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Do Both Areal BMD and Injurious Falls Explain the Higher Incidence of Fractures in Women than in Men?

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Abstract

The higher incidence of fractures in women than in men is generally attributed to the lower areal bone mineral density (areal BMD, g/cm2) of the former. The purpose of the present study was to investigate both areal BMD and injurious falls as risk factors for fractures. In a first cohort, areal BMD was measured in 5,131 men and women (age range 40–95 years). In a second cohort, consisting of 26,565 men and women (age range 40–69 years), a health survey was conducted including questions about lifestyle and medication. Main outcome measures included validated prospective injurious falls and fractures in both cohorts. The higher areal BMD and femoral neck BMD in men compared to women (P < 0.001) were explained by a higher diameter of the femoral neck. Importantly, the diameter of the femoral neck was not associated with fractures in either sex (hazard ratio [HR] 0.94–1.04, P > 0.05 for all), suggesting that a higher areal BMD and lower incidence of osteoporosis in men do not explain their lower incidence of fractures. In contrast, women were more prone to sustain injurious falls than men in both cohorts investigated (HR for women = 1.61 and 1.84, P < 0.001 for both), resulting in a higher incidence of fractures (HR for women = 2.24 and 2.36, P < 0.001 for both). The number of injurious falls and fractures occurring each month during the study period showed a very strong correlation in both women (r = 0.95, P < 0.00001) and men (r = 0.97, P < 0.00001). In summary, low areal BMD, and thus osteoporosis, may not explain the higher fracture incidence in women than in men. Instead, a higher incidence of injurious falls in women was strongly associated with the higher fracture risk.

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Authors and Affiliations

  1. Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90187, Umeå, Sweden

    Peter Nordström, Fredrik Eklund & Yngve Gustafson

  2. Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden

    Ulf Björnstig

  3. Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, Umeå, Sweden

    Anna Nordström & Ronny Lorentzon

  4. The UKK Institute for Health Promotion Research and Research Department, University Hospital of Tampere, Tampere, Finland

    Harri Sievänen

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  1. Peter Nordström
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  2. Fredrik Eklund
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  3. Ulf Björnstig
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  4. Anna Nordström
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Correspondence to Peter Nordström.

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Nordström, P., Eklund, F., Björnstig, U. et al. Do Both Areal BMD and Injurious Falls Explain the Higher Incidence of Fractures in Women than in Men?. Calcif Tissue Int 89, 203–210 (2011). https://doi.org/10.1007/s00223-011-9507-z

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  • DOI: https://doi.org/10.1007/s00223-011-9507-z

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