Skip to main content

Advertisement

SpringerLink
Log in

Association between age at menopause and fracture risk: a systematic review and meta-analysis

  • Meta-Analysis
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. D.M. Black, C.J. Rosen, Clinical practice. Postmenopausal osteoporosis. N. Engl. J. Med. 374(3), 254–262 (2016)

    Article  CAS  Google Scholar 

  2. C. Pike, H.G. Birnbaum, M. Schiller, H. Sharma, R. Burge, E.T. Edgell, Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US. Pharmacoeconomics 28(5), 395–409 (2010)

    Article  Google Scholar 

  3. P. Vestergaard, L. Rejnmark, L. Mosekilde, Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos. Int. 18(12), 1583–1593 (2007)

    Article  CAS  Google Scholar 

  4. S.R. Davis, I. Lambrinoudaki, M. Lumsden, G.D. Mishra, L. Pal, M. Rees, N. Santoro, T. Simoncini, Menopause. Nat. Rev. Dis. Prim. 1, 15004 (2015)

    Article  Google Scholar 

  5. J.S. Finkelstein, S.E. Brockwell, V. Mehta, G.A. Greendale, M.R. Sowers, B. Ettinger, J.C. Lo, J.M. Johnston, J.A. Cauley, M.E. Danielson, R.M. Neer, Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J. Clin. Endocrinol. Metab. 93(3), 861–868 (2008). https://doi.org/10.1210/jc.2007-1876.

    Article  CAS  PubMed  Google Scholar 

  6. S.S. Faubion, C.L. Kuhle, L.T. Shuster, W.A. Rocca, Long-term health consequences of premature or early menopause and considerations for management. Climacteric 18(4), 483–491 (2015)

    Article  CAS  Google Scholar 

  7. L.T. Shuster, D.J. Rhodes, B.S. Gostout, B.R. Grossardt, W.A. Rocca, Premature menopause or early menopause: long-term health consequences. Maturitas 65(2), 161–166 (2010)

    Article  Google Scholar 

  8. R.G. Cumming, R.J. Klineberg, Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int. J. Epidemiol. 22(4), 684–691 (1993)

    Article  CAS  Google Scholar 

  9. F. Parazzini, A. Tavani, E. Ricci, C. La Vecchia, Menstrual and reproductive factors and hip fractures in post menopausal women. Maturitas 24(3), 191–196 (1996)

    Article  CAS  Google Scholar 

  10. A. Papaioannou, L. Joseph, G. Ioannidis, C. Berger, T. Anastassiades, J.P. Brown, D.A. Hanley, W. Hopman, R.G. Josse, S. Kirkland, T.M. Murray, W.P. Olszynski, L. Pickard, J.C. Prior, K. Siminoski, J.D. Adachi, Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos. Int. 16(5), 568–578 (2005)

    Article  Google Scholar 

  11. M. Tuppurainen, H. Kroger, R. Honkanen, E. Puntila, J. Huopio, S. Saarikoski, E. Alhava, Risks of perimenopausal fractures—a prospective population-based study. Acta Obstet. Gynecol. Scand. 74(8), 624–628 (1995)

    Article  CAS  Google Scholar 

  12. A. Paganini-Hill, K.A. Atchison, J.A. Gornbein, A. Nattiv, S.K. Service, S.C. White, Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study. J. Womens. Health. 14(9), 808–819 (2005)

    Article  Google Scholar 

  13. D.F. Stroup, J.A. Berlin, S.C. Morton, I. Olkin, G.D. Williamson, D. Rennie, D. Moher, B.J. Becker, T.A. Sipe, S.B. Thacker, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15), 2008–2012 (2000)

    Article  CAS  Google Scholar 

  14. G.A. Wells, B. Shea, D. O’Connell, J. Peterson, V. Welch, P. Tugwell, The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. (2009). http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [cited 2009 Oct 19]

  15. M. Varenna, L. Binelli, F. Zucchi, P. Beltrametti, M. Gallazzi, L. Sinigaglia, Is the metatarsal fracture in postmenopausal women an osteoporotic fracture? A cross-sectional study on 113 cases. Osteoporos. Int. 7(6), 558–563 (1997)

    Article  CAS  Google Scholar 

  16. D. Huo, D.S. Lauderdale, L. Li, Influence of reproductive factors on hip fracture risk in Chinese women. Osteoporos. Int. 14(8), 694–700 (2003)

