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Risk factors for hip fractures in a middle-aged population: a study of 33,000 men and women

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Abstract

Knowledge about subjects who sustain hip fractures in middle age is poor. This study prospectively investigated risk factors for hip fracture in middle age and compared risk factors for cervical and trochanteric hip fractures. The Malmö Preventive Project consists of 22,444 men, mean age 44 years, and 10,902 women, mean age 50 years at inclusion. Baseline assessment included multiple examinations and lifestyle information. Follow-up was up to 16 years with regard to occurrence of fracture. One hundred thirty-five women had one low-energy hip fracture each, 93 of which were cervical and 42 trochanteric. One hundred sixty-three men had 166 hip fractures, of which 81 were cervical and 85 trochanteric. In the final Cox regression model for women, the risk factors with the strongest associations with hip fracture were diabetes (risk ratio (RR) 3.89, 95% confidence interval (CI) 1.69–8.93, p =0.001) and poor self-rated health (RR 1.74, 95%CI 1.22–2.48, p =0.002). A history of previous fracture (RR 4.76, 95%CI 2.74–8.26, p =0.0001) was also a significant risk factor. In men, diabetes had the strongest association with hip fracture (RR 6.13, 95%CI 3.19–11.8, p =0.001). Smoking (RR 2.20, 95%CI 1.54–3.15, p =0.001), high serum γ-glutamyl transferase (RR 1.84, 95%CI 1.50–2.26, p =0.001), poor self-rated health (RR 1.49, 95%CI 1.06–2.10, p =0.02) and reported sleep disturbances (RR 1.52, 95%CI 1.03–2.27, p =0.04) were other significant risk factors. The strongest risk factor for hip fracture for both women and men in middle age was diabetes. Many risk factors were similar for men and women, although the risk ratio differed. The risk factor pattern for cervical versus trochanteric fractures differed in both men and women. The findings indicate that those suffering a hip fracture before the age of 75 have a shorter life expectancy, suggesting that hip fractures affect the less healthy segment of the population.

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References

  1. Cree M et al (2000) Mortality and institutionalization following hip fracture. J Am Geriatr Soc 48(3):283–288

    PubMed  Google Scholar 

  2. Fransen M et al (2002) Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc 50(4):685–690

    Article  PubMed  Google Scholar 

  3. Richmond J et al (2003) Mortality risk after hip fracture. J Orthop Trauma 17(1):53–56

    Article  PubMed  Google Scholar 

  4. Sernbo I, Johnell O (1993) Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 3(3):148–153

    Article  PubMed  Google Scholar 

  5. Kanis JA et al (2003) The components of excess mortality after hip fracture. Bone 32(5):468–473

    Article  PubMed  Google Scholar 

  6. Melton LJ 3rd (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14 [Suppl 1]:S1–8

    Google Scholar 

  7. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289

    PubMed  Google Scholar 

  8. Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413

    PubMed  Google Scholar 

  9. Robinson CM et al (1995) Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop (312):238–246

    Google Scholar 

  10. Rogmark C et al (1999) Incidence of hip fractures in Malmo, Sweden, 1992–1995. A trend-break. Acta Orthop Scand 70(1):19–22

    PubMed  Google Scholar 

  11. Stewart A et al (2000) Prevalence of hip fracture risk factors in women aged 70 years and over. QJM 93(10):677–680

    Article  PubMed  Google Scholar 

  12. Johnell O et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10(11):1802–1815

    PubMed  Google Scholar 

  13. Cummings SR et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–773

    Article  PubMed  Google Scholar 

  14. Michaelsson K et al (1999) Differences in risk factor patterns between cervical and trochanteric hip fractures. Swedish Hip Fracture Study Group. Osteoporos Int 10(6):487–494

    Article  PubMed  Google Scholar 

  15. Merilainen S et al (2002) Risk factors for cervical and trochanteric hip fracture during a fall on the hip. Scand J Prim Health Care 20(3):188–192

    Article  PubMed  Google Scholar 

  16. Koval KJ et al (1996) Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop, (330):166–172

  17. Fox KM et al (2000) Femoral neck and intertrochanteric fractures have different risk factors: a prospective study. Osteoporos Int 11(12):1018–1023

    Article  PubMed  Google Scholar 

  18. Fox KM et al (1999) Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment, and sequelae. J Gerontol A Biol Sci Med Sci 54(12):M635–640

    PubMed  Google Scholar 

  19. Mautalen CA, Vega EM, Einhorn TA (1996) Are the etiologies of cervical and trochanteric hip fractures different? Bone 18 [Suppl 3]:133S–137S

  20. Greenspan SL et al (1994) Trochanteric bone mineral density is associated with type of hip fracture in the elderly. J Bone Miner Res 9(12):1889–1894

