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Hip Fracture Risk (hip + fracture_risk)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2009
Eric S Orwoll
Abstract Low areal BMD (aBMD) is associated with increased risk of hip fracture, but many hip fractures occur in persons without low aBMD. Finite element (FE) analysis of QCT scans provides a measure of hip strength. We studied the association of FE measures with risk of hip fracture in older men. A prospective case-cohort study of all first hip fractures (n = 40) and a random sample (n = 210) of nonfracture cases from 3549 community-dwelling men ,65 yr of age used baseline QCT scans of the hip (mean follow-up, 5.6 yr). Analyses included FE measures of strength and load-to-strength ratio and BMD by DXA. Hazard ratios (HRs) for hip fracture were estimated with proportional hazards regression. Both femoral strength (HR per SD change = 13.1; 95% CI: 3.9,43.5) and the load-to-strength ratio (HR = 4.0; 95% CI: 2.7,6.0) were strongly associated with hip fracture risk, as was aBMD as measured by DXA (HR = 5.1; 95% CI: 2.8,9.2). After adjusting for age, BMI, and study site, the associations remained significant (femoral strength HR = 6.5, 95% CI: 2.3,18.3; load-to-strength ratio HR = 4.3, 95% CI: 2.5,7.4; aBMD HR = 4.4, 95% CI: 2.1,9.1). When adjusted additionally for aBMD, the load-to-strength ratio remained significantly associated with fracture (HR = 3.1, 95% CI: 1.6,6.1). These results provide insight into hip fracture etiology and demonstrate the ability of FE-based biomechanical analysis of QCT scans to prospectively predict hip fractures in men. [source]

Osteoporosis medication profile preference: results from the PREFER-US study

HEALTH EXPECTATIONS, Issue 3 2007
Thomas W. Weiss DrPH
Abstract Objective, To assess patient preferences for two osteoporosis medications. Design, Women aged 50+ were surveyed via the Internet to assess preferences for two osteoporosis medication profiles. Drug A and Drug B, consistent with ibandronate and alendronate, respectively, differed by: time on market (recently vs. 10 years), dosing frequency (monthly vs. weekly), effectiveness (not proven vs. proven to reduce non-spine or hip fracture after 3 years) and dosing procedure (60 vs. 30 min wait before eating/drinking). Each profile had the same out-of-pocket costs, side-effects, potential for drug interaction and spine fracture efficacy. Patients force ranked and rated the importance of each attribute. Subgroup comparisons included diagnosed vs. at-risk respondents and treated vs. untreated respondents. Results, Among the 999 respondents, Drug B was preferred by 96%. Effectiveness was ranked as the most important determinant of preference (79% ranked it #1) compared with time on market (14%), dosing procedure (4%) and dosing frequency (3%). Effectiveness had the highest mean importance rating on a scale of 1 (extremely unimportant) to 7 (extremely important): mean (SD) = 6.1 (1.8), followed by time on market: 4.7 (1.7), dosing procedure: 4.6 (1.4) and dosing frequency: 4.5 (1.4). No significant differences in profile choice were found across study subgroups. Conclusions, The drug profile showing reductions in non-vertebral and hip fracture risk was chosen by almost all respondents. Drug effectiveness was the most important determinant of preference, while dosing frequency was the least important determinant. Incorporation of patient preferences in the medication decision-making process could enhance patient compliance and clinical outcomes. [source]

Respiratory Function as a Marker of Bone Health and Fracture Risk in an Older Population,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009
Alireza Moayyeri
Abstract Identification of those at high risk of osteoporosis and fractures using clinically available tests beyond BMD measures is a major clinical challenge. We examined forced expiratory volume in 1 s (FEV1), an easily obtainable measure of respiratory function, as a clinical measure for fracture prediction. In the context of the European Prospective Investigation into Cancer-Norfolk Study, 8304 women and 6496 men 42,81 yr of age underwent a health check including spirometry and heel quantitative ultrasonography between 1997 and 2000 and were followed up for incident hip fractures until 2007. The main outcome measures were broadband ultrasound attenuation (BUA) of the heel (cross-sectional analysis) and hip fracture risk (prospective analysis). In multivariate regression models, a 1-liter increase in FEV1 was associated with a statistically significant 2.2-dB/MHz increase in BUA, independent of age, smoking, height, body mass index, history of fracture, and use of corticosteroids. Mean FEV1 was significantly lower among 84 women and 36 men with hip fracture compared with other participants. In multivariate proportional-hazard regression models, the relative risk (RR) of hip fracture associated with a 1-liter increase in FEV1 was 0.5 (95% CI, 0.3,0.9; p < 0.001) for both men and women. RR of hip fracture for a 1 SD increase in FEV1 was approximately equivalent to a 0.5 SD increase in BUA among women (1 SD among men) and an ,5-yr decrease in age among both men and women. Middle-aged and older people with low respiratory function are at increased risk of osteoporosis and hip fracture. FEV1, an easy, low-cost, and feasible clinical measure, may help improve the identification of high-risk groups. [source]

Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men,

Fracture Risk in Type 2 Diabetes: Update of a Population-Based Study,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2008
L Joseph Melton III
Abstract We found no significant excess of fractures among Rochester, MN, residents with diabetes mellitus initially recognized in 1950,1969, but more recent studies elsewhere have documented an apparent increase in hip fracture risk. To explore potential explanations for any increase in fractures, we performed an historical cohort study among 1964 Rochester residents who first met glycemic criteria for diabetes in 1970,1994 (mean age, 61.7 ± 14.0 yr; 51% men). Fracture risk was estimated by standardized incidence ratios (SIRs), and risk factors were evaluated in Andersen-Gill time-to-fracture regression models. In 23,236 person-years of follow-up, 700 diabetic residents experienced 1369 fractures documented by medical record review. Overall fracture risk was elevated (SIR, 1.3; 95% CI, 1.2,1.4), but hip fractures were increased only in follow-up beyond 10 yr (SIR, 1.5; 95% CI, 1.1,1.9). As expected, fracture risk factors included age, prior fracture, secondary osteoporosis, and corticosteroid use, whereas higher physical activity and body mass index were protective. Additionally, fractures were increased among patients with neuropathy (hazard ratio [HR], 1.3; 95% CI, 1.1,1.6) and those on insulin (HR, 1.3; 95% CI, 1.1,1.5); risk was reduced among users of biquanides (HR, 0.7; 95% CI, 0.6,0.96), and no significant influence on fracture risk was seen with sulfonylurea or thiazolidinedione use. Thus, contrary to our earlier study, the risk of fractures overall (and hip fractures specifically) was increased among Rochester residents with diabetes, but there was no evidence that the rise was caused by greater levels of obesity or newer treatments for diabetes. [source]

Physical Performance and Risk of Hip Fractures in Older Men,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2008
Peggy Mannen Cawthon
Abstract The aim of these analyses was to describe the association between physical performance and risk of hip fractures in older men. Performance on five physical function exams (leg power, grip strength, usual walking pace, narrow walk balance test, and five repeated chair stands) was assessed in 5902 men ,65 yr of age. Performance (time to complete or strength) was analyzed as quartiles, with an additional category for unable to complete the measure, in proportional hazards models. Follow-up averaged 5.3 yr; 77 incident hip fractures were confirmed by physician review of radiology reports. Poor physical performance was associated with an increased risk of hip fracture. In particular, repeated chair stand performance was strongly related to hip fracture risk. Men unable to complete this exam were much more likely to experience a hip fracture than men in the fastest quartile of this test (multivariate hazard ratio [MHR]: 8.15; 95% CI: 2.65, 25.03). Men with the worst performance (weakest/slowest quartile or unable) on at least three exams had an increased risk of hip fracture compared with men with higher functioning (MHR: 3.14, 95% CI: 1.46, 6.73). Nearly two thirds of the hip fractures (N = 49, 64%) occurred in men with poor performance on at least three exams. Poor physical function is independently associated with an increased risk of hip fracture in older men. The repeated chair stands exam should be considered in clinical settings for evaluation of hip fracture risk. Concurrent poor performance on multiple physical function exams is associated with an increased risk of hip fractures. [source]

