Osteoporosis International

, Volume 22, Issue 2, pp 541–549

Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance


    • National Center for Health StatisticsCenters for Disease Control and Prevention
  • B. Dawson-Hughes
    • Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University
  • A. N. A. Tosteson
    • Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth Medical School
  • H. Johansson
    • WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical School
  • J. A. Kanis
    • WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical School
  • L. J. MeltonIII
    • Division of Epidemiology, College of MedicineMayo Clinic
Original Article

DOI: 10.1007/s00198-010-1288-0

Cite this article as:
Looker, A.C., Dawson-Hughes, B., Tosteson, A.N.A. et al. Osteoporos Int (2011) 22: 541. doi:10.1007/s00198-010-1288-0



This analysis of National Health and Nutrition Examination Survey III data found a significant risk of incident hip fracture in adults aged 65 years and older who are candidates for treatment to lower fracture risk, according to the new National Osteoporosis Foundation Clinician's Guide.


The relationship between treatment eligibility by the new National Osteoporosis Foundation (NOF) Guide to the Prevention and Treatment of Osteoporosis and the risk of subsequent hip fracture is unknown.


The study sample consisted of 3,208 men and women ages 65 years and older who were examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988–1994), a nationally representative survey. Risk factors used to define treatment eligibility at baseline were measured in NHANES III or were simulated using World Health Organization study cohorts. Incident hip fractures were ascertained using linked mortality and Medicare records that were obtained for NHANES III participants through December 31, 2000. Cox proportional hazards models were used to estimate the relative risk (RR) of hip fracture by treatment eligibility status.


The RR for subsequent hip fracture was 4.9 (95% CI 3.30, 7.94) in treatment-eligible vs treatment-ineligible persons. The increased risk for treatment-eligible persons remained statistically significant when examined by sex or age: RRmen = 5.5 (2.6, 11.4) and RRwomen = 4.3 (2.2, 8.4); RR65-79 y = 4.8 (2.6, 8.7) and RR80+ y = 4.6 (2.1, 10.1).


Treatment-eligible persons were about five times more likely to experience a subsequent hip fracture than the non-eligible persons. The new NOF guidelines appear to predict future hip fracture risk equally in men as in women, and fracture risk prediction did not appear to diminish with age.


Incident hip fractureNational Osteoporosis Foundation Clinician's GuidePopulation studyTreatment eligibility

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010