.98; 5.78,8.43) and BSA use (OR 1.69; 1.24,2.32). In EM women, increasing age was associated with greater risk of osteoporosis / fracture (OR 1.09; 1.08,1.11), and MHT use did not significantly reduce this risk (OR 0.78; 0.55,1.11). In EM women, age (OR 1.32; 1.12,1.15), BMI (OR 0.94; 0.91,0.96), current smoking (OR 0.51; 0.35,0.74) and inner (OR 0.69; 0.52,0.91) or outer regional (OR 0.66; 0.46,0.95) residential location were associated with DXA screening. In EM women, increasing age (OR 1.15; 1.13,1.18) and lower BMI (OR 0.91; 0.86,0.95) were associated with BSA use.

Limitations, reasons for caution
Survey data were self-reported by participants, and fracture questions were not included in the 2001 survey. PBS data was only available from 2004, and hospital admissions data for all of Australia was only available from 2007.

Wider implications of the findings
Osteoporosis and fractures affect a significant number of women with EM. Focus must be made on improving screening and treatment of these women.

Trial registration number
N/A