Hot Flushes Not Associated With Osteoporotic Fracture in Elderly Women

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NEW YORK (Reuters Health) Apr 10 - Among women who are at least 5 years post-menopausal, the severity of hot flushes is not associated with progressive bone loss or risk of fracture, according to a report in the April issue of Obstetrics & Gynecology.

Therefore, "clinical assessment of vasomotor symptoms should not be used to identify older postmenopausal women at high risk for osteoporotic fracture," advise Dr. Alison Huang of the San Francisco Veterans Affairs Medical Center and her colleagues.

Previous research in this area pointed to a relationship between vasomotor symptoms and bone loss during menopause, the investigators explain. However, they add, the studies were small and failed to include women in the age range in which osteoporosis is most likely to cause fractures.

Dr. Huang and her team evaluated the relationship between hot flushes, bone mineral density, and incident fractures among 3167 women, mean age 68. They were all diagnosed with osteoporosis, and 96% were at least 5 years postmenopausal. Approximately 2% of subjects reported severe hot flushes, 10% reported moderate hot flushes, and 88% reported minimal hot flushes at baseline.

After adjusting for multiple confounders, subjects with high or moderate severity of hot flushes had higher bone mineral density at the femoral neck and lumbar spine compared against those with low severity of hot flushes (p = 0.008 for trend). Greater severity of this vasomotor symptom was also associated with fewer prevalent vertebral or nonvertebral fractures that had occurred after age 45 (p = 0.002 and 0.035, respectively).

At the 3-year follow-up, baseline hot flush severity was not related to change in bone mineral density or incident vertebral or nonvertebral fractures, the authors note.

These findings are opposite of what has been reported in the medical literature, Dr. Huang and associates note. They suggest the possibility that "higher health status and physical activity" may account for the higher bone mineral density among women who report severe hot flushes.

Obstet Gynecol 2007;109:841-847.