Assessment of the 10-Year Probability of Osteoporotic Hip Fracture Combining Clinical Risk Factors and Heel Bone Ultrasound: The EPISEM Prospective Cohort of 12,958 Elderly Women,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2008
Didier Hans
Abstract This study aimed to develop a hip screening tool that combines relevant clinical risk factors (CRFs) and quantitative ultrasound (QUS) at the heel to determine the 10-yr probability of hip fractures in elderly women. The EPISEM database, comprised of ,13,000 women ,70 yr of age, was derived from two population-based white European cohorts in France and Switzerland. All women had baseline data on CRFs and a baseline measurement of the stiffness index (SI) derived from QUS at the heel. Women were followed prospectively to identify incident fractures. Multivariate analysis was performed to determine the CRFs that contributed significantly to hip fracture risk, and these were used to generate a CRF score. Gradients of risk (GR; RR/SD change) and areas under receiver operating characteristic curves (AUC) were calculated for the CRF score, SI, and a score combining both. The 10-yr probability of hip fracture was computed for the combined model. Three hundred seven hip fractures were observed over a mean follow-up of 3.2 yr. In addition to SI, significant CRFs for hip fracture were body mass index (BMI), history of fracture, an impaired chair test, history of a recent fall, current cigarette smoking, and diabetes mellitus. The average GR for hip fracture was 2.10 per SD with the combined SI + CRF score compared with a GR of 1.77 with SI alone and of 1.52 with the CRF score alone. Thus, the use of CRFs enhanced the predictive value of SI alone. For example, in a woman 80 yr of age, the presence of two to four CRFs increased the probability of hip fracture from 16.9% to 26.6% and from 52.6% to 70.5% for SI Z-scores of +2 and ,3, respectively. The combined use of CRFs and QUS SI is a promising tool to assess hip fracture probability in elderly women, especially when access to DXA is limited. [source]

Femoral Neck BMD Is a Strong Predictor of Hip Fracture Susceptibility in Elderly Men and Women Because It Detects Cortical Bone Instability: The Rotterdam Study,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2007
Fernando Rivadeneira
Abstract We studied HSA measurements in relation to hip fracture risk in 4806 individuals (2740 women). Hip fractures (n = 147) occurred at the same absolute levels of bone instability in both sexes. Cortical instability (propensity of thinner cortices in wide diameters to buckle) explains why hip fracture risk at different BMD levels is the same across sexes. Introduction: Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute BMD. We aimed to elucidate the main structural properties of bone that underlie the measured BMD and that ultimately determines the risk of hip fracture in elderly men and women. Materials and Methods: This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 yr). Indices compared in relation to fracture included neck width, cortical thickness, section modulus (an index of bending strength), and buckling ratio (an index of cortical bone instability). We used a mathematical model to calculate the hip fracture distribution by femoral neck BMD, BMC, bone area, and hip structure analysis (HSA) parameters (cortical thickness, section modulus narrow neck width, and buckling ratio) and compared it with prospective data from the Rotterdam Study. Results: In the prospective data, hip fracture cases in both sexes had lower BMD, thinner cortices, greater bone width, lower strength, and higher instability at baseline. In fractured individuals, men had an average BMD that was 0.09 g/cm2 higher than women (p < 0.00001), whereas no significant difference in buckling ratios was seen. Modeled fracture distribution by BMD and buckling ratio levels were in concordance to the prospective data and showed that hip fractures seem to occur at the same absolute levels of bone instability (buckling ratio) in both men and women. No significant differences were observed between the areas under the ROC curves of BMD (0.8146 in women and 0.8048 in men) and the buckling ratio (0.8161 in women and 0.7759 in men). Conclusions: The buckling ratio (an index of bone instability) portrays in both sexes the critical balance between cortical thickness and bone width. Our findings suggest that extreme thinning of cortices in expanded bones plays a key role on local susceptibility to fracture. Even though the buckling ratio does not offer additional predictive value, these findings improve our understanding of why low BMD is a good predictor of fragility fractures. [source]

Evidence From Data Searches and Life-Table Analyses for Gender-Related Differences in Absolute Risk of Hip Fracture After Colles' or Spine Fracture: Colles' Fracture as an Early and Sensitive Marker of Skeletal Fragility in White Men,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2004
Patrick Haentjens
Abstract Based on data searches and life-table analyses, we determined the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture after sustaining a Colles' or spine fracture and searched for potential gender-related differences. In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. Introduction: Colles' fracture occurrence has been largely ignored in public health approaches to identify target populations at risk for hip fracture. The aim of this study was to estimate the long-term and short-term absolute risks of hip fracture after sustaining a Colles' or spine fracture and to search for potential gender-related differences in the relationship between fracture history and future fracture risk. Materials and Methods: To determine the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture, we applied life-table methods using U.S. age- and sex-specific hip fracture incidence rates, U.S. age-specific mortality rates for white women and men, pooled hazard ratios for mortality after Colles' and spine fracture, and pooled relative risks for hip fracture after Colles' and spine fracture, estimated from cohort studies by standard meta-analytic methods. Results: Our results indicate that the estimated remaining lifetime risks are dependent on age in both genders. In women, remaining lifetime risks increase until the age of 80 years, when they start to decline because of the competing probabilities of fracture and death. The same pattern is found in men until the age of 85 years, the increment in lifetime risk being even more pronounced. As expected, the risk of sustaining a hip fracture was found to be higher in postmenopausal women with a previous spine fracture compared with those with a history of Colles' fracture. In men, on the other hand, the prospective association between fracture history and subsequent hip fracture risk seemed to be strongest for Colles' fracture. At the age of 50, for example, the remaining lifetime risk was 13% in women with a previous Colles' fracture compared with 15% in the context of a previous spine fracture and 9% among women of the general population. In men at the age of 50 years, the corresponding risk estimates were 8%, 6%, and 3%, respectively. Similar trends were observed when calculating 5- and 10-year risks. Conclusions: In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. The gender-related differences reported in this analysis should be taken into account when designing screening and treatment strategies for prevention of hip fracture in men. [source]

