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

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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, Vogt, Thomas M.·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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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: Cummings, Steven R.
Nevitt, Michael C.
Browner, Warren S.
Stone, Katie
Fox, Kathleen M.
Ensrud, Kristine E.
Cauley, Jane
Black, Dennis
Vogt, Thomas M.
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: bronze
doi.org
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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Risk Factors for Hip Fracture in White Women

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