Skip to main content

Advertisement

SpringerLink
Log in

Education, marital status, and risk of hip fractures in older men and women: the CHANCES project

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk.

Introduction

The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA.

Methods

A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models.

Results

Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72–0.95]. Respective HRs were 0.97 (95 % CI 0.82–1.13) for men and 0.75 (95 % CI 0.65–0.85) for women. Overall, individuals living alone, especially those aged 60–69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02–1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05).

Conclusions

The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60–69 years, when compared to those being married/cohabiting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Cooper C, Cole ZA, Holroyd CR et al (2011) IOF CSA working group on fracture epidemiology. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international osteoporosis foundation (IOF) and the European federation of pharmaceutical industry associations (EFPIA). Arch Osteoporos 8(1–2):136

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Antonovsky A (1967) Social class, life expectancy and overall mortality. Milbank Mem Fund Q 45(2):31–73

    Article  CAS  PubMed  Google Scholar 

  4. Feinstein JS (1993) The relationship between socioeconomic status and health: a review of the literature. Milbank Q 71(2):279–322

    Article  CAS  PubMed  Google Scholar 

  5. Mackenbach JP, Stirbu I, Roskam AJ et al (2008) European union working group on socioeconomic inequalities in health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481

    Article  CAS  PubMed  Google Scholar 

  6. Adler NE, Stewart J (2010) Using team science to address health disparities: MacArthur network as case example. Ann N Y Acad Sci 1186:252–260

    Article  PubMed  Google Scholar 

  7. Dupre ME, Meadow SO (2007) Disaggregating the effects of marital trajectories on health. J Fam Issues 28:623–652

    Article  Google Scholar 

  8. Robards J, Evandrou M, Falkingham J, Vlachantoni A (2012) Marital status, health and mortality. Maturitas 73(4):295–299

    Article  PubMed Central  PubMed  Google Scholar 

  9. Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18(3):333–337

    Article  CAS  PubMed  Google Scholar 

  10. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, IOF Working Group on Epidemiology and Quality of Life (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Farahmand BY, Persson PG, Michaëlsson K, Baron JA, Parker MG, Ljunghall S (2000) Swedish hip fracture group. Socioeconomic status, marital status and hip fracture risk: a population-based case–control study. Osteoporos Int 11(9):803–808

    Article  CAS  PubMed  Google Scholar 

  12. Zigmond DS, Soohoo NF, Silverman SL (2006) The role of socioeconomic status on hip fracture. Osteoporos Int 17(10):1562–1568

    Article  Google Scholar 

  13. Brennan SL, Henry MJ, Kotowicz MA, Nicholson GC, Zhang Y, Pasco JA (2011) Incident hip fracture and social disadvantage in an Australian population aged 50 years or greater. Bone 48(3):607–610

    Article  CAS  PubMed  Google Scholar 

  14. Guilley E, Herrmann F, Rapin CH, Hoffmeyer P, Rizzoli R, Chevalley T (2011) Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly. Osteoporos Int 22(2):647–653

    Article  CAS  PubMed  Google Scholar 

  15. Quah C, Boulton C, Moran C (2011) The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. J Bone Joint Surg (Br) 93(6):801–805

    Article  CAS  Google Scholar 

  16. Crandall CJ, Han W, Greendale GA et al (2014) Socioeconomic status in relation to incident fracture risk in the study of women’s health across the nation. Osteoporos Int 25(4):1379–1388

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Reimers A, Laflamme L (2007) Hip fractures among the elderly: personal and contextual social factors that matter. J Trauma 62(2):365–369

    Article  PubMed  Google Scholar 

  18. Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20(9):1487–1497

    Article  CAS  PubMed  Google Scholar 

  19. Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case–control study from Denmark. Scand J Public Health 34(4):371–377

    Article  PubMed  Google Scholar 

  20. Syddall HE, Evandrou M, Dennison EM et al (2012) Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire cohort study. Arch Osteoporos 7(1–2):37–48

    Article  PubMed Central  PubMed  Google Scholar 

  21. Boffetta P, Bobak M, Borsch-Supan A et al (2014) The consortium on health and ageing: network of cohorts in Europe and the United States (CHANCES) project-design, population and data harmonization of a large-scale, international study. Eur J Epidemiol 29(12):929–36