Genome Screen for Quantitative Trait Loci Underlying Normal Variation in Femoral Structure

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2001
Daniel L. Koller
Abstract Femoral structure contributes to bone strength at the proximal femur and predicts hip fracture risk independently of bone mass. Quantitative components of femoral structure are highly heritable traits. To identify genetic loci underlying variation in these structural phenotypes, we conducted an autosomal genome screen in 309 white sister pairs. Seven structural variables were measured from femoral radiographs and used in multipoint sib-pair linkage analyses. Three chromosomal regions were identified with significant evidence of linkage (log10 of the odds ratio [LOD] > 3.6) to at least one femoral structure phenotype. The maximum LOD score of 4.3 was obtained for femur neck axis length on chromosome 5q. Evidence of linkage to chromosome 4q was found with both femur neck axis length (LOD = 3.9) and midfemur width (LOD = 3.5). Significant evidence of linkage also was found to chromosome 17q, with a LOD score of 3.6 for femur head width. Two additional chromosomal regions 3q and 19p gave suggestive (LOD > 2.2) evidence of linkage with at least two of the structure phenotypes. Chromosome 3 showed evidence of linkage with pelvic axis length (LOD = 3.1), midfemur width (LOD = 2.8), and femur head width (LOD = 2.3), spanning a broad (60 cm) region of chromosome 3q. Linkage to chromosome 19 was supported by two phenotypes, femur neck axis length (LOD = 2.8) and femur head width (LOD = 2.8). This study is the first genome screen for loci underlying variation in femoral structure and represents an important step toward identifying genes contributing to the risk of osteoporotic hip fracture in the general population. [source]

Use of Oral Corticosteroids and Risk of Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2000
T. P. Van Staa
Abstract Treatment with oral corticosteroids is known to decrease bone density but there are few data on the attendant risk of fracture and on the reversibility of this risk after cessation of therapy. A retrospective cohort study was conducted in a general medical practice setting in the United Kingdom (using data from the General Practice Research Database [GPRD]). For each oral corticosteroid user aged 18 years or older, a control patient was selected randomly, who was matched by age, sex, and medical practice. The study comprised 244,235 oral corticosteroid users and 244,235 controls. The average age was 57.1 years in the oral corticosteroid cohort and 56.9 years in the control cohort. In both cohorts 58.6% were female. The most frequent indication for treatment was respiratory disease (40%). The relative rate of nonvertebral fracture during oral corticosteroid treatment was 1.33 (95% confidence interval [CI], 1.29,1.38), that of hip fracture 1.61 (1.47,1.76), that of forearm fracture 1.09 (1.01,1.17), and that of vertebral fracture 2.60 (2.31,2.92). A dose dependence of fracture risk was observed. With a standardized daily dose of less than 2.5 mg prednisolone, hip fracture risk was 0.99 (0.82,1.20) relative to control, rising to 1.77 (1.55,2.02) at daily doses of 2.5,7.5 mg, and 2.27 (1.94,2.66) at doses of 7.5 mg or greater. For vertebral fracture, the relative rates were 1.55 (1.20,2.01), 2.59 (2.16,3.10), and 5.18 (4.25,6.31), respectively. All fracture risks declined toward baseline rapidly after cessation of oral corticosteroid treatment. These results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm. They also suggest a rapid offset of this increased fracture risk on cessation of therapy, which has implications for the use of preventative agents against bone loss in patients at highest risk. [source]