Calcium2026-05

The association between 10-year cardiovascular risk and fracture incidence in postmenopausal women: a prospective analysis from the Women's Health Initiative.

Hossain Rafeka, Laddu Deepika, Crandall Carolyn J, Ensrud Kristine E et al. — Lancet regional health. Americas

Summary

This study explored the connection between a woman's risk of heart disease and her likelihood of experiencing bone fractures after menopause. Researchers found that postmenopausal women with a higher predicted risk of heart disease also had an increased risk of major bone fractures, including hip fractures. This suggests that factors contributing to heart health might also play a role in bone strength.

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Key points

Postmenopausal women with a higher predicted risk of heart disease also face an increased risk of bone fractures.
This association was particularly strong for major osteoporotic fractures and hip fractures.
Factors influencing heart health may also be important for maintaining strong bones in older women.
Assessing heart disease risk could potentially help identify women at higher risk for fractures.

What the study looked at

What question the study asked: This research aimed to understand if there's a link between a postmenopausal woman's predicted risk of developing heart disease and her chances of experiencing a bone fracture. While both conditions are common in older women and share some underlying biological processes, this specific connection hadn't been thoroughly investigated. How it was studied (design/participants): Researchers used data from over 21,000 postmenopausal women who participated in the long-running Women's Health Initiative study. They assessed each woman's 10-year risk of heart disease using a standard prediction tool, categorizing them into low, borderline, intermediate, or high-risk groups. They then tracked how many women in each group experienced various types of fractures over time. What it found: The study revealed that postmenopausal women with a higher predicted risk of heart disease were more likely to experience major bone fractures, including hip fractures, compared to those with a low heart disease risk. This association remained even after accounting for other factors like lifestyle and medical conditions. The findings suggest that a higher risk for heart problems may also indicate a higher risk for bone fractures.

Dietary takeaway

This study suggests that maintaining good cardiovascular health might also be beneficial for bone strength in postmenopausal women. While calcium is crucial for bone health, a balanced diet rich in fruits, vegetables, and lean proteins, which often includes calcium-rich foods, supports overall health, including both your heart and bones. Remember, this is one study, and more research is needed to fully understand these complex connections and how dietary choices specifically impact both risks.

Abstract

BACKGROUND: Cardiovascular disease (CVD) and fractures share pathophysiological mechanisms, yet the relationship between predicted CVD risk and fracture incidence remains unexplored. Using the PREventing cardiovascular disease eVENTs (PREVENT) score, this study aimed to determine the association between CVD risk and incident fractures in postmenopausal women. METHODS: This study included 21,300 participants from the Women's Health Initiative (WHI) (1993-2024). PREVENT 10-year CVD risk was categorized as low (<5·0%), borderline (5·0%-7·4%), intermediate (7·5%-19·9%), or high (≥20·0%). Cox proportional hazards models estimated adjusted hazard ratios [HR (95% CI)] for incident fractures, including any clinical, major osteoporotic fracture (MOF), and hip fracture. FINDINGS: In the sample [mean (SD) age: 63·7 (7·3) years], 9224 (43·3%) experienced any clinical fracture, 4997 (23·5%) MOF, and 1717 (8·1%) hip fractures. Overall, 5370 (25·2%) had low, 4169 (19·6%) borderline, 10,661 (50·1%) intermediate, and 1100 (5·2%) high CVD risk. In fully adjusted models, compared with low-CVD risk, higher risk of MOF was observed in the intermediate- [1·14 (1·04-1·24)] and high- [1·22 (1·07-1·40)] CVD risk groups; and higher risk of hip fracture [intermediate: 1·33 (1·14-1·56); high: 1·93 (1·55-2·42)]. Associations attenuated after accounting for the competing risk of mortality, but higher CVD risk remained associated with higher fracture risk. INTERPRETATION: A higher 10-year predicted CVD risk was associated with higher MOF and hip fracture risk after adjustment for sociodemographic, lifestyle, and clinical factors. CVD risk may have implications for fracture risk assessment in postmenopausal women. FUNDING: WHI is funded by the US National Heart, Lung, and Blood Institute. No additional funding was received for this study.

View on PubMed →DOI: 10.1016/j.lana.2026.101440