ArticleFertility and sterility2026
The association of infertility, miscarriage, stillbirth, and parity with osteoporosis: a pooled analysis of five cohort studies.
Article in Fertility and sterility, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo test, among women with natural menopause, whether: infertility, miscarriage, stillbirth, and low parity are associated with a higher risk of osteoporosis; menopause age can partly explain their associations.
designPooled analysis of five retrospective and prospective cohorts within the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events. SUBJECTS: A total of 141,222 naturally postmenopausal women with data on fertility factors (i.e., infertility, miscarriage, stillbirth, or parity), osteoporosis, and covariates (i.e., race, age at last follow-up, education level, smoking status, alcohol intake, body mass index, physical activity level, and age at menarche). EXPOSURE: The history of infertility, miscarriage, stillbirth, and parity was self-reported.
main outcome measuresOsteoporosis was identified through surveys, hospital, death registry, primary care, or pharmaceutical data. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between fertility factors and osteoporosis, taking into account clustering within each cohort. All models were first adjusted for fixed covariates, including race, education level, smoking status, alcohol intake, body mass index, physical activity level, and age at menarche, and then time-varying covariate of age at natural menopause.
resultsThere was a modestly higher risk of osteoporosis for women with a history of infertility (HR = 1.16, 95% CI: 1.13-1.19), recurrent miscarriages (≥3; HR = 1.17, 95% CI: 1.05-1.30), stillbirth (HR = 1.14, 95% CI: 1.10-1.17), and low parity (no live births: HR = 1.20, 95% CI: 1.15-1.25; 1 live birth: HR = 1.15, 95% CI: 1.14-1.16). These associations were unchanged or only slightly attenuated after additional adjustment for age at natural menopause.
conclusionThese female-specific factors could be considered as part of the risk assessment and may inform prevention strategies for osteoporosis.
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