    Article  Google Scholar 

  17. D.J. van Der Voort, P.H. van Der Weijer, R. Barentsen, Early menopause: increased fracture risk at older age. Osteoporos. Int. 14(6), 525–530 (2003)

    Article  Google Scholar 

  18. M. van der Klift, C.E. de Laet, E.V. McCloskey, O. Johnell, J.A. Kanis, A. Hofman, H.A. Pols, Risk factors for incident vertebral fractures in men and women: the Rotterdam Study. J. Bone Miner. Res. 19(7), 1172–1180 (2004)

    Article  Google Scholar 

  19. M.R. Jenkins, A.V. Denison, Smoking status as a predictor of hip fracture risk in postmenopausal women of northwest Texas. Prev. Chronic Dis. 5(1), A09 (2008)

    PubMed  Google Scholar 

  20. E. Banks, G.K. Reeves, V. Beral, A. Balkwill, B. Liu, A. Roddam, Million Women Study, C.: Hip fracture incidence in relation to age, menopausal status, and age at menopause: prospective analysis. PLoS. Med. 6(11), e1000181 (2009)

    Article  Google Scholar 

  21. E. Lespessailles, F.E. Cotte, C. Roux, P. Fardellone, F. Mercier, A.F. Gaudin, Prevalence and features of osteoporosis in the French general population: the Instant study. Jt. Bone Spine 76(4), 394–400 (2009)

    Article  Google Scholar 

  22. F.A. Tremollieres, J.M. Pouilles, N. Drewniak, J. Laparra, C.A. Ribot, P. Dargent-Molina, Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: sensitivity of the WHO FRAX tool. J. Bone Miner. Res. 25(5), 1002–1009 (2010)

    Article  Google Scholar 

  23. C.S. Shin, M.J. Kim, S.M. Shim, J.T. Kim, S.H. Yu, B.K. Koo, H.Y. Cho, H.J. Choi, S.W. Cho, S.W. Kim, S.Y. Kim, S.O. Yang, N.H. Cho, The prevalence and risk factors of vertebral fractures in Korea. J. Bone Miner. Metab. 30(2), 183–192 (2012)

    Article  Google Scholar 

  24. A.K. Pfister, C.A. Welch, M.K. Emmett, N.W. Sheets, Risk factors predicting fractures in early postmenopausal women. W. V. Med. J. 109(3), 14–15 (2013). 8-12

    Google Scholar 

  25. S.D. Sullivan, A. Lehman, F. Thomas, K.C. Johnson, R. Jackson, J. Wactawski-Wende, M. Ko, Z. Chen, J.D. Curb, B.V. Howard, Effects of self-reported age at nonsurgical menopause on time to first fracture and bone mineral density in the Women’s Health Initiative Observational Study. Menopause 22(10), 1035–1044 (2015)

    Article  Google Scholar 

  26. I. Lambrinoudaki, M. Flokatoula, E. Armeni, P. Pliatsika, A. Augoulea, A. Antoniou, A. Alexandrou, M. Creatsa, C. Panoulis, S. Dendrinos, X. Papacharalambous, Vertebral fracture prevalence among Greek healthy middle-aged postmenopausal women: association with demographics, anthropometric parameters, and bone mineral density. Spine J. 15(1), 86–94 (2015)

    Article  Google Scholar 

  27. S.R. Cummings, M.C. Nevitt, W.S. Browner, K. Stone, K.M. Fox, K.E. Ensrud, J. Cauley, D. Black, T.M. Vogt, Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N. Engl. J. Med. 332(12), 767–773 (1995)

    Article  CAS  Google Scholar 

  28. B.L. Riggs, S. Khosla, L.J. Melton 3rd, : Sex steroids and the construction and conservation of the adult skeleton. Endocr. Rev. 23(3), 279–302 (2002)

    Article  CAS  Google Scholar 

  29. J.E. Rossouw, G.L. Anderson, R.L. Prentice, A.Z. LaCroix, C. Kooperberg, M.L. Stefanick, R.D. Jackson, S.A. Beresford, B.V. Howard, K.C. Johnson, J.M. Kotchen, J. Ockene, Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. JAMA 288(3), 321–333 (2002)

