The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies

Background/Aims Vasomotor symptoms (VMS) adversely affect postmenopausal quality of life. However, their association with bone health has not been elucidated. This study aimed to systematically review and meta-analyze the evidence regarding the association of VMS with fracture risk and bone mineral density (BMD) in peri- and postmenopausal women. Methods A literature search was conducted in PubMed, Scopus and Cochrane databases until 31 August 2023. Fracture, low BMD (osteoporosis/osteopenia) and mean change in lumbar spine (LS) and femoral neck (FN) BMD were assessed. The results are presented as odds ratio (OR) and mean difference (MD), respectively, with a 95% confidence interval (95% CI). The I 2 index quantified heterogeneity. Results Twenty studies were included in the qualitative and 12 in the quantitative analysis ( n =49,659). No difference in fractures between women with and without VMS was found ( n =5, OR 1.04, 95% CI 0.93–1.16, I 2 16%). However, VMS were associated with low BMD ( n =5, OR 1.54, 95% CI 1.42–1.67, I 2 0%). This difference was evident for LS (MD -0.019 g/cm 2 , 95% CI -0.03 to -0.008, I 2 85.2%), but not for FN BMD (MD -0.010 g/cm 2 , 95% CI -0.021 to 0.001, I 2 78.2%). These results were independent of VMS severity, age and study design. When the analysis was confined to studies that excluded menopausal hormone therapy use, the association with BMD remained significant. Conclusions The presence of VMS is associated with low BMD in postmenopausal women, although it does not seem to increase fracture risk.