Postmenopausal women face a high risk of bone fracture. Due to the decrease in estrogen levels, which can lead to an increased risk of osteoporosis, even a low-impact fall can lead to a serious hip, back or wrist injury. It is estimated that 1 in 3 women over the age of 50 will experience a bone loss fracture in their lifetime.
A new study from Tulane University found that heart health can affect fracture risk after menopause, with women at higher risk of cardiovascular disease more likely to experience fractures of the hip and other major bones.
The association between CVD risk and fractures was also stronger in women younger than 65, compared with women 65 and older.
In the study, published in The Lancet Regional Health – Americasresearchers used the American Heart Association’s newly developed PREVENT score to estimate a patient’s 10-year risk of CVD. Women in the study were grouped as low, borderline, intermediate, or high risk.
The strongest association was seen with hip fractures. Women in the high cardiovascular risk group had a 93% higher risk of hip fracture than women in the low risk group. Women in the medium risk group had a 33% higher risk. Higher cardiovascular risk was also associated with a greater risk of fractures in weakened bones in major areas such as the hip, spine, forearm or shoulder.
The findings could indicate that the PREVENT score, developed by the AHA in 2024, may be a valuable tool for identifying patients who could benefit from bone mineral density screening or referral to a bone health specialist. Given the prevalence of both conditions and the economic burden they impose, reducing the risk for both could improve the lives of older adults.
While previous studies have suggested a relationship between cardiovascular disease and fracture risk, we were surprised by the magnitude associated with hip fracture risk. Both of these conditions are common and costly, and reducing the risk of both could improve the lives of older people.”
Rafeka Hossain, lead author, researcher, Tulane University School of Medicine
The study included data from more than 21,000 women in the Women’s Health Initiative, one of the largest national studies of women’s health.
The findings add to growing evidence that heart health and bone health are closely linked. The researchers say several biological processes may help explain the link, including chronic inflammation, oxidative stress, changes in calcium regulation, and reduced blood flow to bones caused by atherosclerosis. Hormonal changes after menopause, especially the decline in estrogen levels, can also increase the risk of both heart disease and bone loss at the same time.
“Many of the same factors that protect your heart—regular physical activity, a balanced diet rich in calcium and vitamin D, smoking cessation, and managing conditions like diabetes and high blood pressure—also help protect your bones,” Hossain said. “If you’ve been told you’re at intermediate or high cardiovascular risk, particularly if you’re a postmenopausal woman, it may be worth talking to your doctor about getting your bone health checked, given the many effective treatments that reduce fracture risk.”
The study found that women in the high-risk group tended to experience fractures earlier than women in the low-risk group. For hip fractures, the median time to fracture was 15 years in the high-risk group versus almost 20 years in the low-risk group.
The researchers caution that more work is needed before cardiovascular risk scores are added to standard fracture screening tools. However, they say the findings suggest that women at intermediate or high cardiovascular risk may want to talk to their doctors about bone health, especially after menopause.
“Taking care of your heart and bones should go hand in hand,” Hossein said.