    Article  PubMed  Google Scholar 

  22. Trichopoulou A, Orfanos P, Norat T et al (2005) Modified mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991

    Article  PubMed Central  PubMed  Google Scholar 

  23. Gao L, Weck MN, Michel A, Pawlita M, Brenner H (2009) Association between chronic atrophic gastritis and serum antibodies to 15 Helicobacter pylori proteins measured by multiple serology. Cancer Res 69(7):2973–2980

    Article  CAS  PubMed  Google Scholar 

  24. Ahmed LA, Schirmer H, Bjørnerem A et al (2009) The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24(8):441–448

    Article  PubMed  Google Scholar 

  25. Harris H, Håkansson N, Olofsson C, Julin B, Åkesson A, Wolk A (2013) The Swedish mammography cohort and the cohort of Swedish men: study design and characteristics of two population-based longitudinal cohorts. OA Epidemiology 1(2):16

    Article  Google Scholar 

  26. Colditz GA, Hankinson SE (2005) The nurses’ health study: lifestyle and health among women. Nat Rev Cancer 5(5):388–396

    Article  CAS  PubMed  Google Scholar 

  27. Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19(6):860–867

    Article  PubMed  Google Scholar 

  28. Colditz GA, Martin P, Stampfer MJ et al (1986) Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol 123(5):894–900

    CAS  PubMed  Google Scholar 

  29. Ludvigsson JF, Andersson E, Ekbom A et al (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450

    Article  PubMed Central  PubMed  Google Scholar 

  30. Wilson RT, Chase GA, Chrischilles EA, Wallace RB (2006) Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. Am J Public Health 96(7):1210–1218

    Article  PubMed Central  PubMed  Google Scholar 

  31. Bacon WE, Hadden WC (2000) Occurrence of hip fractures and socioeconomic position. J Aging Health 12(2):193–203

    Article  CAS  PubMed  Google Scholar 

  32. Icks A, Haastert B, Wildner M et al (2009) Hip fractures and area level socioeconomic conditions: a population-based study. BMC Public Health 9:114

    Article  PubMed Central  PubMed  Google Scholar 

  33. Laaksonen M, Talala K, Martelin T et al (2008) Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health 18(1):38–43

    Article  PubMed  Google Scholar 

  34. Kanis JA, Johnell O, Odén A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162

    Article  CAS  PubMed  Google Scholar 

  35. Benetou V, Orfanos P, Benetos IS et al (2011) Anthropometry, physical activity and hip fractures in the elderly. Injury 42(2):188–193

    Article  PubMed  Google Scholar 

  36. Berg KM, Kunins HV, Jackson JL et al (2008) Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med 121(5):406–418

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Coulson CE, Williams LJ, Henry MJ et al (2010) Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines. Aust N Z J Psychiatry 44(10):946–51

    Article  PubMed  Google Scholar 

  38. McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev 29:29–48

    Article  PubMed  Google Scholar 

  39. Johansson H, Kanis JA, Odén A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29(1):223–233

    Article  PubMed  Google Scholar 

  40. Brennan SL, Henry MJ, Nicholson GC, Kotowicz MA, Pasco JA (2009) Socioeconomic status and risk factors for obesity and metabolic disorders in a population-based sample of adult females. Prev Med 49(2–3):165–71

    Article  PubMed  Google Scholar 

  41. Södergren M, Wang WC, Salmon J, Ball K, Crawford D, McNaughton SA (2014) Predicting healthy lifestyle patterns among retirement age older adults in the WELL study: a latent class analysis of sex differences. Maturitas 77(1):41–6

    Article  PubMed  Google Scholar 

  42. Manzoli L, Villari P, Pirone GM, Boccia A (2007) Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med 64(1):77–94

    Article  PubMed  Google Scholar 

  43. Goldman N, Korenman S, Weinstein R (1995) Marital status and health among the elderly. Soc Sci Med 40(12):1717–1730

    Article  CAS  PubMed  Google Scholar 

  44. Staehelin K, Schindler C, Spoerri A, Zemp Stutz E, Swiss National Cohort Study Group (2012) Marital status, living arrangement and mortality: does the association vary by gender? J Epidemiol Community Health 66(7):e22

    Article  PubMed  Google Scholar 

  45. Dykstra PA, de Jong GJ (2004) Gender and marital-history differences in emotional and social loneliness among Dutch older adults. Can J Aging 23(2):141–155

    Article  PubMed  Google Scholar 

  46. Schousboe JT, Paudel ML, Taylor BC et al (2013) Magnitude and consequences of misclassification of incident hip fractures in large cohort studies: the study of osteoporotic fractures and medicare claims data. Osteoporos Int 24(3):801–10

