Osteoporosis could prove deadly in postmenopausal women, suggests study

Osteoporosis, which is highly prevalent in postmenopausal women, has long been associated with an increased risk of fractures. A new study suggests it may also increase a woman’s overall risk of death-by as much as 47%-especially within specific ranges of bone mineral density (0.46-0.71 g/cm2 for total femur bone mineral density). Results of the study are published online today in Menopause, the journal of The Menopause Society.

As the total population ages, the incidence of osteoporosis also increases. In 2022, the global prevalence of osteoporosis was 19.7%, with women exhibiting a significantly higher prevalence than men (23.1%). One study projected that by 2030 the number of people affected by osteoporosis worldwide will reach 263 million, with 154 million of them being women. Previous research has documented that postmenopausal women experience a significantly higher mortality rate within 1 year after hip or vertebral fractures.

The decline of estrogen levels during the menopause transition has been linked to a number of physiologic changes across multiple systems, including bone metabolism, cardiovascular function, muscle mass, and fat distribution. Regarding bone health, declining estrogen levels accelerate bone resorption and inhibit bone formation, leading to a rapid decrease in bone mineral density (especially in the femoral region), which in turn increases the risk of osteoporosis and fractures.

Most research to date has focused on the association between low bone mineral density and adverse outcomes, such as falls and fractures. However, there is a lack of systematic studies examining whether increasing bone density in postmenopausal women can reduce the risk of death. In this new study involving nearly 3,000 postmenopausal women, bone mineral density at four femoral sites was assessed using dual-energy x-ray absorptiometry.

The analysis revealed that mortality risk was significantly elevated when femoral bone mineral density reached the osteoporotic threshold or in the presence of osteoporotic fractures. After full adjustment, osteoporosis was associated with a 47% increased risk of mortality. A stronger inverse association between increased bone mineral density and mortality risk was observed within specific ranges, suggesting that bone mineral density should serve as a prognostic biomarker of systemic health.

Study results are published in the article “Femoral bone mineral density and mortality risk in postmenopausal women: a National Health and Nutrition Examination Survey cohort study.”

“Osteoporosis often remains a silent threat after menopause, despite its profound effect on women’s lives-from loss of height, poor balance, and reduced mobility to disfigurement, pain, and even premature death. Early screening and preventive measures, including a calcium-rich diet (preferably from food sources), regular weight-bearing exercise, and hormone therapy when appropriate, can significantly improve bone health and reduce risks not only of fractures but also cardiovascular disease, certain cancers, and dementia. It’s time we bring this conversation to the forefront,” says Dr. Monica Christmas, associate medical director for The Menopause Society.

Reference:

Zheng Zhang, Peng Gu, ,Yanqing Jia, Femoral bone mineral density and mortality risk in postmenopausal women: a National Health and Nutrition Examination Survey cohort study, Menopause, DOI:10.1097/GME.0000000000000002787