Reduced Incidence of Hip Fracture in the Old Order Amish

Authors

  • Elizabeth A Streeten,

    Corresponding author
    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
    • Address reprint requests to: Elizabeth A Streeten, MD, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Room N3W130, 22 South Greene Street, Baltimore, MD 21201, USA
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  • Daniel J Mcbride,

    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
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  • Amy L Lodge,

    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
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  • Toni I Pollin,

    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
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  • David G Stinchcomb,

    1. Spatial Approaches to Health Outcomes, Center for Health Statistics, Texas Department of Health, Austin, Texas, USA
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  • Richa Agarwala,

    1. Information Engineering Branch, National Center for Biotechnology Information, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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  • Alejandro A Schäffer,

    1. Computational Biology Branch, National Center for Biotechnology Information, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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  • Jay R Shapiro,

    1. Kennedy Kreiger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. The Armed Forces University, Bethesda, Maryland, USA
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  • Alan R Shuldiner,

    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
    2. Geriatric Research and Education Clinical Center (GRECC), Veterans Administration Medical Center, Baltimore, Maryland, USA
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  • Braxton D Mitchell

    1. Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
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  • The authors have no conflict of interest.

Abstract

The incidence of hip fracture was estimated in a community of Old Order Amish and compared with available data from non-Amish whites. Hip fracture rates were 40% lower in the Amish, and the Amish also experienced higher BMD.

Introduction: Understanding the patterns of fracture risk across populations could reveal insights about bone health and lead to the earlier detection and prevention of osteoporosis. Toward this aim, we compared hip fracture incidence and bone mineral density (BMD) between an Old Order Amish (OOA) community, characterized by a rural and relatively active lifestyle, and non-Amish U.S. whites.

Materials and Methods: All hospital admissions for hip fracture among OOA individuals in Lancaster County, PA, were identified between 1995 and 1998 from four area hospitals. Hip fracture incidence was calculated by cross-referencing an available Anabaptist genealogy database with communities located within these hospital service areas and compared with non-Amish whites obtained from National Hospital Discharge data. Additionally, BMD at the hip was compared between 287 Amish subjects and non-Amish whites from the National Health and Nutrition Examination Survey III survey.

Results and Conclusions: OOA experienced 42% fewer hip fractures than would be expected had they experienced the same rate of hip fracture as observed in non-Amish whites (p < 0.01) and a higher mean BMD that was significant in women (p < 0.05) but not men. Further evaluation of lifestyle and/or genetic differences between Amish and non-Amish populations may shed insights into etiologic factors influencing hip fracture risk.

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