Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture

Jerilynn C Prior; Christine L Hitchcock; Y M Vigna; Seifert-Klauss V

doi:10.1055/s-0042-103751

Bone Health · Bone Mineral Density

Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture

Prior JC, Hitchcock CL, Vigna YM, Seifert-Klauss V

Published August 2016 Geburtshilfe Frauenheilkd, 76(8), 895-901

DOI 10.1055/s-0042-103751 PMID 27582584 PMC PMC5000784

Abstract

Introduction

Although a fragility fracture family history (FFFH+) has repeatedly been shown to be associated with lower bone mineral density (BMD), its relationship to human BMD change is unclear. Animal research, however, documented that different purebred strains within rodent species have wide ranges in rates of bone acquisition during growth as well as in change post-ovariectomy. Our objective was to compare the rate of premenopausal spinal trabecular BMD change between women with and without a general family history of fragility fracture.

Participants and Methods

Healthy premenopausal community women participated in prospective observational studies at two academic medical research centres: Vancouver, Canada (n = 66) and Munich, Germany (n = 20). The primary outcome was annual spinal BMD change, measured by quantitative computed tomography (QCT). The two studies employed similar methodologies for assessing QCT and FFFH.

Results

Volunteer community participants had a mean age of 36.0 (SD, 6.9) years, body mass index 22.5 (2.4) and baseline QCT of 150.2 (22.5) mg/cm3 trabecular bone. The rates of BMD change were similar in both cities: - 3.5 (5.1)/year Vancouver, - 2.0 (3.4)/year Munich (95 % CI of difference: - 3.9, 0.9). Over a third of the women (31 of the 86, 36 %) reported FFFH+. Those with and without a FFFH were similar in demographics, nutrition, exercise, menstrual cycle and luteal phase lengths and physiological measures (serum calcium, osteocalcin and estradiol). However, women with FFFH+ lost trabecular BMD more rapidly: FFFH+, - 4.9 (5.0), FFFH-, - 2.2 (4.4) mg/cm3/year (95 % CI diff - 0.7 to - 4.8, F1.83 = 7.88, p = 0.006). FFFH+ explained 7.7 % of the variance in QCT volumetric trabecular spinal bone change/year in these healthy premenopausal women.

Conclusion

This study shows for the first time that having a history of a fragility fracture in a family member is associated with a greater rate of premenopausal spinal trabecular bone loss.

Topics

Bone Health Bone Mineral Density Measurement

By this author

Luteal Phase · Luteal Phase Deficiency

The influence of the menstrual cycle on muscle injuries - a systematic review and meta-analysis

Guthardt Y et al., 2026 Sci Rep Free full text on PubMed Central

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Breast Health · Benign Breast Conditions

MON-154 Breast areolar diameter in healthy menstruating women—a single cycle cross-sectional study of associations with body size and ovulatory characteristics

Baaske AV et al., 2025 Journal of the Endocrine Society Free full text on PubMed Central

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Breast Health · Benign Breast Conditions

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Wood M et al., 2025 Journal of the Endocrine Society Free full text on PubMed Central

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Hormonal Agents · Progesterone and Progestins

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Nelson K et al., 2025 J Endocr Soc Free full text on PubMed Central

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Bone Mineral Density · Measurement

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Bone Mineral Density · Measurement

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Bone Mineral Density · Measurement

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Shieh A et al., 2021 The Journal of clinical endocrinology and metabolism Free full text on PubMed Central

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Fracture Risk · Risk Factors

A family history of fracture and fracture risk: a meta-analysis

Kanis JA et al., 2004 Bone

The aims of the present study were to determine whether a parental history of any fracture or hip fracture specifically are significant risk factors for future fracture in an international setting, and to explore the effects of age, sex and bone mineral density (BMD) on this risk. We studied 34,928 men and women from seven prospectively studied cohorts followed for 134,374 person-years. The cohorts comprised the EPOS/EVOS study, CaMos, the Rotterdam Study, DOES and cohorts at Sheffield, Rochester and Gothenburg. The effect of family history of osteoporotic fracture or of hip fracture in first-degree relatives, BMD and age on all clinical fracture, osteoporotic fracture and hip fracture risk alone was examined using Poisson regression in each cohort and for each sex. The results of the different studies were merged from the weighted beta coefficients. A parental history of fracture was associated with a modest but significantly increased risk of any fracture, osteoporotic fracture and hip fracture in men and women combined. The risk ratio (RR) for any fracture was 1.17 (95% CI=1.07-1.28), for any osteoporotic fracture was 1.18 (95% CI=1.06-1.31), and for hip fracture was 1.49 (95% CI=1.17-1.89). The risk ratio was higher at younger ages but not significantly so. No significant difference in risk was seen between men and women with a parental history for any fracture (RR=1.17 and 1.17, respectively) or for an osteoporotic fracture (RR=1.17 and 1.18, respectively). For hip fracture, the risk ratios were somewhat higher, but not significantly higher, in men than in women (RR=2.02 and 1.38, respectively). A family history of hip fracture in parents was associated with a significant risk both of all osteoporotic fracture (RR 1.54; 95CI=1.25-1.88) and of hip fracture (RR=2.27; 95% CI=1.47-3.49). The risk was not significantly changed when BMD was added to the model. We conclude that a parental history of fracture (particularly a family history of hip fracture) confers an increased risk of fracture that is independent of BMD. Its identification on an international basis supports the use of this risk factor in case-finding strategies.

Bone Health › Bone Mineral Density › Measurement

Jerilynn C Prior, Christine L Hitchcock

J Prior, Chris Hitchcock, C Hitchcock

PMID 27582584 27582584 DOI 10.1055/s-0042-103751 10.1055/s-0042-103751 Prior et al. 2016, Prior 2016

Cite this article

Prior, J. C., Hitchcock, C. L., Vigna, Y. M., & Seifert-Klauss, V. (2016). Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture. Geburtshilfe Frauenheilkd, 76(8), 895-901. https://doi.org/10.1055/s-0042-103751