Skip to main content
Log in

Effect of seasonality and weather on fracture risk in individuals 65 years and older

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

In this large population-based study, fracture rates for hips, distal forearms, proximal humeri, and ankles were higher in winter than in other seasons, although the winter peak was small for hip fractures (p < 0.05 at all sites). Younger age between 65 and 80, living in warmer states and male gender were associated with increased winter morbidity due to fractures.

Introduction

The objective was to investigate seasonal variation in the incidence of four common fractures, and explore the association of weather with risk.

Methods

Population-based analysis of individuals age 65 and older, including fractures of the hip, the distal forearm, the proximal humerus and the ankle. Weather information was obtained from the US National Oceanic and Atmospheric Administration website.

Results

For all fractures, rates were highest in winter and lowest in summer (p < 0.05 at all sites). Winter peaks were more pronounced in warm climate states, in men, and in those younger than 80 years old. In winter, total snowfall was associated with a reduced risk of hip fracture (−5% per 20 inches) but an increased risk of non-hip fractures (6–12%; p < 0.05 at all sites). In summer, hip fracture risk tended to be lower during sunny weather (− 3% per 2 weeks of sunny days; p = 0.13), while other fractures were increased (15%–20%; p < 0.05) in sunny weather.

Conclusion

Fractures contribute considerably to winter morbidity in older individuals. Younger age between 65 and 80, living in warmer states and male gender are risk factors for increased winter morbidity due to fractures. Weather affects hip fracture risk differently than the other fractures studied.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Douglas AS, Allan TM, Rawles JM (1991) Composition of seasonality of disease. Scott Med J 36(3):76–82

    PubMed  CAS  Google Scholar 

  2. Wilkinson P, Pattenden S, Armstrong B et al (2004) Vulnerability to winter mortality in elderly people in Britain: population based study. BMJ 17:17

    Google Scholar 

  3. Wilkinson P, Pattenden S, Armstrong B et al (2004) Vulnerability to winter mortality in elderly people in Britain: population based study. BMJ 329(7467):647, Epub 2004 Aug 17

    Article  PubMed  Google Scholar 

  4. Lieberman D, Friger MD (1999) Seasonal variation in hospital admissions for community-acquired pneumonia: a 5-year study. J Infect 39(2):134–140

    Article  PubMed  CAS  Google Scholar 

  5. Vilkman S, Keistinen T, Tuuponen T, Kivela SL (1996) Seasonal variation in hospital admissions for chronic obstructive pulmonary disease in Finland. Arctic Med Res 55(4):182–186

    PubMed  CAS  Google Scholar 

  6. Spencer FA, Goldberg RJ, Becker RC, Gore JM (1998) Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol 31(6):1226–1233

    Article  PubMed  CAS  Google Scholar 

  7. Jacobsen SJ, Sargent DJ, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1995) Population-based study of the contribution of weather to hip fracture seasonality. Am J Epidemiol 141(1):79–83

    PubMed  CAS  Google Scholar 

  8. Bulajic-Kopjar M (2000) Seasonal variations in incidence of fractures among elderly people. Inj Prev 6(1):16–19

    Article  PubMed  CAS  Google Scholar 

  9. Hemenway D, Colditz GA (1990) The effect of climate on fractures and deaths due to falls among white women. Accident Anal Prev 22(1):59–65

    Article  CAS  Google Scholar 

  10. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1991) Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984–1987. Am J Epidemiol 133(10):996–1004

    PubMed  CAS  Google Scholar 

  11. Lau EM, Gillespie BG, Valenti L, O’Connell D (1995) The seasonality of hip fracture and its relationship with weather conditions in New South Wales. Aust J Public Health 19(1):76–80

    Article  PubMed  CAS  Google Scholar 

  12. Mannius S, Mellstrom D, Oden A, Rundgren A, Zetterberg C (1987) Incidence of hip fracture in western Sweden 1974–1982. Comparison of rural and urban populations. Acta Orthop Scand 58(1):38–42

    Article  PubMed  CAS  Google Scholar 

  13. Zetterberg C, Andersson GB (1982) Fractures of the proximal end of the femur in Goteborg, Sweden, 1940–1979. Acta Orthop Scand 53(3):419–426

    Article  PubMed  CAS  Google Scholar 

  14. Jacobsen SJ, Sargent DJ, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1999) Contribution of weather to the seasonality of distal forearm fractures: a population-based study in Rochester, Minnesota. Osteoporos Int 9(3):254–259

    Article  PubMed  CAS  Google Scholar 

  15. Ralis ZA (1981) Epidemic of fractures during period of snow and ice. Br Med J (Clin Res Ed) 282(6264):603–605

    CAS  Google Scholar 

  16. O’Neill TW, Marsden D, Adams JE, Silman AJ (1996) Risk factors, falls, and fracture of the distal forearm in Manchester, UK. J Epidemiol Community Health 50(3):288–292

    PubMed  CAS  Google Scholar 

  17. Graafmans WC, Ooms ME, Bezemer PD, Bouter LM, Lips P (1996) Different risk profiles for hip fractures and distal forearm fractures: a prospective study. Osteoporos Int 6(6):427–431

    Article  PubMed  CAS  Google Scholar 

  18. Keegan TH, Kelsey JL, King AC, Quesenberry CP Jr, Sidney S (2004) Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture. Am J Epidemiol 159(2):192–203

