The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies

Panagiotis Anagnostis; Konstantinos Lallas; Anna Pappa; Georgios Avgeris; Kristina Beta; Dimitrios Damakis; Eirini Fountoukidou; Maria Zidrou; Irene Lambrinoudaki; Dimitrios G Goulis

doi:10.1007/s00198-024-07075-8

The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies

Osteoporos Int. 2024 Apr 2. doi: 10.1007/s00198-024-07075-8. Online ahead of print.

Affiliations

¹ 1st Department of Obstetrics and Gynecology, Medical School, Unit of Reproductive Endocrinology, Aristotle University of Thessaloniki, Thessaloniki, Greece. pan.anagnostis@gmail.com.
² Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ 1st Department of Obstetrics and Gynecology, Medical School, Unit of Reproductive Endocrinology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 38563960
DOI: 10.1007/s00198-024-07075-8

Abstract

Background/aims: Vasomotor symptoms (VMS) adversely affect postmenopausal quality of life. However, their association with bone health has not been elucidated. This study aimed to systematically review and meta-analyze the evidence regarding the association of VMS with fracture risk and bone mineral density (BMD) in peri- and postmenopausal women.

Methods: A literature search was conducted in PubMed, Scopus and Cochrane databases until 31 August 2023. Fracture, low BMD (osteoporosis/osteopenia) and mean change in lumbar spine (LS) and femoral neck (FN) BMD were assessed. The results are presented as odds ratio (OR) and mean difference (MD), respectively, with a 95% confidence interval (95% CI). The I² index quantified heterogeneity.

Results: Twenty studies were included in the qualitative and 12 in the quantitative analysis (n=49,659). No difference in fractures between women with and without VMS was found (n=5, OR 1.04, 95% CI 0.93-1.16, I² 16%). However, VMS were associated with low BMD (n=5, OR 1.54, 95% CI 1.42-1.67, I² 0%). This difference was evident for LS (MD -0.019 g/cm², 95% CI -0.03 to -0.008, I² 85.2%), but not for FN BMD (MD -0.010 g/cm², 95% CI -0.021 to 0.001, I² 78.2%). These results were independent of VMS severity, age and study design. When the analysis was confined to studies that excluded menopausal hormone therapy use, the association with BMD remained significant.

Conclusions: The presence of VMS is associated with low BMD in postmenopausal women, although it does not seem to increase fracture risk.

Keywords: Fractures; Night sweats; Osteoporosis; Postmenopausal women; Vasomotor symptoms; hot flushes.

Publication types

Review