Postmenopausal women are at increased risk of fractures. Reduced estrogen levels can lead to an increased risk of osteoporosis, so even low-impact falls can cause serious injuries to the hips, back, and wrists. It is estimated that one in three women over the age of 50 will experience a fracture due to bone loss during their lifetime.
A new study from Tulane University finds that heart health may influence fracture risk after menopause, with women at higher risk for cardiovascular disease more likely to experience hip and other major fractures.
The association between cardiovascular disease risk and fractures was also stronger for women younger than 65 years compared to women older than 65 years.
In a study published in Lancet Community Health – Americasresearchers used the American Heart Association’s recently developed PREVENT score to estimate patients’ 10-year risk of cardiovascular disease. Women in the study were categorized as low risk, borderline risk, intermediate risk, or high risk.
The strongest association was found for 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 intermediate risk group had a 33% higher risk. Increased cardiovascular risk was also associated with increased risk of fractures in weakened bones in key areas such as the hip, spine, forearm, and shoulder.
The findings may indicate that the PREVENT score, developed by the AHA in 2024, may be a valuable tool in identifying patients who may benefit from bone density screening and referral to a bone health specialist. Given the prevalence of both diseases and the economic burden they impose, reducing the risks of both has the potential to improve the lives of older adults.
Previous studies have suggested an association between cardiovascular disease and fracture risk, but the magnitude of the association with femoral neck fracture risk was surprising. Both of these conditions are prevalent and costly, so reducing the risk of both has the potential to improve the lives of older adults. ”
Rafeka Hossain, first author, research fellow, Tulane University School of Medicine
The study includes data from more than 21,000 women who participated in the Women’s Health Initiative, one of the nation’s largest women’s health studies.
The findings add to the evidence that heart health and bone health are closely linked. Researchers say several biological processes may help explain this association, including chronic inflammation, oxidative stress, altered calcium regulation, and decreased blood flow to bone due to atherosclerosis. Hormonal changes after menopause, particularly decreased 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 also help protect your bones, including regular physical activity, a balanced diet rich in calcium and vitamin D, not smoking, and managing conditions such as diabetes and high blood pressure,” Hossein says. “If you’ve been told you have moderate or high cardiovascular risk, especially if you’re a postmenopausal woman, it may be worth talking to your doctor about a bone health exam, given that there are many effective treatments to reduce your risk of fractures.”
The study found that women in high-risk groups tended to experience fractures earlier than women in low-risk groups. For femoral neck fractures, the median time to fracture was almost 20 years in the low-risk group compared with 15 years in the high-risk group.
Researchers caution that further research is needed before cardiovascular risk scores can be added to standard fracture screening tools. However, the findings suggest that women at moderate or high cardiovascular risk may want to talk to their doctors about their bone health, especially after menopause, the researchers said.
“Caring for the heart and bones must go hand in hand,” Hossein says.
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Reference magazines:
Hossain, R. others. (2026). Association between 10-year cardiovascular risk and fracture incidence in postmenopausal women: A prospective analysis from the Women’s Health Initiative. Lancet Community Health – Americas. DOI: 10.1016/j.lana.2026.101440. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(26)00070-0/fulltext
