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Identification of high-risk individuals for hip fracture: a 14-year prospective study.

Abstract

In this 14-year prospective study, men and women were found to share a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. The combination of these risk factors accounted for 57% and 37% of hip fractures in women and men, respectively.

INTRODUCTION

Risk factors for hip fracture, including low BMD, identified in women, have not been shown to be useful in men. It is also not known whether fall-related factors (muscle strength and postural instability) predict hip fracture. This study examined the association between falls-related factors and hip fractures in elderly men and women.

MATERIALS AND METHODS

This is an epidemiologic, community-based prospective study, which included 960 women and 689 men > or = 60 years of age who have been followed for a median of 12 years (interquartile range, 6-13). The number of person-years was 9961 for women and 4463 for men. The outcome measure was incidence of hip fracture. Risk factors were femoral neck BMD (FNBMD), postural sway, quadriceps strength, prior fracture, and fall.

RESULTS

Between 1989 and 2003, 115 (86 women) sustained a hip fracture. The risk of hip fracture (as measured by hazards ratio [HR]) was increased by 3.6-fold (95% CI: 2.6-4.5) in women and 3.4-fold (95% CI: 2.5-4.6) in men for each SD (0.12 g/cm2) reduction in FNBMD. After adjusting for BMD, the risk of hip fracture was also increased in individuals with the highest tertile of postural sway (HR: 2.7; 95% CI: 1.6-4.5) and low tertiles of quadriceps strength (HR: 3.0; 95% CI: 1.3-6.8). Furthermore, a history of fall during the preceding 12 months and a history of fracture were independent predictors of hip fracture. For each level of BMD, the risk of hip fracture increased linearly with the number of non-BMD risk factors. Approximately 57% and 37% of hip fracture cases in women and men, respectively, were attributable to the presence of risk factors, osteoporosis (BMD T score < or = -2.5), and advancing age.

CONCLUSIONS

Men and women had a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. Preventive strategies should simultaneously target reducing falls and improvement of bone strength in both men and women.

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  • Authors+Show Affiliations

    ,

    Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia.

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    Source

    MeSH

    Accidental Falls
    Age Factors
    Aged
    Australia
    Bone Density
    Female
    Fractures, Bone
    Hip Fractures
    Humans
    Male
    Middle Aged
    Multivariate Analysis
    Osteoporosis
    Postural Balance
    Proportional Hazards Models
    Prospective Studies
    Quadriceps Muscle
    Risk Assessment
    Risk Factors
    Sex Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16234964

    Citation

    Nguyen, Nguyen D., et al. "Identification of High-risk Individuals for Hip Fracture: a 14-year Prospective Study." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 20, no. 11, 2005, pp. 1921-8.
    Nguyen ND, Pongchaiyakul C, Center JR, et al. Identification of high-risk individuals for hip fracture: a 14-year prospective study. J Bone Miner Res. 2005;20(11):1921-8.
    Nguyen, N. D., Pongchaiyakul, C., Center, J. R., Eisman, J. A., & Nguyen, T. V. (2005). Identification of high-risk individuals for hip fracture: a 14-year prospective study. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 20(11), pp. 1921-8.
    Nguyen ND, et al. Identification of High-risk Individuals for Hip Fracture: a 14-year Prospective Study. J Bone Miner Res. 2005;20(11):1921-8. PubMed PMID: 16234964.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Identification of high-risk individuals for hip fracture: a 14-year prospective study. AU - Nguyen,Nguyen D, AU - Pongchaiyakul,Chatlert, AU - Center,Jacqueline R, AU - Eisman,John A, AU - Nguyen,Tuan V, Y1 - 2005/05/31/ PY - 2005/01/23/received PY - 2005/04/11/revised PY - 2005/05/27/accepted PY - 2005/10/20/pubmed PY - 2006/2/28/medline PY - 2005/10/20/entrez SP - 1921 EP - 8 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 20 IS - 11 N2 - UNLABELLED: In this 14-year prospective study, men and women were found to share a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. The combination of these risk factors accounted for 57% and 37% of hip fractures in women and men, respectively. INTRODUCTION: Risk factors for hip fracture, including low BMD, identified in women, have not been shown to be useful in men. It is also not known whether fall-related factors (muscle strength and postural instability) predict hip fracture. This study examined the association between falls-related factors and hip fractures in elderly men and women. MATERIALS AND METHODS: This is an epidemiologic, community-based prospective study, which included 960 women and 689 men > or = 60 years of age who have been followed for a median of 12 years (interquartile range, 6-13). The number of person-years was 9961 for women and 4463 for men. The outcome measure was incidence of hip fracture. Risk factors were femoral neck BMD (FNBMD), postural sway, quadriceps strength, prior fracture, and fall. RESULTS: Between 1989 and 2003, 115 (86 women) sustained a hip fracture. The risk of hip fracture (as measured by hazards ratio [HR]) was increased by 3.6-fold (95% CI: 2.6-4.5) in women and 3.4-fold (95% CI: 2.5-4.6) in men for each SD (0.12 g/cm2) reduction in FNBMD. After adjusting for BMD, the risk of hip fracture was also increased in individuals with the highest tertile of postural sway (HR: 2.7; 95% CI: 1.6-4.5) and low tertiles of quadriceps strength (HR: 3.0; 95% CI: 1.3-6.8). Furthermore, a history of fall during the preceding 12 months and a history of fracture were independent predictors of hip fracture. For each level of BMD, the risk of hip fracture increased linearly with the number of non-BMD risk factors. Approximately 57% and 37% of hip fracture cases in women and men, respectively, were attributable to the presence of risk factors, osteoporosis (BMD T score < or = -2.5), and advancing age. CONCLUSIONS: Men and women had a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. Preventive strategies should simultaneously target reducing falls and improvement of bone strength in both men and women. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/16234964/Identification_of_high_risk_individuals_for_hip_fracture:_a_14_year_prospective_study_ L2 - https://doi.org/10.1359/JBMR.050520 DB - PRIME DP - Unbound Medicine ER -