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The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study

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A Correction to this article was published on 01 July 2019

An Erratum to this article was published on 20 March 2014

This article has been updated

Abstract

Summary

We examined the relation between a biomechanical measure, factor-of-risk, and hip fracture risk in 1,100 men and women from the Framingham Study and found that it predicted hip fracture (men, ORs of 1.8; women, 1.2–1.4).

Introduction

Alternative methods of predicting hip fracture are needed since 50% of adults who fracture do not have osteoporosis by bone mineral density (BMD) measurements. One method, factor-of-risk (Φ), computes the ratio of force on the hip in a fall to femoral strength. We examined the relation between Φ and hip fracture in 1,100 subjects from the Framingham Study with measured hip BMD, along with weight, height, and age, collected in 1988–1989.

Methods

We estimated both peak and attenuated force applied to the hip in a sideways fall from standing height, where attenuated force incorporated cushioning effects of trochanteric soft tissue. Femoral strength was estimated from femoral neck BMD, using cadaveric femoral strength data. Sex-specific, age-adjusted survival models were used to calculate hazard ratios (HR) and 95% confidence intervals for the relation between Φ peak, Φ attenuated, and their components with hip fracture.

Results

In 425 men and 675 women (mean age, 76 years), 136 hip fractures occurred over median follow-up of 11.3 years. Factor-of-risk, Φ, was associated with increased age-adjusted risk for hip fracture. One standard deviation increase in Φ peak and Φ attenuated was associated with HR of 1.88 and 1.78 in men and 1.23 and 1.41 in women, respectively. Examining components of Φ, in women, we found fall force and soft tissue thickness were predictive of hip fracture independent of femoral strength (was estimated from BMD).

Conclusions

Thus, both Φ peak and Φ attenuated predict hip fracture in men and women. These findings suggest additional studies of Φ predicting hip fracture using direct measurements of trochanteric soft tissue.

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Change history

  • 01 July 2019

    The original version of this article, published 23 February 2011, unfortunately contained a mistake. The following correction has therefore been made in the original:

  • 01 July 2019

    The original version of this article, published 23 February 2011, unfortunately contained a mistake. The following correction has therefore been made in the original:

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Acknowledgments

We acknowledge grant funding for this project was provided by the American College of Rheumatology Research and Education Foundation’s Abbott Health Professional Graduate Student Research Preceptorship; the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging (R01-AR/AG 41398 and AR053986); and by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (N01-HC-25195).

Conflicts of interest

Dr. Douglas P. Kiel is involved in research grants from Novartis, Merck, Amgen, Pfizer, and Hologic, and consulting for GlaxoSmithKline, Merck, Novartis, Amgen, Eli Lilly, Procter & Gamble, Wyeth, and Sanofi Aventis. All other authors have no relevant conflicts of interest.

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Authors and Affiliations

  1. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    A. B. Dufour

  2. Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St., Boston, MA, 02131, USA

    A. B. Dufour, K. E. Broe, D. P. Kiel & M. T. Hannan

  3. Harvard Medical School, Boston, MA, USA

    D. P. Kiel, M. L. Bouxsein & M. T. Hannan

  4. Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Boston, MA, USA

    B. Roberts & M. L. Bouxsein

  5. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    D. P. Kiel & M. T. Hannan

Authors
  1. A. B. Dufour
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  2. B. Roberts
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  3. K. E. Broe
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  4. D. P. Kiel
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  5. M. L. Bouxsein
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  6. M. T. Hannan
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Correspondence to A. B. Dufour.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00198-014-2686-5.

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Dufour, A.B., Roberts, B., Broe, K.E. et al. The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study. Osteoporos Int 23, 513–520 (2012). https://doi.org/10.1007/s00198-011-1569-2

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  • DOI: https://doi.org/10.1007/s00198-011-1569-2

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