TOPLINE:

Among women with natural menopause, the risk for osteoporosis was elevated in those with a history of infertility, recurrent miscarriages, stillbirth, or low parity. Age at menopause had minimal or no influence on these associations.

METHODOLOGY:

• Osteoporosis affects more than one fourth of postmenopausal women; therefore, understanding the risk factors for osteoporosis specific to women may benefit them as well as their clinicians.
• Researchers pooled data from 141,222 women with natural menopause (median age, 59 years) from five retrospective and prospective cohorts to analyze whether infertility, miscarriage, stillbirth, and low parity were associated with an increased risk for osteoporosis; follow-up continued up to a median age of 72 years.
• They collected data on infertility, miscarriage, stillbirth, parity, and menopause status through surveys. Osteoporosis was identified through survey responses, hospital records, primary care data, death registry data, or pharmaceutical data.

TAKEAWAY:

• The risk for osteoporosis was 16% higher in women with a history of infertility vs those without (adjusted hazard ratio [aHR], 1.16; 95% CI, 1.13-1.19) and 14% higher in women with a history of stillbirth vs those without (aHR, 1.14; 95% CI, 1.10-1.17).
• A history of miscarriage was also associated with an elevated risk for osteoporosis (aHR, 1.06; 95% CI, 1.04-1.08), with the risk being further elevated in women with a history of recurrent miscarriages (aHR for at least three miscarriages, 1.17; 95% CI, 1.05-1.30).
• Compared with women who had two live births, those who had no live births and those who had one live birth had a 20% and 15% higher risk for osteoporosis, respectively (aHR, 1.20; 95% CI, 1.15-1.25 and aHR, 1.15; 95% CI, 1.14-1.16, respectively).
• The associations remained largely unchanged when adjusted for the age of the women at natural menopause.

IN PRACTICE:

"In clinical practice, health care providers should be aware of the potentially increased risk of osteoporosis among women with these reproductive experiences. This information might inform earlier detection and prevention strategies," the authors noted.

SOURCE:

This study was led by Chen Liang, PhD, School of Public Health, the University of Queensland in Brisbane, Australia. It was published online in Fertility and Sterility.

LIMITATIONS: 

The data on various fertility-related factors were self-reported by the women, which may have introduced recall bias. The underlying causes of fertility issues were not consistently captured across the pooled dataset. Information on the use of hormone replacement therapy was missing. 

DISCLOSURES:

This study received support from the Australian Government Department of Health and Aged Care. One author reported receiving funding from the National Institutes of Health. Another author received support from the National Health and Medical Research Council, served as co-president of the World Congress on Endometriosis, and held other ties with several sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.