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Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem

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Abstract

Introduction

Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented.

Methods

To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry.

Results

Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture.

Conclusion

In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern.

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Acknowledgements

We would like to acknowledge the Baltimore Hip Studies, funded through Public Health Service Grant R37AG09901; the Study of Osteoporotic Fractures, funded through Public Health Service Grants AG05395, AG05407, AR35582, AR35583, and AR35584; and the Claude D. Pepper Older Americans Independence Center, grant P60-AG12583.

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Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Suite 200, Baltimore, MD, 21201, USA

    J. Magaziner, L. Wehren, W. G. Hawkes, D. Orwig, J. R. Hebel & M. C. Hochberg

  2. Department of Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD,, USA

    M. C. Hochberg

  3. Department of Epidemiology, School of Public Health, Boston University, Boston, MA,, USA

    L. Fredman

  4. Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA,, USA

    K. Stone

  5. Sheps Center for Health Services Research and School of Social Work, University of North Carolina, Chapel Hill, NC,, USA

    S. Zimmerman

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  1. J. Magaziner
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  2. L. Wehren
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  4. D. Orwig
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  5. J. R. Hebel
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Correspondence to J. Magaziner.

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Magaziner, J., Wehren, L., Hawkes, W.G. et al. Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem. Osteoporos Int 17, 971–977 (2006). https://doi.org/10.1007/s00198-006-0092-3

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