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Incidence and risk factors for a second hip fracture in elderly women. The Study of Osteoporotic Fractures

Abstract

Women with hip fracture have an increased risk of second hip fracture but other risk factors for a second hip fracture have not been established. We sought to determine the incidence and risk factors for second hip fracture, in a prospective cohort study of community-dwelling postmenopausal women over 65 years: the Study of Osteoporotic Fractures. From a cohort of 9,704 women, 632 women with a documented first hip fracture during the study were followed up until a second hip fracture or the end of follow-up. Clinical risk factors and bone mineral density were assessed at the beginning of the study. Fifty-three second hip fractures were validated by radiographs. Women with hip fracture had a 2.3% per year risk of second hip fracture. Women who walked for exercise at baseline were less likely to sustain a second hip fracture with a relative risk (RR) of 0.5 [0.3–0.9], as were those who had normal depth perception (RR=0.5 [0.3–0.9]). Women who lost weight since age 25 years had an increased risk of second incident hip fracture (RR = 2.7 [1.6–4.6]), as did those who had a low calcaneal bone mineral density (RR=1.5 [1.1–2.0] per standard deviation decrease in bone mineral density). Current use of estrogen replacement therapy at baseline was protective (RR=0.5 [0.3–0.9]) up to 2 years of follow-up. We conclude that community-dwelling women with a first hip fracture have a high risk of second hip fracture, and risk factors for this second fracture are similar to those of first hip fracture.

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References

  1. Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, collar, or vertebral fracture and coronary artery disease among white postmenopausal women. Arch Intern Med 1989;149:2445–8.

    CAS  PubMed  Google Scholar 

  2. Beatriz JE, Perry HM III. Age-related osteoporosis. Clin Geriatr Med 1994;10:575–87.

    PubMed  Google Scholar 

  3. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995;332:767–73.

    CAS  PubMed  Google Scholar 

  4. Dargent-Molina P, Favier F, Grandjean H, et al. Fall related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996;348:145–9.

    CAS  PubMed  Google Scholar 

  5. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637–42.

    CAS  PubMed  Google Scholar 

  6. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348:1535–41.

    CAS  PubMed  Google Scholar 

  7. McClung M, Gueusens P, Miller PD, et al. Risedronate reduces hip fracture risk in elderly women with osteoporosis. N Engl J Med 2001;344:333–40.

    Article  CAS  PubMed  Google Scholar 

  8. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282:637–45.

    CAS  PubMed  Google Scholar 

  9. Kamel HK, Hussain MS, Tariq S, et al. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 2000;109:326–8.

    CAS  PubMed  Google Scholar 

  10. Black DM, Arden NK, Palermo L, et al. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 1999;14:821–8.

    CAS  PubMed  Google Scholar 

  11. Mallmin H, Ljunghall S, Persson I, et al. Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 1993;52:269–72.

    CAS  PubMed  Google Scholar 

  12. Dretakis E, Kritsikis N, Economou K, Christodolou N. Bilateral non-contemporary fractures of the proximal femur. Acta Orthop Scand 1981;52:227–9.

    CAS  PubMed  Google Scholar 

  13. Melton LJ, Ilstrup DM, Beckenbaugh RD, Riggs BL. Hip fracture recurrence. A population-based study. Clin Orthop 1982;167:131–8.

    PubMed  Google Scholar 

  14. Boston DA. Bilateral fractures of the femoral neck. Injury 1983;14:207–10.

    Google Scholar 

  15. Finsen V, Benum P. The second hip fracture. An epidemiologic study. Acta Orthop Scand 1986;57:431–3.

    CAS  PubMed  Google Scholar 

  16. Chiu KY, Pun WK, Luk KDK, Chow SP. Sequential fractures of both hips in elderly patients. A prospective study. J Trauma 1992;32:584–7.

    CAS  PubMed  Google Scholar 

  17. Schroder HM, Petersen KK, Erlansdsen M. Occurrence and incidence of the second hip fracture. Clin Orthop 1993;289:166–9.