    Article  PubMed  Google Scholar 

  19. Nevitt MC, Cummings SR (1994) Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc 42(8):909

    PubMed  CAS  Google Scholar 

  20. Carter SE, Campbell EM, Sanson-Fisher RW, Gillespie WJ (2000) Accidents in older people living at home: a community-based study assessing prevalence, type, location and injuries. Aust N Z J Public Health 24(6):633–636

    PubMed  CAS  Google Scholar 

  21. Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19(2):136–141

    Article  PubMed  CAS  Google Scholar 

  22. Bastow MD, Rawlings J, Allison SP (1983) Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1(8317):143–146

    Article  PubMed  CAS  Google Scholar 

  23. Bischoff HA, Stahelin HB, Dick W et al (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18(2):343–351

    Article  PubMed  CAS  Google Scholar 

  24. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B (2006) Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 166(4):424–430

    Article  PubMed  CAS  Google Scholar 

  25. Bischoff-Ferrari HA, Dawson-Hughes B, Willett CW et al (2004) Effect of vitamin D on falls: a meta-analysis. JAMA 291(16):1999–2006

    Article  PubMed  CAS  Google Scholar 

  26. Chapuy MC, Arlot ME, Duboeuf F et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642

    Article  PubMed  CAS  Google Scholar 

  27. Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326(7387):469

    Article  PubMed  CAS  Google Scholar 

  28. Baron JA, Karagas M, Barrett J et al (1996) Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 7(6):612–618

    Article  PubMed  CAS  Google Scholar 

  29. Karagas MR, Baron JA, Barrett JA, Jacobsen SJ (1996) Patterns of fracture among the United States elderly: geographic and fluoride effects. Ann Epidemiol 6(3):209–216

    Article  PubMed  CAS  Google Scholar 

  30. Fisher ES, Baron JA, Malenka DJ, Barrett J, Bubolz TA (1990) Overcoming potential pitfalls in the use of Medicare data for epidemiologic research. Am J Public Health 80(12):1487–1490

    PubMed  CAS  Google Scholar 

  31. Barrett JA, Baron JA, Karagas MR, Beach ML (1999) Fracture risk in the U.S. Medicare population. J Clin Epidemiol 52(3):243–249

    Article  PubMed  CAS  Google Scholar 

  32. Baron JA, Barrett JA, Karagas MR (1996) The epidemiology of peripheral fractures. Bone 18(3 Suppl):209S–213S

    Article  PubMed  CAS  Google Scholar 

  33. Baron JA, Barrett J, Malenka D et al (1994) Racial differences in fracture risk. Epidemiology 5(1):42–47

    Article  PubMed  CAS  Google Scholar 

  34. Levy AR, Bensimon DR, Mayo NE, Leighton HG (1998) Inclement weather and the risk of hip fracture. Epidemiology 9(2):172–177

    Article  PubMed  CAS  Google Scholar 

  35. Pedrazzoni M, Alfano FS, Malvi C, Ostanello F, Passeri M (1993) Seasonal variation in the incidence of hip fractures in Emilia-Romagna and Parma. Bone 14(Suppl 1):S57–S63

    Article  PubMed  Google Scholar 

  36. Holmberg S, Thorngren KG (1987) Statistical analysis of femoral neck fractures based on 3053 cases. Clin Orthop 218:32–41

    PubMed  Google Scholar 

  37. Parker MJ, Martin S (1994) Falls, hip fractures and the weather. Eur J Epidemiol 10(4):441–442

    Article  PubMed  CAS  Google Scholar 

  38. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1990) Regional variation in the incidence of hip fracture. US white women aged 65 years and older. JAMA 264(4):500–502

    Article  PubMed  CAS  Google Scholar 

  39. O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137(3):342–354

    PubMed  CAS  Google Scholar 

  40. Vellas BJ, Wayne SJ, Garry PJ, Baumgartner RN (1998) A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol 53A:M264–M274

    Google Scholar 

  41. Holick MF (1985) The photobiology of vitamin D and its consequences for humans. Ann N Y Acad Sci 453:1–13

    Article  PubMed  CAS  Google Scholar 

  42. Harris SS, Dawson-Hughes B (1998) Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. Am J Clin Nutr 67(6):1232–1236

    PubMed  CAS  Google Scholar 

  43. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676

    Article  PubMed  CAS  Google Scholar 

  44. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158(6):531–537

    Article  PubMed  Google Scholar 

  45. Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67(2):373–378

    Article  PubMed  CAS  Google Scholar 

  46. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (1997) Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D, and fluoride. National Academy Press, Washington, DC

    Google Scholar 

  47. Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45(7):703–714

    Article  PubMed  CAS  Google Scholar 

  48. Fisher ES, Whaley FS, Krushat WM et al (1992) The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain. Am J Public Health 82(2):243–248

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. A. Bischoff-Ferrari.

Additional information

Funding

Supported by fellowships from the Harvard Hartford Foundation, from the Swiss Foundation for Nutrition Research, and the International Foundation for the Promotion of Nutrition Research and Nutrition Education.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bischoff-Ferrari, H.A., Orav, J.E., Barrett, J.A. et al. Effect of seasonality and weather on fracture risk in individuals 65 years and older. Osteoporos Int 18, 1225–1233 (2007). https://doi.org/10.1007/s00198-007-0364-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-007-0364-6

Keywords

Navigation