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

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ABSTRACT

Background Many risk factors for hip fractures have been suggested but 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 no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films.

Results During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1000 woman-years among those with five or more risk factors and bone density in the lowest third for their age.

Conclusions Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are 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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