1. Fracture Rates and Bone Density Among Postmenopausal Veteran and Non-Veteran Women From the Women’s Health Initiative
- Author
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LaFleur, Joanne, Rillamas-Sun, Eileen, Colón-Emeric, Cathleen S, Knippenberg, Kristin A, Ensrud, Kristine E, Gray, Shelly L, Cauley, Jane A, and LaCroix, Andrea Z
- Subjects
Biomedical and Clinical Sciences ,Health Services and Systems ,Public Health ,Clinical Sciences ,Health Sciences ,Reproductive Medicine ,Physical Injury - Accidents and Adverse Effects ,Clinical Research ,Aging ,Osteoporosis ,Musculoskeletal ,Absorptiometry ,Photon ,Aged ,Aged ,80 and over ,Alcohol Drinking ,Bone Density ,Case-Control Studies ,Cohort Studies ,Estrogen Replacement Therapy ,Female ,Fractures ,Bone ,Hip ,Humans ,Incidence ,Middle Aged ,Osteoporosis ,Postmenopausal ,Osteoporotic Fractures ,Postmenopause ,Proportional Hazards Models ,Prospective Studies ,Smoking ,Spine ,United States ,Veterans ,Cohort ,Fracture ,Postmenopausal osteoporosis ,Risk factors ,Gerontology - Abstract
Purpose of the studyPostmenopausal osteoporosis can impact quality-of-life even prefracture. To determine whether osteoporosis should be a greater concern in women Veterans versus non-Veterans, we compared fracture rates and bone mineral density (BMD) for Veterans and non-Veterans using Women's Health Initiative data.Design and methodsIn this cohort study, participants were women aged 50-79 years. Outcomes were hip, central body, and limb fractures occurring during up to 19 years of follow-up and hip, spine, and whole body BMD collected three times over a 6-year period in a participant subsample. Covariates comprised risk factors for fracture, including fall history and other components of the World Health Organization Fracture Risk Assessment Tool (FRAX). Cox Proportional Hazards models were used to examine fracture rates for Veterans compared with non-Veterans.ResultsOf 161,808 women, 145,521 self-identified as Veteran (n = 3,719) or non-Veteran (n = 141,802). Baseline FRAX scores showed that Veterans had higher 10-year probabilities for any major fracture (13.3 vs 10.2; p < .01) and hip fracture (4.1 vs 2.2; p < .01) compared with non-Veterans. The age-adjusted rate of hip fracture per 1,000 person-years for Veterans was 3.3 versus 2.4 for non-Veterans (p < .01). After adjustment, the hazards ratio for hip fracture was 1.24 (95% confidence interval 1.03-1.49) for Veterans versus non-Veterans. Hazards ratios at other anatomic sites did not differ by Veteran status. Mean BMD at baseline and at Years 3 and 6 also did not differ by Veteran status at any site.ImplicationsWomen Veterans had an increased hip fracture rate not explained by differences in well-recognized fracture risk factors.
- Published
- 2016