Osteoporosis International

, Volume 17, Issue 7, pp 1065–1077 | Cite as

Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women

  • A. H. Holmberg
  • O. Johnell
  • P. M. Nilsson
  • J. Nilsson
  • G. Berglund
  • K. Åkesson
Original Article


The incidence of fragility fractures begins to increase in middle age. We investigated prospectively risk factors for low-energy fractures in men and women, and specifically for forearm, proximal humerus, vertebral, and ankle fractures. The population-based Malmö Preventive Project consists of 22,444 men and 10,902 women, mean age 44 and 50 years, respectively, at inclusion. Baseline assessment included multiple examinations and lifestyle information. Mean follow-up was 19 and 15 years for men and women, respectively, regarding incident fractures. Fractures were ascertained from radiographic files. At least one low-energy fracture occurred in 1,262 men and 1,257 women. In men, the risk factors most strongly associated with low-energy fractures were diabetes [relative risk (RR) 2.38, confidence interval (CI) 95% 1.65–3.42] and hospitalization for mental health problems (RR 1.92, CI 95% 1.47–2.51). Factors associated with mental health and lifestyle significantly increased the fracture risk in most of the specific fracture groups: hospitalizations for mental health problems (RR 2.28–3.38), poor appetite (RR 3.05–3.43), sleep disturbances (RR 1.72–2.95), poor self-rated health (RR 1.80–1.83), and smoking (RR 1.70–2.72). In women, the risk factors most strongly associated with low-energy fractures were diabetes (RR 1.87, CI 95% 1.26–2.79) and previous fracture (RR 2.00, CI 95% 1.56–2.58). High body mass index (BMI) significantly increased the risk of proximal humerus and ankle fractures (RR 1.21–1.33) while, by contrast, lowering the risk of forearm fractures (RR 0.88, CI 95% 0.81–0.96). Risk factors for fracture in middle-aged men and women are similar but with gender differences for forearm, vertebral, proximal humerus, and hip fracture whereas risk factors for ankle fractures differ to a certain extent. The risk-factor pattern indicates a generally impaired health status, with mental health problems as a major contributor to fracture risk, particularly in men.


Diabetes Fragility fractures Mental health Risk factors 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • A. H. Holmberg
    • 1
  • O. Johnell
    • 1
  • P. M. Nilsson
    • 2
  • J. Nilsson
    • 1
  • G. Berglund
    • 2
  • K. Åkesson
    • 1
    • 3
  1. 1.Clinical and Molecular Research Unit, Department of Clinical Sciences MalmöLund University, Malmö University HospitalMalmöSweden
  2. 2.Internal Medicine Research Unit, Department of Clinical Sciences MalmöLund University, Malmö University HospitalMalmöSweden
  3. 3.Department of OrthopaedicsMalmö University HospitalMalmöSweden

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