Osteoporosis International

, Volume 22, Issue 4, pp 1263–1274 | Cite as

Clinical and demographic factors associated with fractures among older Americans

  • A. J. TaylorEmail author
  • L. C. Gary
  • T. Arora
  • D. J. Becker
  • J. R. Curtis
  • M. L. Kilgore
  • M. A. Morrisey
  • K. G. Saag
  • R. Matthews
  • H. Yun
  • W. Smith
  • E. Delzell
Original Article



Medicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.


This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies.


We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005.


For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture.


This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.


Epidemiology Fractures Incidence Medicare Osteoporosis 


Conflicts of interest

This research was supported by a contract between UAB and Amgen, Inc. Only the authors from UAB had access to the Medicare data used. The analysis, presentation, and interpretation of the results were solely the responsibility of the authors. Some of the investigators (JRC, KGS) also receive salary support from the National Institutes of Health (AR053351, AR052361), the Agency for Healthcare Research and Quality (U18 HS016956), and the Arthritis Foundation (JRC). Two investigators received research support from Novartis, Merck, Eli Lilly, Amgen (JRC, KGS), and Procter & Gamble (JRC), in a consulting and/or advisory board role for Procter & Gamble (JRC), Novartis, Merck, Eli Lilly, and Amgen (KGS) and as members of the speakers bureau for Novartis (JRC, KGS) and for Procter & Gamble and Eli Lilly (JRC).

Supplementary material

198_2010_1300_MOESM1_ESM.pdf (32 kb)
ESM 1 (PDF 31 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • A. J. Taylor
    • 1
    • 2
    Email author
  • L. C. Gary
    • 2
  • T. Arora
    • 1
  • D. J. Becker
    • 2
  • J. R. Curtis
    • 3
  • M. L. Kilgore
    • 2
  • M. A. Morrisey
    • 2
  • K. G. Saag
    • 3
  • R. Matthews
    • 1
  • H. Yun
    • 1
  • W. Smith
    • 1
  • E. Delzell
    • 1
  1. 1.Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Health Care Organization and PolicyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Division of Clinical Immunology and RheumatologyUniversity of Alabama at BirminghamBirminghamUSA

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