Abstract：
Early menopause (EM, age at menopause < 45 years) and premature ovarian insufficiency (POI, age at menopause < 40 years) are associated with an increased risk of osteoporosis. However, their association with increased fracture risk has not been established, with studies yielding conflicting results. The primary aim of this systematic review and meta-analysis was to synthesize studies evaluating the association between age at menopause and fracture risk. The secondary aim was to evaluate this effect concerning the site of fractures.
A comprehensive search was conducted in PubMed, CENTRAL and Scopus, up to 31 January 2018. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). The I2 index was employed for quantifying heterogeneity.
Eighteen studies were included in the qualitative and quantitative analysis (462,393 postmenopausal women, 12,130 fractures). Compared with women with age at menopause > 45 years, women with EM demonstrated higher fracture risk (OR 1.36, 95% CI 1.11-1.66, p < 0.002, I² 81.5%). Women with POI did not display any difference in fracture risk compared either with women with age at menopause > 40 (OR 1.23, 95% CI 0.72-2.09, p = 0.436, I² 62.5%) or >45 years (OR 0.54, 95% CI 0.22-1.29, p = 0.17, I2 0%). No difference was evident when a separate analysis was performed for vertebral, non-vertebral and hip fractures.
This is the first meta-analysis showing that EM is associated with increased fracture risk compared with normal age at menopause, without any distinct effect on the site of the fracture.
A comprehensive search was conducted in PubMed, CENTRAL and Scopus, up to 31 January 2018. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). The I2 index was employed for quantifying heterogeneity.
Eighteen studies were included in the qualitative and quantitative analysis (462,393 postmenopausal women, 12,130 fractures). Compared with women with age at menopause > 45 years, women with EM demonstrated higher fracture risk (OR 1.36, 95% CI 1.11-1.66, p < 0.002, I² 81.5%). Women with POI did not display any difference in fracture risk compared either with women with age at menopause > 40 (OR 1.23, 95% CI 0.72-2.09, p = 0.436, I² 62.5%) or >45 years (OR 0.54, 95% CI 0.22-1.29, p = 0.17, I2 0%). No difference was evident when a separate analysis was performed for vertebral, non-vertebral and hip fractures.
This is the first meta-analysis showing that EM is associated with increased fracture risk compared with normal age at menopause, without any distinct effect on the site of the fracture.
摘要：
更年期早期（EM，绝经年龄<45岁)和过早卵巢功能不全(POI，绝经年龄<40岁）与骨质疏松症的风险增加有关。然而,它们与骨折风险增加的关联尚未确定，研究结果相互矛盾。本系统综述和荟萃分析的主要目的是综合评估绝经年龄与骨折风险之间关系的研究。次要目的是评估有关骨折部位的这种影响。
在PubMed中进行了全面搜索，CENTRAL和Scopus,截至2018年1月31日。数据表示为比值比（OR），95%置信区间（CI）。I2指数用于量化异质性。
18项研究纳入了定性和定量分析(462,393名绝经后妇女，12130处骨折）。与绝经年龄>45岁的女性相比，女性EM患者骨折风险较高(OR1.36,95%CI1.11-1.66,p<0.002,I²81.5%).与绝经年龄>40岁（OR1.23，95％CI0.72-2.09，p=0.436，I²62.5％）或>45岁（OR0.54，95％CI0.22-1.29，p=0.17，I20％）的女性相比，患有POI的女性骨折风险没有任何差异。当对椎骨进行单独分析时，没有明显差异，非椎骨和髋部骨折。
这是首次荟萃分析，显示与绝经时正常年龄相比，EM与骨折风险增加有关。对骨折部位没有任何明显的影响。
在PubMed中进行了全面搜索，CENTRAL和Scopus,截至2018年1月31日。数据表示为比值比（OR），95%置信区间（CI）。I2指数用于量化异质性。
18项研究纳入了定性和定量分析(462,393名绝经后妇女，12130处骨折）。与绝经年龄>45岁的女性相比，女性EM患者骨折风险较高(OR1.36,95%CI1.11-1.66,p<0.002,I²81.5%).与绝经年龄>40岁（OR1.23，95％CI0.72-2.09，p=0.436，I²62.5％）或>45岁（OR0.54，95％CI0.22-1.29，p=0.17，I20％）的女性相比，患有POI的女性骨折风险没有任何差异。当对椎骨进行单独分析时，没有明显差异，非椎骨和髋部骨折。
这是首次荟萃分析，显示与绝经时正常年龄相比，EM与骨折风险增加有关。对骨折部位没有任何明显的影响。