    Article  CAS  Google Scholar 

  30. G.L. Anderson, M. Limacher, A.R. Assaf, T. Bassford, S.A. Beresford, H. Black, D. Bonds, R. Brunner, R. Brzyski, B. Caan, R. Chlebowski, D. Curb, M. Gass, J. Hays, G. Heiss, S. Hendrix, B.V. Howard, J. Hsia, A. Hubbell, R. Jackson, K.C. Johnson, H. Judd, J.M. Kotchen, L. Kuller, A.Z. LaCroix, D. Lane, R.D. Langer, N. Lasser, C.E. Lewis, J. Manson, K. Margolis, J. Ockene, M.J. O’Sullivan, L. Phillips, R.L. Prentice, C. Ritenbaugh, J. Robbins, J.E. Rossouw, G. Sarto, M.L. Stefanick, L. Van Horn, J. Wactawski-Wende, R. Wallace, S. Wassertheil-Smoller, Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 291(14), 1701–1712 (2004)

    Article  CAS  Google Scholar 

  31. H. Mizunuma, Y. Taketani, H. Ohta, H. Honjo, I. Gorai, A. Itabashi, M. Shiraki, Dose effects of oral estradiol on bone mineral density in Japanese women with osteoporosis. Climacteric 13(1), 72–83 (2010)

    Article  CAS  Google Scholar 

  32. F.A. Tremollieres, J.M. Pouilles, C. Ribot, Withdrawal of hormone replacement therapy is associated with significant vertebral bone loss in postmenopausal women. Osteoporos. Int. 12(5), 385–390 (2001)

    Article  CAS  Google Scholar 

  33. G. Papadakis, D. Hans, E. Gonzalez-Rodriguez, P. Vollenweider, G. Waeber, P.M. Marques-Vidal, O. Lamy, The benefit of menopausal hormone therapy on bone density and microarchitecture persists after its withdrawal. J. Clin. Endocrinol. Metab. 101(12), 5004–5011 (2016)

    Article  CAS  Google Scholar 

  34. N.B. Watts, J.A. Cauley, R.D. Jackson, A.Z. LaCroix, C.E. Lewis, J.E. Manson, J.M. Neuner, L.S. Phillips, M.L. Stefanick, J. Wactawski-Wende, C. Crandall, No increase in fractures after stopping hormone therapy: results from the women’s health initiative. J. Clin. Endocrinol. Metab. 102(1), 302–308 (2017)

    PubMed  Google Scholar 

  35. E.B. Gold, S.L. Crawford, N.E. Avis, C.J. Crandall, K.A. Matthews, L.E. Waetjen, J.S. Lee, R. Thurston, M. Vuga, S.D. Harlow, Factors related to age at natural menopause: longitudinal analyses from SWAN. Am. J. Epidemiol. 178(1), 70–83 (2013)

    Article  Google Scholar 

  36. U. Stepaniak, K. Szafraniec, R. Kubinova, S. Malyutina, A. Peasey, H. Pikhart, A. Pajak, M. Bobak, Age at natural menopause in three central and eastern European urban populations: the HAPIEE study. Maturitas 75(1), 87–93 (2013)

    Article  CAS  Google Scholar 

  37. V. Mpalaris, P. Anagnostis, D.G. Goulis, I. Iakovou, Complex association between body weight and fracture risk in postmenopausal women. Obes. Rev. 16(3), 225–233 (2015)

    Article  CAS  Google Scholar 

  38. M.C. Navarro, M. Sosa, P. Saavedra, P. Lainez, M. Marrero, M. Torres, C.D. Medina, Poverty is a risk factor for osteoporotic fractures. Osteoporos. Int. 20(3), 393–398 (2009)