    PubMed  Google Scholar 

  18. Wolinsky FD, Fitzgerald JF. Subsequent hip fracture among older adults. Am J Public Health 1994;84:1316–8.

    CAS  PubMed  Google Scholar 

  19. Dretakis KE, Dretakis EK, Papakitsou EF, Psarakis S, Teriopoulos K. Possible predisposing factors for the second hip fracture. Calcif Tissue Int 1998;62:366–9.

    Article  CAS  Google Scholar 

  20. Stewart A, Walker LG, Porter RW, Reid DM, Primrose WR. Predicting a second hip fracture. J Clin Densitom 1999;2:363–70.

    CAS  PubMed  Google Scholar 

  21. Dirschl DR, Piedrahita L, Henderson RC. Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study. Bone 2000;26:95–8.

    Article  CAS  PubMed  Google Scholar 

  22. Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone density and age predict hip fracture in women. JAMA 1990;263:665–8.

    CAS  PubMed  Google Scholar 

  23. Farmer ME, White LR, Brody JA, Bailey DR. Race and sex differences in hip fracture incidence. Am J Public Health 1984;74:1374–80.

    CAS  PubMed  Google Scholar 

  24. Black DM, Palermo L, Nevitt MC, et al. Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Miner Res 1995;10:890–902.

    CAS  PubMed  Google Scholar 

  25. Kleinbaum DG. Survival analysis. Berlin Heidelberg New York: Springer, 1996.

  26. Grambsch PM, Therneau TM. Proportional hazards tests and diagnostic based on weighted residuals. Biometrika 1994;81:515–26.

    Google Scholar 

  27. Schroder HM, Petersen KK, Erlandsen M. Occurrence and incidence of the second hip fracture. Clin Orthop 1993;289:166–9.

    PubMed  Google Scholar 

  28. Fox KM, Cummings SR, Williams E, Stone K. Femoral neck and intertrochanteric fractures have different risk factors: a prospective study. Osteoporos Int 2000;11:1018–23.

    Article  CAS  PubMed  Google Scholar 

  29. Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for falls as a cause of hip fracture in women. N Engl J Med 1991;324:1326–31.

    CAS  PubMed  Google Scholar 

  30. Farmer ME, Harris T, Madans JH, et al. Anthropometric indicators and hip fracture: the NHANES I epidemiologic follow-up study. J Am Geriatr Soc 1989;37:9–16.

    CAS  PubMed  Google Scholar 

  31. Chapurlat RD, Garnero P, Bréart G, et al. Serum estradiol and sex hormone binding globulin and the risk of hip fracture in elderly women: the EPIDOS study. J Bone Miner Res 2000;15:1835–41.

    CAS  PubMed  Google Scholar 

  32. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fractures in ambulatory elderly. JAMA 1994;271:128–33.

    CAS  PubMed  Google Scholar 

  33. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254–9.

    CAS  PubMed  Google Scholar 

  34. Cauley JA, Seeley DG, Ensrud K, et al. Estrogen replacement therapy and fractures in older women. Ann Intern Med 1995;122:9–16.

    CAS  PubMed  Google Scholar 

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Acknowledgements

The Study of Osteoporotic Fractures has been funded by grants from the Public Health Service (1 RO1-AG05407, 1 RO1-AR35582, 5 RO1-AG05394, 1 RO1-AM35584, and 1 RO1-AR35583).

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Correspondence to R. D. Chapurlat.

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Chapurlat, R.D., Bauer, D.C., Nevitt, M. et al. Incidence and risk factors for a second hip fracture in elderly women. The Study of Osteoporotic Fractures. Osteoporos Int 14, 130–136 (2003). https://doi.org/10.1007/s00198-002-1327-6

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  • DOI: https://doi.org/10.1007/s00198-002-1327-6

Keywords

  • Estrogen
  • Osteoporosis
  • Risk factors
  • Second hip fracture