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Risk Factors for Hip Fracture in White Women
Open accessAbstract
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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“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]
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“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”
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“and increase the risk of arrhythmias24 25 and falls,15”
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Metadata
- 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
- 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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