Heart Health Linked to Higher Hip Fracture Risk in Postmenopausal Women

A study from Tulane University has identified a link between heart health and the risk of bone fractures in postmenopausal women. The research indicates that women with a higher risk of cardiovascular disease are more likely to experience hip and other major bone fractures.

The findings, published in The Lancet Regional Health – Americas, suggest that cardiovascular health may play a significant role in bone stability following menopause. Postmenopausal women are already at a high risk of fractures due to declines in estrogen levels, which can lead to osteoporosis and make even low-impact falls result in serious injuries to the wrist, back, or hip.

According to the research, an estimated 1 in 3 women over the age of 50 will experience a fracture due to bone loss during their lifetime.

Taking care of your heart and bones should go hand in hand.

Rafeka Hossain, researcher with the Tulane University School of Medicine

Cardiovascular Risk and Fracture Probability

To conduct the study, researchers analyzed data from more than 21,000 women participating in the Women’s Health Initiative. The team used the PREVENT score, a tool developed by the American Heart Association in 2024, to estimate the 10-year risk of cardiovascular disease for each patient.

Participants were categorized into low, borderline, intermediate, or high-risk groups. The strongest correlation was found regarding hip fractures. Women in the high cardiovascular risk group faced a 93% higher risk of hip fracture compared to those in the low-risk group. Those in the intermediate-risk group had a 33% higher risk.

The study also found that higher cardiovascular risk was associated with an increased likelihood of fractures in other major areas, including the shoulder, forearm, and spine.

The timing of these injuries also differed by risk level. For hip fractures, the median time to fracture was 15 years for women in the high-risk group, compared to nearly 20 years for those in the low-risk group.

Biological Connections and Demographics

Researchers noted that the association between cardiovascular disease risk and fractures was stronger in women under 65 than in women 65 and older.

Several biological processes may explain why heart health and bone health are connected. These include oxidative stress, chronic inflammation, and changes in how the body regulates calcium. Atherosclerosis can reduce blood flow to the bones, further increasing fragility.

Hormonal shifts after menopause, specifically the decline of estrogen, may simultaneously increase the risk for both bone loss and heart disease.

Clinical Implications and Prevention

The study suggests that the PREVENT score could serve as a valuable tool for clinicians to identify patients who might benefit from a referral to a bone health specialist or a bone density screening.

Lead author Rafeka Hossain noted that many of the same factors protect both the heart and the bones. These include:

• Maintaining a balanced diet rich in vitamin D and calcium
• Engaging in regular physical activity
• Avoiding smoking
• Managing high blood pressure and diabetes

Hossain stated that postmenopausal women who have been informed of an intermediate or high cardiovascular risk may find it worthwhile to talk to your doctor about bone health screening because of the available treatments that reduce fracture risk.

Despite these findings, the researchers cautioned that further work is required before cardiovascular risk scores are integrated into standard fracture screening tools.