    PubMed  Google Scholar 

  21. Vega E et al (1991) Bone mineral density in patients with cervical and trochanteric fractures of the proximal femur. Osteoporos Int 1(2):81–86

    Article  PubMed  Google Scholar 

  22. Berglund G et al (1996) Cardiovascular risk groups and mortality in an urban Swedish male population: the Malmo Preventive Project. J Intern Med 239(6):489–497

    Article  PubMed  Google Scholar 

  23. Holmberg A et al (2004) Forearm bone mineral density in 1,294 middle-aged women: a strong predictor of fragility fractures. J Clin Densitom 7(4):419–423

    Article  PubMed  Google Scholar 

  24. Jonsson B et al (1993) Life-style and different fracture prevalence: a cross-sectional comparative population-based study. Calcif Tissue Int 52(6):425–433

    Article  PubMed  Google Scholar 

  25. Kanis J et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 9(1):45–54

    Article  PubMed  Google Scholar 

  26. Kanis JA et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382

    Article  PubMed  Google Scholar 

  27. Johnell O et al (2004) Associations between baseline risk factors and vertebral fracture risk in the Multiple Outcomes of Raloxifene Evaluation (MORE) Study. J Bone Miner Res 19(5):764–772

    PubMed  Google Scholar 

  28. Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137(11):1203–1211

    PubMed  Google Scholar 

  29. Leidig-Bruckner G, Ziegler R (2001) Diabetes mellitus a risk for osteoporosis? Exp Clin Endocrinol Diabetes 109 [Suppl 2]:S493–514

    Google Scholar 

  30. Nicodemus KK, Folsom AR (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24(7):1192–1197

    PubMed  Google Scholar 

  31. Adami S et al (2004) Relationship between lipids and bone mass in 2 cohorts of healthy women and men. Calcif Tissue Int 74(2):136–142

    Article  PubMed  Google Scholar 

  32. Lidfeldt J et al (2002) The influence of hormonal status and features of the metabolic syndrome on bone density: a population-based study of Swedish women aged 50 to 59 years. The women’s health in the Lund area study. Metabolism 51(2):267–270

    Article  PubMed  Google Scholar 

  33. Kanis JA et al (2004) Smoking and fracture risk: a meta-analysis. Osteoporos Int

    Google Scholar 

  34. Conigrave KM et al (2003) Traditional markers of excessive alcohol use. Addiction 98 [Suppl 2]:31–43

    Google Scholar 

  35. Mussolino ME et al (1998) Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. J Bone Miner Res 13(6):918–924

    PubMed  Google Scholar 

  36. Felson DT et al (1988) Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 128(5):1102–1110

    PubMed  Google Scholar 

  37. Hoidrup S et al (1999) Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen Centre for Prospective Population Studies. Am J Epidemiol 149(11):993–1001

    PubMed  Google Scholar 

  38. Af Sillén U et al (2005) Self-related health in relation to age and gender: Influence on mortality risk in the Malmö Preventive Project. Scand J Public Health :1–7

    Google Scholar 

  39. Ward JA et al (1995) Physiologic, health and lifestyle factors associated with femoral neck bone density in older women. Bone 16(4 Suppl):373S–378S

    PubMed  Google Scholar 

  40. Orwoll ES, Bevan L, Phipps KR (2000) Determinants of bone mineral density in older men. Osteoporos Int 11(10):815–821

    Article  PubMed  Google Scholar 

  41. Huuskonen J et al (2000) Determinants of bone mineral density in middle-aged men: a population-based study. Osteoporos Int 11(8):702–708

    Article  PubMed  Google Scholar 

  42. Nguyen TV et al (1994) Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 9(9):1339–1346

    PubMed  Google Scholar 

  43. Nilsson P, Berglund G (2000) Prevention of cardiovascular disease and diabetes: lessons from the Malmo Preventive Project. J Intern Med 248(6):455–462

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Lund University, Malmö University Hospital, 20502, Malmö, Sweden

    Anna H. Holmberg, Olof Johnell & Kristina Åkesson

  2. Department of Medicine, Lund University, Malmö University Hospital, 20502 , Malmö, Sweden

    Peter M. Nilsson, Jan-Åke Nilsson, Jan-Åke Nilsson & Göran Berglund

Authors
  1. Anna H. Holmberg
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  2. Olof Johnell
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  3. Peter M. Nilsson
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  4. Jan-Åke Nilsson
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  5. Göran Berglund
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  6. Kristina Åkesson
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Correspondence to Anna H. Holmberg.

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Holmberg, A.H., Johnell, O., Nilsson, P.M. et al. Risk factors for hip fractures in a middle-aged population: a study of 33,000 men and women. Osteoporos Int 16, 2185–2194 (2005). https://doi.org/10.1007/s00198-005-2006-1

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  • DOI: https://doi.org/10.1007/s00198-005-2006-1

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