Risk Factors for Hip Fracture in White Women

doi:10.1056/NEJM199503233321202

Volume 332:767-774		March 23, 1995		Number 12

Risk Factors for Hip Fracture in White Women

Steven R. Cummings, M.D., Michael C. Nevitt, Ph.D., Warren S. Browner, M.D., M.P.H., Katie Stone, M.A., Kathleen M. Fox, Ph.D., Kristine E. Ensrud, M.D., M.P.H., Jane Cauley, Dr.P.H., Dennis Black, Ph.D., Thomas M. Vogt, M.D., M.P.H., for The Study of Osteoporotic Fractures Research Group

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ABSTRACT

Background Many risk factors for hip fractures have been suggestedbut have not been evaluated in a comprehensive prospective study.

Methods We assessed potential risk factors, including bone mass,in 9516 white women 65 years of age or older who had had noprevious hip fracture. We then followed these women at 4-monthintervals for an average of 4.1 years to determine the frequencyof hip fracture. All reports of hip fractures were validatedby review of x-ray films.

Results During the follow-up period, 192 women had first hipfractures not due to motor vehicle accidents. In multivariableage-adjusted analyses, a maternal history of hip fracture doubledthe risk of hip fracture (relative risk, 2.0; 95 percent confidenceinterval, 1.4 to 2.9), and the increase in risk remained significantafter adjustment for bone density. Women who had gained weightsince the age of 25 had a lower risk. The risk was higher amongwomen who had previous fractures of any type after the age of50, were tall at the age of 25, rated their own health as fairor poor, had previous hyperthyroidism, had been treated withlong-acting benzodiazepines or anticonvulsant drugs, ingestedgreater amounts of caffeine, or spent four hours a day or lesson their feet. Examination findings associated with an increasedrisk included the inability to rise from a chair without usingone's arms, poor depth perception, poor contrast sensitivity,and tachycardia at rest. Low calcaneal bone density was alsoan independent risk factor. The incidence of hip fracture rangedfrom 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1000woman-years among women with no more than two risk factors andnormal calcaneal bone density for their age to 27 (95 percentconfidence interval, 20 to 34) per 1000 woman-years among thosewith five or more risk factors and bone density in the lowestthird for their age.

Conclusions Women with multiple risk factors and low bone densityhave an especially high risk of hip fracture. Maintaining bodyweight, walking for exercise, avoiding long-acting benzodiazepines,minimizing caffeine intake, and treating impaired visual functionare among the steps that may decrease the risk.

Source Information

From the Division of General Internal Medicine (S.R.C., W.S.B.) and the Department of Epidemiology and Biostatistics (S.R.C., M.C.N., W.S.B., K.S., D.B.), University of California, San Francisco; the Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore (K.M.F.); the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (K.E.E.); the Department of Epidemiology, University of Pittsburgh, Pittsburgh (J.C.); and the Kaiser Permanente Center for Health Research, Portland, Oreg. (T.M.V.).

Address reprint requests to Dr. Cummings at the Prevention Sciences Group, 74 New Montgomery St., Suite 600, San Francisco, CA 94105.

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