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Cited by 3,595Bone health and osteoporosis researchHip and Femur FracturesBalance, Gait, and Falls Prevention

Risk Factors for Hip Fracture in White Women

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Cummings, Steven R., Nevitt, Michael C., Browner, Warren S., Stone, Katie, Fox, Kathleen M., Ensrud, Kristine E., Cauley, Jane, Black, Dennis +1 more·1995·New England Journal of Medicine
DOI 10.1056/nejm199503233321202
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Abstract

BACKGROUND: Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study. METHODS: We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films. RESULTS: During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age. CONCLUSIONS: Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.

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51 of 51 references verified0 citation errors · 0 not checkable

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  • Studies largely in younger people and postmenopausal women have not found a relation between any fracture or hip fractures and levothyroxine use.

    “Studies largely in younger people30 and postmenopausal women15 26 have not found a relation between any fracture or hip fractures and levothyroxine use.”

    From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [15]

    In “Factors Not Significant after Multivariate Adjustment” (p. 767), the paper reports that current thyroid-hormone therapy was no longer significantly associated with hip-fracture risk after adjustment for a history of hyperthyroidism. This supports the claim for hip fractures in older white women, but the paper does not identify the therapy specifically as levothyroxine or address fractures of any type as an outcome. (LLM, conf=0.82)

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  • Older adults have a higher baseline risk of fracture.

    “Our study specifically focused on older adults, who have a higher baseline risk of fracture15 26 56 and are more vulnerable to excessive levothyroxine replacement.11 12 13 14”

    From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [15]

    Table 2 reports that hip-fracture risk increased with age among white women aged 65 or older (relative risk 1.5 per five years). The Discussion says the findings may not generalize to men or younger women. Thus the paper supports an age-related increase in hip-fracture risk in the studied population, but not the broader claim about all older adults or fractures generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • An excess of thyroid hormone can increase the risk of arrhythmias and falls.

    “and increase the risk of arrhythmias24 25 and falls,15”

    From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [15]

    Citation 15 is attached to falls, not arrhythmias. The Results and Discussion (p. 767) associate previous hyperthyroidism with hip fracture and suggest possible neuromuscular impairment, but they do not report whether excess thyroid hormone increases the risk of falling. Searches for hyperthyroidism and falls found no passage establishing that outcome. (LLM, conf=0.76)

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Cites

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2 of the 53 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone density and age predict hip fracture in women. JAMA 1990;263:665-8.
  2. Fallon MD, Perry HM, Bergfeld M, Droke D, Teitelbaum SL, Avioli LV. Ex- ogenous hyperthyroidism with osteoporosis. Arch Intern Med 1983;143: 442-4.

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Authors
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., & Vogt, T. M.
Affiliations
University of Maryland, Baltimore (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1995-03-23
Volume
332
Issue
12
Pages
767-773
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199503233321202
OpenAlex
W2323830513
Cited by
3,595
References
53
Citations by year
2026: 23 · 2025: 26 · 2024: 42 · 2023: 52 · 2022: 46 · 2021: 68 · 2020: 62 · 2019: 60 · 2018: 71 · 2017: 87 · 2016: 84 · 2015: 98 · 2014: 118 · 2013: 145 · 2012: 135
FWCI
108.38
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (1-RO1-AG05407, R01AG005394, 5 RO1-AG05394, R01AG005407)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (1-RO1-AR35582, R01AR035582)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Hip and Femur Fractures
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords
hip fracture, risk factors, white women, older women, bone mineral density, weight gain, previous fractures, hyperthyroidism, benzodiazepines, antiepileptic drugs, caffeine consumption, visual function, tachycardia, hip fracture incidence, osteoporosis
MeSH terms
Aged, Body Weight, Caffeine, Female, Follow-Up Studies, Hip Fractures, Humans, Prospective Studies, Risk Factors, Bone Density, Confidence Intervals, Black People, White People

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