Menopausal Status, Age at Menopause, and Fracture Risk in Women: A Systematic Review of Observational Studies

Early menopause is thought to raise fracture risk, but observational studies define menopause and fracture differently.This systematic review related menopausal status, age at menopause, reproductive span, and surgical menopause to fracture risk in women.PubMed, Europe PMC, and Google Scholar were searched on August 30, 2026, followed by a broadened PubMed search on September 21, 2026, and supplementary PubMed and Europe PMC searches on October 22, 2026, which identified one more report; unsystematic searches outside the databases identified four further reports.The review was not registered, and the eligibility criteria were amended after full-text screening decisions had been made.A total of 17 reports (13 cohort and four case-control studies) from 15 distinct source populations were included; four were extracted from abstracts only.Fragility fracture was the stated outcome in four reports; the rest used any-site, osteoporosis-related, or single-site fracture.Newcastle-Ottawa Scale scores (minimum totals) were 4-8 of 9 for 11 rated cohort studies and 2 and 4 for two rated case-control studies.Synthesis was narrative because of heterogeneity.Earlier natural menopause was associated with higher fracture risk in several analyses, but findings were inconsistent and depended on the exposure definition, comparison group, population, and fracture outcome.Longer reproductive span was associated with lower risk in some analyses.Surgical menopause showed no clear association in two cohorts, although precision was limited for some comparisons; one abstract-only report found more hip fractures after iatrogenic menopause in cancer survivors.Evidence on verified fragility fracture was sparse.The findings are observational; certainty of evidence was not formally graded, and causation cannot be inferred.