    Article  CAS  Google Scholar 

  39. J.S. Laven, Genetics of early and normal menopause. Semin. Reprod. Med. 33(6), 377–383 (2015)

    Article  Google Scholar 

  40. L. Stolk, J.R. Perry, D.I. Chasman, C. He, M. Mangino, P. Sulem, M. Barbalic, L. Broer, E.M. Byrne, F. Ernst, T. Esko, N. Franceschini, D.F. Gudbjartsson, J.J. Hottenga, P. Kraft, P.F. McArdle, E. Porcu, S.Y. Shin, A.V. Smith, S. van Wingerden, G. Zhai, W.V. Zhuang, E. Albrecht, B.Z. Alizadeh, T. Aspelund, S. Bandinelli, L.B. Lauc, J.S. Beckmann, M. Boban, E. Boerwinkle, F.J. Broekmans, A. Burri, H. Campbell, S.J. Chanock, C. Chen, M.C. Cornelis, T. Corre, A.D. Coviello, P. d’Adamo, G. Davies, U. de Faire, E.J. de Geus, I.J. Deary, G.V. Dedoussis, P. Deloukas, S. Ebrahim, G. Eiriksdottir, V. Emilsson, J.G. Eriksson, B.C. Fauser, L. Ferreli, L. Ferrucci, K. Fischer, A.R. Folsom, M.E. Garcia, P. Gasparini, C. Gieger, N. Glazer, D.E. Grobbee, P. Hall, T. Haller, S.E. Hankinson, M. Hass, C. Hayward, A.C. Heath, A. Hofman, E. Ingelsson, A.C. Janssens, A.D. Johnson, D. Karasik, S.L. Kardia, J. Keyzer, D.P. Kiel, I. Kolcic, Z. Kutalik, J. Lahti, S. Lai, T. Laisk, J.S. Laven, D.A. Lawlor, J. Liu, L.M. Lopez, Y.V. Louwers, P.K. Magnusson, M. Marongiu, N.G. Martin, I.M. Klaric, C. Masciullo, B. McKnight, S.E. Medland, D. Melzer, V. Mooser, P. Navarro, A.B. Newman, D.R. Nyholt, N.C. Onland-Moret, A. Palotie, G. Pare, A.N. Parker, N.L. Pedersen, P.H. Peeters, G. Pistis, A.S. Plump, O. Polasek, V.J. Pop, B.M. Psaty, K. Raikkonen, E. Rehnberg, J.I. Rotter, I. Rudan, C. Sala, A. Salumets, A. Scuteri, A. Singleton, J.A. Smith, H. Snieder, N. Soranzo, S.N. Stacey, J.M. Starr, M.G. Stathopoulou, K. Stirrups, R.P. Stolk, U. Styrkarsdottir, Y.V. Sun, A. Tenesa, B. Thorand, D. Toniolo, L. Tryggvadottir, K. Tsui, S. Ulivi, R.M. van Dam, Y.T. van der Schouw, C.H. van Gils, P. van Nierop, J.M. Vink, P.M. Visscher, M. Voorhuis, G. Waeber, H. Wallaschofski, H.E. Wichmann, E. Widen, C.J. Wijnands-van Gent, G. Willemsen, J.F. Wilson, B.H. Wolffenbuttel, A.F. Wright, L.M. Yerges-Armstrong, T. Zemunik, L. Zgaga, M.C. Zillikens, M. Zygmunt, A.M. Arnold, D.I. Boomsma, J.E. Buring, L. Crisponi, E.W. Demerath, V. Gudnason, T.B. Harris, F.B. Hu, D.J. Hunter, L.J. Launer, A. Metspalu, G.W. Montgomery, B.A. Oostra, P.M. Ridker, S. Sanna, D. Schlessinger, T.D. Spector, K. Stefansson, E.A. Streeten, U. Thorsteinsdottir, M. Uda, A.G. Uitterlinden, C.M. van Duijn, H. Volzke, A. Murray, J.M. Murabito, J.A. Visser, K.L. Lunetta, Meta-analyses identify 13 loci associated with age at menopause and highlight DNA repair and immune pathways. Nat. Genet. 44(3), 260–268 (2012)

    Article  CAS  Google Scholar 

  41. M.G. Braem, M. Voorhuis, Y.T. van der Schouw, P.H. Peeters, L.J. Schouten, M.J. Eijkemans, F.J. Broekmans, N.C. Onland-Moret, Interactions between genetic variants in AMH and AMHR2 may modify age at natural menopause. PLoS. One. 8(3), e59819 (2013)

    Article  CAS  Google Scholar 

  42. A. La Marca, G. Sighinolfi, C. Argento, V. Grisendi, L. Casarini, A. Volpe, M. Simoni, Polymorphisms in gonadotropin and gonadotropin receptor genes as markers of ovarian reserve and response in in vitro fertilization. Fertil. Steril. 99(4), 970–978.e971 (2013)

    Article  Google Scholar 

  43. U. Styrkarsdottir, B.V. Halldorsson, S. Gretarsdottir, D.F. Gudbjartsson, G.B. Walters, T. Ingvarsson, T. Jonsdottir, J. Saemundsdottir, J.R. Center, T.V. Nguyen, Y. Bagger, J.R. Gulcher, J.A. Eisman, C. Christiansen, G. Sigurdsson, A. Kong, U. Thorsteinsdottir, K. Stefansson, Multiple genetic loci for bone mineral density and fractures. N. Engl. J. Med. 358(22), 2355–2365 (2008)