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Chen Z, Kooperberg C, Pettinger MB et al (2004) Validity of self-report for fractures among a multi-ethnic cohort of postmenopausal women: results from the women’ health initiative observational study and clinical trials. Menopause 11(3):264–274

    Article  PubMed  Google Scholar 

References for the Appendix

  1. Trichopoulou A, Orfanos P, Norat T et al (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991

  2. Riboli E, Hunt KJ, Slimani N. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5(6B):1113–1124

  3. Gao L, Weck MN, Michel A, Pawlita M, Brenner H. (2009) Association between chronic atrophic gastritis and serum antibodies to 15 Helicobacter pylori proteins measured by multiple serology. Cancer Res 69(7):2973–2980

  4. Schöttker, Müller H, Rothenbacher D, Brenner H. (2013) Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus. Diabetologia 56(1):92–100

  5. Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. (2012) Cohort profile: The Tromsø Study. Int J Epidemiol 41(4):961–967

  6. Ahmed LA, Schirmer H, Bjørnerem A et al (2009).The genderand age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24(8):441–448

  7. Ahmed LA, Center JR, Bjørnerem A et al (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Miner Res 28(10):2214–2221

  8. Harris H, Håkansson N, Olofsson C, Julin B, Åkesson A, Wolk A (2013) The Swedish mammography cohort and the cohort of Swedish men: study design and characteristics of two population-based longitudinal cohorts. OA Epidemiology 1(2):16

  9. Boffetta P, Bobak M, Borsch-Supan A, et al (2014) The Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) project-design, population and data harmonization of a large-scale, international study. Eur J Epidemiol. 29(12):929–36

  10. Colditz GA, Hankinson SE (2005) The Nurses’ Health Study: lifestyle and health among women. Nat Rev Cancer 5(5):388–396

Download references

Conflicts of interest

None.

Funding

This work, derived from the CHANCES project, was supported by the FP7 framework programme of DG-RESEARCH in the European Commission [Grant number: HEALTH-F3-2010-242244]. The project is coordinated by the Hellenic Health Foundation, Greece. The national cohorts are supported by (1) EPIC-Elderly Greece: the Hellenic Health Foundation; (2) EPIC-Elderly Umea, Sweden: the Swedish Cancer Society and the Swedish Research Council; (3) ESTHER, Germany: the Baden-Württemberg state Ministry of Science, Research and Arts (Stuttgart, Germany), the Federal Ministry of Education and Research (Berlin, Germany) and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany); (4) the Tromsø study: UiT–The Arctic University of Norway, the National Screening Services, the Research Council of Norway, Northern Norway Regional Health Authority, the Norwegian Council on Cardiovascular Diseases, the Norwegian Foundation for Health and Rehabilitation, the Norwegian Diabetes Association, the Cancer Registry of Norway, the Odd Berg Group Research Fund, and Troms County Council; (5) COSM and SMC, Karolinska Institutet, Sweden: the Swedish Research Council Karolinska Institutet’s Strategic Foundation and Uppsala University, and the Swedish Cancer Society; (6) NHS: the National Cancer Institute [grant P01CA87969].

Author information

Authors and Affiliations

  1. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece

    V. Benetou, P. Orfanos, E. Klinaki, E. Valanou & A. Trichopoulou

  2. Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece

    V. Benetou, P. Orfanos, E.-M. Papatesta, P. Boffetta & A. Trichopoulou

  3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    D. Feskanich & F. Grodstein

  4. Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden

    K. Michaëlsson

  5. Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    U. Pettersson-Kymmer

  6. Department of Health and Care Sciences, Faculty of Health Sciences, UiT–The Arctic University of Norway, Tromsø, Norway

    L. A. Ahmed

  7. Department of Epidemiology and Public Health, University College London, London, UK

    A. Peasey & M. Bobak

  8. Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden

    A. Wolk & A. Bellavia

  9. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany

    H. Brenner, B. Schöttker & K.-U. Saum

  10. Department of Community Medicine, Faculty of Health Sciences, UiT–The Arctic University of Norway, Tromsø, Norway

    T. Wilsgaard

  11. Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA

    P. Boffetta

  12. Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates

    L. A. Ahmed

Authors
  1. V. Benetou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Orfanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Feskanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Michaëlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Pettersson-Kymmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. A. Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Peasey
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Wolk
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Bobak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. T. Wilsgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. B. Schöttker
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. K.-U. Saum
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A. Bellavia
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. F. Grodstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. E. Klinaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. E. Valanou
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. E.-M. Papatesta
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. P. Boffetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. A. Trichopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Benetou.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Fig. S1

