Long-Term Prediction of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures

Authors

  • Brent C. Taylor MPH,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Pamela J. Schreiner PhD,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Katie L. Stone PhD,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Howard A. Fink MD, MPH,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Steven R. Cummings MD,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Michael C. Nevitt PhD,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Paula J. Bowman MPH,

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Kristine E. Ensrud MD, MPH

    1. From the *Division of Epidemiology, School of Public Health, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Departments of Medicine§Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaGeriatric Research Education and Clinical Center, and Center for Chronic Disease Outcome Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Research Institute, California Pacific Medical Center, San Francisco, California.
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  • Grant Support from the National Institutes of Health through the National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grants AG05394, AR35582, AR35583, AR35584, and AG05407).

Address correspondence to Kristine Ensrud, Department of Medicine (111–0), VA Medical Center, One Veterans Drive, Minneapolis, MN 55417. E-mail: ensru001@tc.umn.edu

Abstract

Objectives: To identify independent risk factors for first hip fracture over 10 years of follow-up.

Design: Prospective cohort study.

Setting: Four U.S. clinical centers.

Participants: A total of 6,787 women aged 66 and older in the Study of Osteoporotic Fractures.

Measurements: Total hip bone mineral density (BMD) using dual-energy x-ray absorptiometry and a comprehensive set of potential risk factors were collected. Incident hip fractures were identified prospectively and confirmed using radiographic report.

Results: Six hundred two women (8.9%) had a hip fracture during a mean ±standard deviation (SD) follow-up of 10.1±3.2 years. Older age, previous self-reported fracture after age 50, maternal history of hip fracture after age 50, greater height at age 25, impaired cognition, slower walking speed, nulliparity, type II diabetes mellitus, Parkinson's disease, and depth perception each independently predicted a 1.17- to 1.83-fold increase in hip fracture risk, whereas each SD (0.13 g/cm2) decrease in hip BMD was independently associated with a 1.84-fold increase in risk. Lower body mass index also was associated with an increased risk of hip fracture, although lower hip BMD largely explained this association.

Conclusion: Although hip BMD is strongly related to hip fracture risk in elderly white women, other clinical risk factors also are independent predictors of long-term risk and provide additional insight into the prevention of fracture in high-risk women. Clinicians should be alert to factors other than BMD that place older women at a high risk of hip fracture.

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