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

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

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Notes

  1. May be unreliable, estimate/standard error >30%

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Conflicts of interest

Dr. Anne Looker: nothing to disclose

Dr. Bess Dawson-Hughes: National Osteoporosis Foundation, National Osteoporosis Foundation Physician Guide Committee chairman, International Osteoporosis Foundation; consultant to : Amgen, Cytochroma, Danone, GlaxoSmithKline, Johnson &Johnson, Eli Lilly, Merck, Pfizer, Procter and Gamble, Servier, and Unilever.

Dr. Anna Tosteson: National Osteoporosis Foundation Physician Guide Committee member, consultant to Amgen Inc. and Eli Lilly & Co.

Dr. Helena Johansson: nothing to disclose

Dr. John Kanis: nothing relevant to disclose

Dr. L. Joseph Melton: National Osteoporosis Foundation Physician Guide Committee member

Author information

Authors and Affiliations

  1. National Center for Health Statistics, Centers for Disease Control and Prevention, Rm 4310, 3311 Toledo Rd, Hyattsville, MD, 20782, USA

    A. C. Looker

  2. Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA

    B. Dawson-Hughes

  3. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA

    A. N. A. Tosteson

  4. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

    H. Johansson & J. A. Kanis

  5. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    L. J. Melton III

Authors
  1. A. C. Looker
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  2. B. Dawson-Hughes
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  3. A. N. A. Tosteson
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  4. H. Johansson
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  5. J. A. Kanis
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  6. L. J. Melton III
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Corresponding author

Correspondence to A. C. Looker.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the US Department of Agriculture.

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Looker, A.C., Dawson-Hughes, B., Tosteson, A.N.A. et al. Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance. Osteoporos Int 22, 541–549 (2011). https://doi.org/10.1007/s00198-010-1288-0

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