Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women.

Objective: A prospective evaluation of the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis.

Design: Prospective population-based observational study.

Setting: Malmö, Sweden.

Population: A total of 390 white north European women aged 48 years at the start of the study.

Methods: At baseline, bone mineral density (BMD) was measured by single-photon absorptiometry (SPA) in the distal forearm and menopausal status was noted. Menopause was determined according to the World Health Organization criterion of a minimum of 12 months of continuous amenorrhoea. Women were divided into early menopause (occurring before age 47 years) and late menopause (occurring at age 47 years or later). At age 77, forearm BMD was re-measured by SPA and proximal femur and lumbar spine BMD were measured by dual-energy X-ray absorptiometry (DXA). The prevalence of osteoporosis was determined using the DXA data. Mortality rate and the incidence of fractures were registered up until age 82. Data are presented as means with 95% confidence intervals (95% CI).

Main Outcome Measures: Incidence of fragility fractures, mortality, prevalence of osteoporosis at age 77.

Results: Women with early menopause had a risk ratio of 1.83 (95% CI 1.22-2.74) for osteoporosis at age 77, a risk ratio of 1.68 (95% CI 1.05-2.57) for fragility fracture and a mortality risk of 1.59 (95% CI 1.04-2.36).

Conclusions: Menopause before age 47 is associated with increased mortality risk and increased risk of sustaining fragility fractures and of osteoporosis at age 77.