Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies

Wang, Q.; Huang, Qian; Zeng, Yun; Liang, Jie; Liu, S.-y.; Gu, Xiaoqing; Liu, Ji-Jia

doi:10.1007/s00198-015-3351-3

Cited by 31 publications

(33 citation statements)

References 55 publications

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“…Cure-Cure and Cure [1] for their interest in our recently published article [2]. We agree that well-designed cross-sectional studies are early, reliable, and cost-effective sources of information.…”

Section: Dear Editorsupporting

confidence: 60%

Re: Validation of cross-sectional studies with longitudinal meta-analysis

Liu

Wang

2016

Osteoporos Int

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Dear Editor,We thank Drs. Cure-Cure and Cure [1] for their interest in our recently published article [2]. We agree that well-designed cross-sectional studies are early, reliable, and cost-effective sources of information. Meta-analysis of high-quality crosssectional studies should be encouraged. This analysis will facilitate the presentation of valuable and reliable evidence combined with findings of prospective studies.In our previous meta-analyses, we searched for prospective and non-prospective (e.g., cross-sectional and case control) studies reporting the parity-related risk of osteoporotic fracture (OF) at any skeletal location, such as spine, wrist, and hip. Subgroup analysis based on non-prospective reports indicated that parous women exhibited a lower OF risk than nulliparous women, with the corresponding pooled OR of 0.725 (95 % confidence interval (CI) = 0.614-0.836, I 2 = 57.3 %, n = 19), 0.803 (95 % CI = 0.730-0.876, I 2 = 0.0 %, n = 15), and 0.612 (95 % CI = 0.490-0.733, I 2 = 47.1 %, n = 14) for at least 1, 1-2, and 3 or more parities, respectively. When the hip fracture risk was exclusively considered, the respective counterpart values were 0.797 (95 % CI = 0.717-0.877, I 2 = 0.0 %, n = 12), 0.835 (95 % CI = 0.725-0.944, I 2 = 0.0 %, n = 10), and 0.726 (95 % CI = 0.610-0.843, I 2 = 0.0 %, n = 10).We hypothesize that the specific explanatory variable of interest (i.e., parity) contributes to the concurrent findings from prospective and non-prospective studies. Based on Hill's criteria for epidemiologic causal inference, time sequence of cause and effect is legitimate. That's the major limitation of cross-sectional study. Generally, deliveries occur before menopause, and women often suffer OF after menopause. Therefore, it's reasonable to assume that most OFs among women occur after delivery. That's why crosssectional studies may also present reliable information on parity-related OF risk.

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Section: Dear Editorsupporting

confidence: 60%

Re: Validation of cross-sectional studies with longitudinal meta-analysis

Liu

Wang

2016

Osteoporos Int

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“…The number of biological children has been linked with higher risks of hip fracture [8][9][10][11][12]. Pregnancy and hormonal changes in women are believed to have adverse effects on bone health in women.…”

Section: Introductionmentioning

confidence: 99%

Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China

et al. 2019

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This prospective study of Chinese adults demonstrated an inverse J-shaped association of number of children with risk of hip fracture in both men and postmenopausal women aged 50 years or older. Women with 2 or 3 children and men with 4 children had the lowest risk of hip fracture. Introduction Women have higher absolute risks of fracture than men, which is believed to reflect differences in oestrogen exposure. The aim of this study was to compare the associations of number of children with risk of hip fracture between men and women aged over 50 years. Methods The China Kadoorie Biobank (CKB) recruited 133,399 women and 110,296 men, aged 50 years or older between 2004 and 2008. During 10-year follow-up, 2068 participants (1394 women and 674 men) suffered a hip fracture. Cox regression analysis was used to estimate sex-specific adjusted hazard ratios (HRs) and 95% CI for incident hip fracture. Results Over 98% of both subsets of men and women aged 50 or older reported having children. Women who had 2 or 3 children had the lowest risks of hip fracture compared with other groups. Compared with nulliparous women, the adjusted HR for hip fracture were 0.89 (95% CI; 0.72, 1.10) for 1 child, 0.79 (0.70, 0.90) for 2 children, 0.79 (0.72, 0.87) for 3 children, 0.81 (0.72, 0.91) for 4 children, and 0.95 (0.83, 1.10) for those with 5 or more children. The associations of number of children with hip fracture were broadly consistent in men of a similar age. Conclusions The concordant effects of the number of children with risk of hip fracture between men and women suggest that the lower risks in multiparous women are not due to differences in oestrogen exposure or other biological effects, but may reflect residual confounding by socioeconomic or lifestyle factors.

