In the U.S. 47 million women are of menopausal age, 19 million experience vasomotor symptoms, 9 million of whom experience moderate-to-severe symptoms. Vasomotor symptoms or VMS i.e., hot flashes and/or night sweats, are common in women during the menopause transition
A few studies have examined the association between VMS and bone mineral density that were either brief or focused on premenopausal in fertile women. A 30 month study did suggest bone mineral density in the spine is lower among women with VMS.
In this new study Dr. Jean Wactawski-Wende, PhD, epidemiologist, interim dean of the University at Buffalo School of Public Health and Health Professions and co-author of this study along with colleagues examined associations of baseline VMS with fracture incidence and bone mineral density.
For the current study researcher’s data from participants from the Women’s Health Initiative (WHI) initiated by the U.S. National Institutes of Health (NIH) in 1991 to address major health issues causing morbidity and mortality in postmenopausal women. Of the 68,132 women enrolled onto from the WHI-CT, they excluded data from 588 participants who lacked data regarding the severity of VMS, Data from 35,217 participants who reported current or prior hormone therapy (HT) use were excluded because HT can influence fracture risk and 13,816 who were randomly assigned to receive HT (conjugated equine estrogens alone or conjugated equine estrogens + medroxyprogesterone acetate),were excluded.
Therefore, the sample sized study was 23,573 clinical trial participants, aged 50 to 79, who were not then using menopausal hormone therapy nor assigned to use it during the trial. They conducted baseline and follow-up bone density examinations in 4,867 of these women.
Participants answered questionnaires at baseline regarding age, race/ethnicity, education, amily income, age at menopause, hysterectomy, oophorectomy, smoking, alcohol consumption, physical activity, previous fracture, sleep disturbance, incident falls, and medication use.
After adjusting for age, body mass index and demographic factors, the results showed women who had reported moderate to severe hot flashes at time of enrollment showed a significant reduction in the bone mineral density in the femoral neck region and lumber spine. Women with moderate to severe VMS at base line had almost double the risk for a hip fracture in the future.
Dr. Wactawski-Wende said “We knew that during menopause, about 60 percent of women experience vasomotor symptoms (VMS), such as hot flashes and night sweats. They are among the most bothersome symptoms of menopause and can last for many years.
“It also was known that osteoporosis, a condition in which bones become structurally weak and more likely to break, afflicts 30 percent of all postmenopausal women in the United States and Europe, and that at least 40 percent of that group will sustain one or more fragility fractures in their remaining lifetime,” she says.
What we did not know,” says Dr. Wactawski-Wende, “was whether VMS are associated with reductions in bone mineral density or increased fracture incidence.
Women who experience vasomotor menopausal symptoms will lose bone density at a faster rate and nearly double their risk of hip fracture,” she says, “and the serious public health risk this poses is underscored by previous research that found an initial fracture poses an 86 percent risk for a second new fracture.”
In closing Dr. Wactawski-Wende commented “Clearly more research is needed to understand the relationship between menopausal symptoms and bone health. In the meantime, women at risk of fracture may want to engage in behaviors that protect their bones including increasing their physical activity and ensuring they have adequate intakes of calcium and vitamin D.”
