Osteoporotic fractures represent a major public health burden, accounting for substantial morbidity, mortality, and healthcare costs among older women. This study evaluated whether surgical menopause is associated with a higher risk of postmenopausal osteoporotic fracture compared with natural menopause. Using 20 years of prospective data from 9,704 community-dwelling Caucasian women aged 65 years and older in the Study of Osteoporotic Fractures, women were categorized by menopausal status and followed for nontraumatic, nonvertebral fractures. Multivariable Cox proportional hazards models, stratified by oral estrogen use, were used to estimate fracture risk. Among women who had never used oral estrogen, surgical menopause was associated with a modestly increased risk of nonvertebral fracture compared with natural menopause (RR 1.23, 95% CI 1.04–1.45). However, surgical menopause was not associated with an increased risk of hip or wrist fracture. These findings suggest that surgical menopause does not increase the risk of the most clinically significant osteoporotic fractures, although a small increase in nonvertebral fracture risk may exist among women who have never used oral estrogen.