    Article  CAS  Google Scholar 

  44. G.R. Ji, M. Yao, C.Y. Sun, Z.H. Li, Z. Han, BsmI, TaqI, ApaI, and FokI polymorphisms in the vitamin D receptor (VDR) gene and risk of fracture in Caucasians: a meta-analysis. Bone 47(3), 681–686 (2010)

    Article  CAS  Google Scholar 

  45. A.E. Weel, A.G. Uitterlinden, I.C. Westendorp, H. Burger, S.C. Schuit, A. Hofman, T.J. Helmerhorst, J.P. van Leeuwen, H.A. Pols, Estrogen receptor polymorphism predicts the onset of natural and surgical menopause. J. Clin. Endocrinol. Metab. 84(9), 3146–3150 (1999)

    CAS  PubMed  Google Scholar 

  46. V. Dvornyk, J.R. Long, P.Y. Liu, H. Shen, R.R. Recker, H.W. Deng, Polymorphisms of the vitamin D receptor gene predict the onset of surgical menopause in Caucasian females. Gynecol. Endocrinol. 22(10), 552–556 (2006)

    Article  CAS  Google Scholar 

  47. D.M. Black, J.A. Cauley, R. Wagman, K. Ensrud, H.A. Fink, T.A. Hillier, L.Y. Lui, S.R. Cummings, J.T. Schousboe, N. Napoli, The ability of a single BMD and fracture history assessment to predict fracture over 25 years in postmenopausal women: the study of osteoporotic fractures. J. Bone Miner. Res. 33(3), 389–395 (2018)

    Article  Google Scholar 

Download references

Author contributions

P.A. designed the research, extracted and analysed the data and wrote the first draft of the paper. P.S., N.K.G., N.K., A.M.A., and K.C. searched the literature, extracted and analysed the data. P.S. was responsible for the statistical analysis and reviewed the manuscript. S.A.P., M.P., E.T., E.K., I.L., and J.C.S. reviewed the manuscript and provided critical scientific input. D.G.G. resolved discrepancies regarding the quality of the studies included in the meta-analysis, provided critical scientific input and had the primary responsibility for the paper’s final content.

Author information

Authors and Affiliations

  1. Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis Anagnostis & Dimitrios G. Goulis

  2. Police Medical Center of Thessaloniki, Thessaloniki, Greece

    Panagiotis Anagnostis, Pavlos Siolos, Nifon K. Gkekas, Nikoletta Kosmidou, Aikaterini-Maria Artzouchaltzi & Konstantinos Christou

  3. Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis Anagnostis, Pavlos Siolos, Nifon K. Gkekas, Nikoletta Kosmidou, Aikaterini-Maria Artzouchaltzi, Konstantinos Christou, Michael Potoupnis, Eustathios Kenanidis & Eleftherios Tsiridis

  4. Division of Endocrinology and Diabetes, “Aghia Sophia” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Stavroula A. Paschou

  5. Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece

    Michael Potoupnis, Eustathios Kenanidis & Eleftherios Tsiridis

  6. Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece

    Irene Lambrinoudaki

  7. National Heart and Lung Institute, Imperial College London, Royal Brοmpton and Harefield NHS Foundation Trust, London, SW3 6NP, UK

    John C. Stevenson

Authors
  1. Panagiotis Anagnostis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pavlos Siolos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nifon K. Gkekas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nikoletta Kosmidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aikaterini-Maria Artzouchaltzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Konstantinos Christou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stavroula A. Paschou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Potoupnis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eustathios Kenanidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eleftherios Tsiridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Irene Lambrinoudaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. John C. Stevenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Dimitrios G. Goulis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panagiotis Anagnostis.

Ethics declarations

Conflict of interest

J.C.S. has received grants/research support from Abbott, Mylan and Pfizer; consulting fees from Abbott, Mylan and Pfizer; and speaker’s honoraria from Abbott, Bayer, Gedeon Richter, Menarini, Mylan, and Pfizer. The remaining authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anagnostis, P., Siolos, P., Gkekas, N.K. et al. Association between age at menopause and fracture risk: a systematic review and meta-analysis. Endocrine 63, 213–224 (2019). https://doi.org/10.1007/s12020-018-1746-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-018-1746-6

Keywords

Search

Navigation