Lifestyle factors associated with osteoporosis and fracture among postmenopausal women
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Researchers found that osteoporosis and fracture were associated with certain lifestyle factors among postmenopausal women, although no factors correlated with an increase in both osteoporosis and fracture.
The findings were published in Menopause.
The researchers selected 4,427 postmenopausal women in Japan without a history of osteoporosis or fracture at baseline who were enrolled in the Kyushu University Fukuoka Cohort Study on lifestyle-related diseases between February 2004 and August 2007. The women were followed up between February 2010 and December 2012.
The study looked at numerous lifestyle factors, including BMI, smoking and drinking status, sleep regularity, sleep sufficiency and breakfast habits, as well as time and frequency spent in three types of work-related activities and three types of leisure activities.
The researchers also assessed the women’s personalities using a brief inventory of eight items. Participants additionally rated their subjective health status and life satisfaction. The researchers conducted venous blood sampling to measure HbA1c, high-sensitivity C-reactive protein, and eight items of serum biochemistry.
The participants had a mean age of 61.8 years and a mean duration after menopause of 11.7 years. They were categorized into four groups: no osteoporosis or fracture; osteoporosis present but no fracture; fracture present but no osteoporosis; and both osteoporosis and fracture.
The researchers found numerous associations between certain factors and osteoporosis or fracture. Among them, skipping breakfast was negatively associated with osteoporosis without fracture (OR = 0.4; P = .009) but positively associated with fracture without osteoporosis (OR = 2.3; P = 0009). Additionally, HbA1c levels were negatively associated with osteoporosis without fracture (OR = 0.81; P = .0003) but positively associated with fracture without osteoporosis (OR = 1.18; P = .03).
“Parental history of fracture and extraversion personality trait were both associated with fracture without osteoporosis,” the researchers said.
Participants with poor sleep tended to experience fractures as well. The study also showed significant associations between fracture and total cholesterol and parental history of fracture, but the researchers noted that there is a need to assess the risk of these factors after carefully considering possible confounders.
Additional limitations include the study’s use of self-reporting and its potential for recall bias. There also was a lack of information about when osteoporosis and fracture were detected as well as what caused the fracture.
Finally, the researchers also were concerned about representation among the participants and with the study’s relatively short follow-up duration.
However, the researchers maintained that these associations between osteoporosis, fractures and lifestyle factors underscore why it is important for postmenopausal women to routinely connect with their doctors, maintain a regular lifestyle and avoid strenuous activities beyond their capacity to avoid fractures.
Perspective
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Stephanie S. Faubion, MD, MBA, FACP, NCMP, IF
In this cohort study, Otonari and colleagues investigated the association of osteoporosis and incidence of fracture with lifestyle factors to potentially better inform recommendations for preventive strategies. The population studied included 4,427 postmenopausal women in Japan and assessed self-reported osteoporosis and fracture over a 3-year period.
The researchers found that osteoporosis without fracture was linked with low BMI, worse self-reported health status and more frequent intake of breakfast, whereas fracture without osteoporosis was associated with fracture in a parent, being extroverted and having a diet rich in seafood. None of the studied factors were tied to both osteoporosis and fracture.
The findings are interesting and may be influenced by factors not studied, such as the women’s propensity to take care of their health and to see their primary care providers and thus to be screened for osteoporosis. The association between fracture and extroverted personality is novel and may be related to these women being more likely to take risks.
However, these results should be interpreted with caution for a number of reasons.
The diagnosis of osteoporosis, incidence of fracture and lifestyle habits were all self-reported. Studies have been mixed in terms of consistency between self-reported and objectively diagnosed osteoporosis.
Also, there was a lack of information regarding the timing of diagnosis of osteoporosis and fracture as well as the cause of the fracture, making interpretation of the results challenging.
The study duration was only 3 years, potentially limiting the ability to make conclusions about the influence of lifestyle factors on fracture incidence.
Further, the women who elected to participate in the study may have been more interested in their health at baseline or may have become more health conscious because of participation in the study such that they changed their health habits and may therefore not be representative of the general Japanese population. Similarly, the results may not be generalizable to non-Asian women.
Osteoporotic fractures are associated with substantial physical, emotional and financial burdens. Fractures resulting from osteoporosis are linked with excess morbidity and mortality as well as reduced quality of life. The number of osteoporotic fractures and associated health care expenditures are increasing with the aging population and account for more hospitalizations in women than myocardial infarction, stroke or breast cancer individually. Unfortunately, osteoporosis is most commonly identified when a fragility fracture occurs.
This study highlights the importance of shifting the focus to prevention and the lifestyle strategies that can potentially mitigate fracture risk. Women and the clinicians who care for them should be considering lifestyle factors that could reduce fracture risk well before menopause. Indeed, prevention of osteoporosis should ideally begin in childhood, but it is never too late to work on improving bone health.
In addition to appropriate screening for osteoporosis, avoidance of tobacco and limiting alcohol use, maintaining adequate calcium and vitamin D intake and a regular weight-bearing exercise program, and fall prevention are all important.
These healthy lifestyle recommendations are low tech, low cost and relatively easy to implement and will certainly benefit women in a multitude of ways, particularly if one considers the goal to be extending the health span and maximizing quality of life for women as they age.
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