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“…The risk of wrist fracture in multivariate analysis was reduced by 30% (HR = 0.71[0.52-0.97]) among women with parity compared with nulliparous. The meta-analysis of Wang et al, [47] has included 10 prospective studies about parity and fracture in postmenopausal women. This paper is in accordance with our conclusion as it reports that increasing number of parity is associated with linearly reduced hip fracture risks among women.…”

Section: Discussionmentioning

confidence: 99%

Impact of Parity on Fracture Risk after Menopause: A Systematic Review

Weryha¹

2017

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BackgroundPregnancy and breastfeeding cause temporal bone resorption and can play a role in clinical expression of osteoporosis disease. Objective was to estimate the association between parity and risk of osteoporotic fracture after menopause. MethodsWe performed a systematic review through a search of PubMed, Cochrane, Embase databases from January 1, 1980 through January 31, 2016. We included all studies that evaluated the link between parity and post-menopausal osteoporotic fracture using univariate and/or multivariate analysis. ResultsAmong 29 studies, a positive effect of parity was found in 7/13 prospective, 1/7 transversal and 2/10 retrospective studies. Three studies out of 5 found that parity had a protective role against the risk for any fracture (HR = 0.94[0.90-0.99], OR = 0.41[0.28-0.61] and OR = 0.90[0.84-0.99]). For hip fracture, a protective effect was found in 5 studies out of 17 and concerned women with ≥2 children in two studies (OR = 0.75[0.62-0.91], RR = 0.5[0.32-0.79]). For vertebral fracture, 1 study out of 8 reported a significantly reduced risk in women with ≥2 children (HR = 0.44[0.26-0.76]). Wrist fracture risk was evaluated in 7 studies. One found a reduced risk in parous individuals (HR = 0.71[0.52-0.97]). An increased fracture risk was found in three studies. It's about Asian sub-population with ≥5 children in two studies (HR = 1.65[1.06-2.56] and RR = 2.53[1.07-6.68]). In another, a positive correlation between vertebral fracture and parity was reported (OR = 1.093[1.008-1.186]). ConclusionOverall, pregnancy does not seem to be associated with an increased risk of osteoporotic fracture after menopause. The negative impact of ≥5 childbirth in Asiatic sub-population requires future investigations.Volume 2 • 100009 9 Adjustment by age, handgrip strength, femoral neck BMD, prevalent vertebral fracture and the history of falls in the follow-up. 10 Adjusted for age, postmenopausal, body mass index, dairy calcium intake, hormone replacement therapy during follow-up, Wrist fracture history, parity. 11 Adjusted for age, BMI, milk intake, alcohol intake, menarche, parity. 12 Adjusted for age, BMI, age at menarche, duration of menopause, systolic blood pressure, GFR, PTH, 25(OH)D3, oral contraceptive use, HTN, DM, physical activity, alcohol and smoking status , number of deliveries, and age at first and last delivery.13 Adjustment for age (OR, 1.06; 95% CI, 0.97-1.15), BMI (OR, 1.01; 95% CI, 0.99-1.03), age at menopause (OR, 0.96; 95% CI, 0.89-1.04), time since menopause: (OR, 0.94; 95% CI, 0.87-1.02), wearing veil (OR, 1.02; 95% CI, 0.69-1.53) and total femoral BMD (OR, 0.13; 95% CI, 0.038-0.4).14 Adjusted for age (=54, 55-59, 60-64, 65-69, 70-74, and =75 years), hormone replacement therapy (never, former, and current use), oral contraceptive use (never and ever use), and body mass index (by quintiles) 15 Adjusted for center, age, body mass index and smoking. 16 Adjusted for age, education, BMI, history of estrogen use, age at menopause, history of oral contraceptive use, history of endometri...

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Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies

Abstract: We found that increasing number of parity is associated with linearly reduced HF risks among women. The association between parity of six or more live births and HF risks should be studied further in future.

Cited by 31 publications

References 55 publications

Re: Validation of cross-sectional studies with longitudinal meta-analysis

Re: Validation of cross-sectional studies with longitudinal meta-analysis

Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China

Impact of Parity on Fracture Risk after Menopause: A Systematic Review

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