(DOC 125 kb)

Appendix

Appendix

The participating cohorts

EPIC Elderly (European Prospective Investigation into Cancer and Nutrition)

EPIC-Elderly cohort consists of approximately 100,000 participants (aged 60 years and older at recruitment) recruited initially in the EPIC Study [48]. EPIC is an ongoing, multicenter, prospective cohort study aiming to investigate the role of biological, dietary, lifestyle, and environmental factors in the aetiology of cancer and other chronic diseases. Twenty-three research centers from 10 European countries participate in EPIC (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). Recruitment took place from 1992 to 2000 via administration of baseline questionnaires and interviews. After enrolment, participants were followed up at regular intervals every 3–4 years [49].

ESTHER (Epidemiological Study on the Chances of Prevention, Early Recognition at Optimised Treatment of Chronic Diseases in the Older Population)

ESTHER Study is a population-based cohort study comprising of 9949 adults, aged 50–74 years, who were recruited during 2000–2002 from the entire federal state of Saarland in Germany [50, 51]. Participants were approached during a general health check-up at their general practitioner’s office where they completed a detailed self-administered questionnaire and provided biological samples (blood, stool, urine). Until 2012, three recontacts took place (2, 5, and 8 years after baseline) where all participants completed a standardized questionnaire, similar to that at baseline. In addition, detailed medical data were obtained from the general practitioners, and a comprehensive follow-up with respect to overall and cause-specific mortality and cancer incidence was conducted through record linkage with data from population registries, public health offices, and the Saarland Cancer Registry.

The Tromsø Study

The Tromsø Study is a repeated population-based health survey of inhabitants in the municipality of Tromsø in Norway [52]. The examinations were repeated in 1974 (Tromsø 1), 1979–1980 (Tromsø 2), 1986–1987 (Tromsø 3), 1994–1995 (Tromsø 4), 2001 (Tromsø 5), and 2007–2008 (Tromsø 6). In all surveys, the participants completed self-administered questionnaires covering a wide range of variables of interest. Mortality was assessed until the end of 2009 for this study, via record linkage to National Population Register [53, 54]. Since Tromsø 4 and thereafter, the fracture registry was initiated. Available for CHANCES are four surveys between 1979–1980 and 2001 (Tromsø 2 to 5), for Tromsø 2 (8477 men aged 20–54 years, 8144 women aged 20–49 years), for Tromsø 3 (10413 men aged 20–61 years, 10,189 women aged 20–56 years), for Tromsø 4 (12,865 men and n = 14,293 women aged 25+ years), and for Tromsø 5 (3511 men and n = 4619 women aged 30–89 years).

The Swedish Mammography Cohort (SMC) and the Cohort Of Swedish Men (COSM)

Two population-based prospective cohort studies provided data for the present analyses. The SMC was established between 1987 and 1990, when all women born between 1914 and 1948 and living in central Sweden received a mailed questionnaire that elicited information on diet, weight, height, and education; 66,651 women returned a completed questionnaire. In 1997, an expanded questionnaire that included data on various lifestyle factors and medical history was mailed to women who were still alive and residing in the study area; 39,227 women (70 %) completed the questionnaire. At the same time, 48,850 men born between 1918 and 1952 and residing in central Sweden were enrolled in the COSM after returning a mailed questionnaire that was identical to the 1997 SMC questionnaire (except for some sex-specific questions). The studies were approved by the Regional Ethical Review Board in Stockholm [55].

For the purposes of the CHANCES project, only participants 60 years and older at recruitment were included, that is 19,581 women aged 60–83 years from the SMC study, and 22,661 men aged 60–79 years from the COSM study [56].

The Nurses’ Health Study (NHS)

The NHS started in 1976 when 121,701 married female registered nurses, aged 30–55 years, residents in 11 US states, responded to initial mailed questionnaire collecting information on lifestyle practices, medical history, and risk factors related to cancer and other health outcomes [57]. Follow-up questionnaires were sent every 2 years in order to update individual characteristics and to identify incident diseases. The NHS was approved by the Institutional Review Board of the Brigham and Women’s Hospital.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Benetou, V., Orfanos, P., Feskanich, D. et al. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project. Osteoporos Int 26, 1733–1746 (2015). https://doi.org/10.1007/s00198-015-3054-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3054-9

Keywords

Search

Navigation