Risk Factors for Hip Fracture in Middle-aged Norwegian Women and Men

Abstract

Data from a prospective study were used to investigate risk factors for hip fracture among a representative population of middle-aged adults. During the years 1974-1978, all women (n = 25,298) and men (n = 27,015) aged 35-49 years in three Norwegian counties were invited to attend a cardiovascular screening (attendance rate = 91.5%). This cohort was followed throughout 1990 with respect to hip fracture, for a total of 572,006 person-years. A total of 281 new fractures were identified, of which 71 were excluded from the analysis due to high-energy trauma or fracture in metastatic bone. Age-adjusted relative risks (RR) and 95% confidence intervals (CI) for hip fracture increased with body height in women (RR = 3.62, 95% CI 1.46-8.97, > or = 1.70 m vs. < 1.55 m) and men (RR = 2.92, 95% CI 0.94-9.05, > or = 1.85 m vs. < 1.70 m). A history of diabetes mellitus also gave elevated risk of fracture (RR = 5.81, 95% CI 2.15-15.71 in women and RR = 7.67, 95% CI 2.40-24.53 in men). In addition, hip fracture was related to body mass index (inverse), disability pension, and marital status. An increased risk for smokers appeared only among those consuming > or = 15 cigarettes per day. In multivariate analysis, all these risks remained elevated. This study suggests that, as in older populations, known risk factors for low bone mass are related to hip fracture among middle-aged adults. In addition, body height seems to have an independent influence on hip fracture incidence in this age group.

Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study

“…Between 1977 and 1983, the National Health Screening Service of Norway invited all 52 023 men and women living in the counties of Finnmark, Sogn og Fjordane, and Oppland to a second screening for cardiovascular risk factors and disease (Bjartveit et al, 1979(Bjartveit et al, , 1983Meyer et al, 1993). Participants (de®ned by having a valid serum cholesterol measurement) were 47 114 (90.6% of all invited) men and women, aged 35 ± 56 y, born between 1925and 1942in Finnmark, between 1926and 1940in Sogn og Fjordane and between 1927and 1941 Oppland.…”

“…Because of uneven distributions, the number of participants was unequal between categories, especially in categories 2 and 5 for women (Table 1). Using multiple linear regression analysis, we examined sexspeci®c differences between these categories in mean age adjusted for energy intake, mean energy intake adjusted for age, and age-and energy intake-adjusted mean levels of several other covariates (listed in Tables 2 and 3 and described in detail elsewhere; Bjartveit et al, 1979Bjartveit et al, , 1983Meyer et al, 1993Meyer et al, , 1997Gaard et al, 1995Gaard et al, , 1996.…”

Osteoblast-targeted overexpression of PPARγ inhibited bone mass gain in male mice and accelerated ovariectomy-induced bone loss in female mice

“…(22)(23)(24) However, consistent with in vitro study results, clinical studies have shown that diabetic patients taking TZD have significantly higher risk of major osteoporotic fractures compared with those on other antidiabetic agents. (25)(26)(27) Since type 2 diabetes itself imposes a higher risk for fractures, (28)(29)(30)(31)(32) the additional compounding effects of TZD on bone loss would increase the risk of fracture substantially. Similar to human studies, loss of bone mass by activation of PPARg also has been demonstrated in animal models.…”

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

“…At the present sub-study assessment, weight and height were remeasured. All patients completed a supplementary questionnaire which contained questions relating to (1) conditions predisposing to osteoporosis (family history, hepatic and renal disease, thyroid and parathyroid disease, inflammatory conditions including rheumatoid arthritis, malabsorption, glucocorticoid use, menopausal status and use of hormone replacement therapy [HRT]); (2) details of past fractures; (3) prior use of any treatment for osteoporosis or any medication influencing bone metabolism; and (4) details of previous bone density measurements. Additional data on fractures were obtained from hospitalisations recorded in the Western Australian Data Linkage System [23].…”

“…A history of diabetes, diabetes duration and chronic complications are associated with an increased risk of osteoporotic fracture [1,2], while the fracture site may also be influenced by whether or not the patient has diabetes [3]. The association between low bone mineral density (BMD) and diabetes has most consistently been observed in type 1 patients [4,5], with increased bone mineral loss attributed to early age at diagnosis, long duration, prolonged poor glycaemic control and high insulin doses [6][7][8][9].…”