Risk Factors for Fractures in the Elderly
Abstract
We report the results of a 5-year prospective cohort study of risk factors for fractures, including drinking fluoridated water, in a cohort of 3,216 men and women age 65 years and older. We studied risk factors for hip fracture and fractures at other locations separately. We found a higher risk of hip fractures for subjects exposed to fluorine concentrations over 0.11 mg per liter but without a dose-effect relation [odds ratio (OR) = 3.25 for a concentration of 0.11–0.25 mg per liter; OR = 2.43 for ≥0.25 mg per liter]. For higher thresholds (0.7 and 1 mg per liter), however, the OR was less than 1. We found no association between fluorine and non-hip fractures. Non-hip fractures were associated with polymedication rather than with specific drug use, whereas fracture was associated with polymedication and use of anxiolytic and antidepressive drugs. Subjects drinking spirits every day were more likely to have hip fractures. Tobacco consumption increased the risk for non-hip fractures. (Epidemiology 1998;9:417–423)
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Other studies have found significant increases (OR=1.2-2.6) in the risk of fractures associated with antipsychotics.
“Other studies (506-510) have found significant increases (OR=1.2-2.6) in the risk of fractures associated with AP.”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [509]
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“Other studies (506-510) have found significant increases (OR=1.”
BackgroundGnjidic, D., Hilmer, S. N., Blyth, F., Naganathan, V., Waite, L. M., Seibel, M. J., McLachlan, A. J., Cumming, R. G., Handelsman, D. J., & Couteur, D. G. L. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.02.018 · Cited by 1,182 · see citing works
“Some studies did not explicitly state the minimum number of medicines used for the polypharmacy definition [10,11].”
BackgroundShould We Use a Case-Crossover Design?
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Peuskens, J., Pani, L., Detraux, J., & De Hert, M. (2014) · CNS Drugs · doi:10.1007/s40263-014-0157-3 · Cited by 350 · see citing works
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(EFSA), E. F. S. A. (2005) · EFSA Journal · doi:10.2903/j.efsa.2005.192 · Cited by 179 · see citing works
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Williams, M. E., Pulliam, C. C., Hunter, R., Johnson, T. M., Owens, J. E., Kincaid, J., Porter, C. Q., & Koch, G. G. (2003) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52016.x · Cited by 137 · see citing works
“Comorbid conditions were classified with an index for use with International Classification of Diseases, Ninth Revision, Clinical Modification Codes(28) as an adaptation of the empirically developed Charlson Comorbidity Index.(29)”
MethodInfluentialBenzodiazepines and hip fractures in elderly people: case-control study
Pierfitte, C., Macouillard, G., Thicoïpe, M., Chaslerie, A., Pehourcq, F., Aïssou, M., Martinez, B., Lagnaoui, R., Fourrier, A., Bégaud, B., et al. (2001) · BMJ · doi:10.1136/bmj.322.7288.704 · Cited by 131 · see citing works
Self-citationLackner, T. E., Wyman, J. F., McCarthy, T. C., Monigold, M., & Davey, C. S. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01680.x · Cited by 128 · see citing works
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“1) [26–59].”
BackgroundMukamal, K. J., Robbins, J. A., Cauley, J. A., Kern, L. M., & Siscovick, D. S. (2007) · Osteoporosis International · doi:10.1007/s00198-006-0287-7 · Cited by 115 · see citing works
Oderda, L. H., Young, J. R., Asche, C. V., & Pepper, G. A. (2012) · Annals of Pharmacotherapy · doi:10.1345/aph.1q589 · Cited by 94 · see citing works
Schneeweiß, S., & Wang, P. S. (2004) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000145344.76288.39 · Cited by 87 · see citing works
“{From the Paquid cohort study of 3216 men and women aged 65 and older.(47)”
Piirtola, M., Vahlberg, T. J., Löppönen, M. K., et al. (2008) · European Journal of Epidemiology · doi:10.1007/s10654-008-9289-4 · Cited by 85 · see citing works
“for sustaining fractures [43].”
The Health–Related Effects of Alcohol Use in Older Persons: A Systematic Review
Reid, M. C., Boutros, N. N., O’Connor, P. G., Cadariu, A., & Concato, J. (2002) · Substance Abuse · doi:10.1080/08897070209511485 · Cited by 85 · see citing works
“Table I shows that four studies (26-29) found an increased risk for falls or fall injuries associated with exposures ranging from daily use to an average weekly consumption of >21 drinks when compared with nondrinkers or individuals consuming <1 drink per week.”
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Water fluoridation, osteoporosis, fractures—recent developments
Demos, L., Kazda, H., Cicuttini, F., et al. (2001) · Australian Dental Journal · doi:10.1111/j.1834-7819.2001.tb00561.x · Cited by 60 · see citing works
“In one study, the main outcome was improved BMD(25) while, in the other two studies, the main outcome was improved fracture rate.(26-27) In the study by Cauley,(25) 20 years’ exposure to fluoridated”
ResultRequena, G., Huerta, C., Gardarsdóttir, H., Logie, J. W., González, R., Abbing‐Karahagopian, V., Miret, M., Schneider, C., Souverein, P. C., Webb, D. A., et al. (2015) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.3816 · Cited by 46 · see citing works
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Schneeweiß, S., & Wang, P. S. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53303.x · Cited by 42 · see citing works
Ke, Y., Hu, H., Zhang, J., Yuan, L., Li, T.-Z., Feng, Y., Wu, Y., Fu, X., Wang, M., Gao, Y., et al. (2023) · Advances in Nutrition · doi:10.1016/j.advnut.2023.03.008 · Cited by 39 · see citing works
“tion [15,16,25,50,51,53,69,70], whereas others did not show any significant association.”
BackgroundPsychotropic drugs and the risk of fractures in old age: a prospective population-based study
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“Jacqmin-Gadda et al. (1998) did not find a positive association between the use of APs and the risk of fractures [15].”
BackgroundMethodInfluentialAntipsychotic drug exposure and risk of fracture
Papola, D., Ostuzzi, G., Thabane, L., Guyatt, G. H., & Barbui, C. (2018) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000221 · Cited by 35 · see citing works
Prieto‐Alhambra, D., Petri, H., Goldenberg, J. S. B., Khong, T. P., Klungel, O. H., Robinson, N. J., & de Vries, F. (2014) · Osteoporosis International · doi:10.1007/s00198-013-2612-2 · Cited by 32 · see citing works
“This included four cohort [22–25] and seven case–control studies [26–32].”
BackgroundMortensen, S. J., Beeram, I. R., Florance, J., Momenzadeh, K., Mohamadi, A., Rodriguez, E. K., Keudell, A. G. V., & Nazarian, A. (2021) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-021-01230-5 · Cited by 31 · see citing works
Nurminen, J., Puustinen, J., Piirtola, M., Vahlberg, T. J., Lyles, A., & Kivelä, S. (2012) · Age and Ageing · doi:10.1093/ageing/afs178 · Cited by 31 · see citing works
“A positive association between the use of an antipsychotic drug and an increased risk of fractures is reported in case–control studies [9–11], but not in a cohort study [7].”
BackgroundPark, H., Kim, S., Sohn, H. S., & Kwon, J. (2018) · Clinical Drug Investigation · doi:10.1007/s40261-018-0716-3 · Cited by 27 · see citing works
Mulligan, R., & Sobel, S. (2005) · Dental Clinics of North America · doi:10.1016/j.cden.2004.10.005 · Cited by 26 · see citing works
“Hip fractures have been shown to be strongly associated with smoking [28], as have vertebral fractures [29] and fractures at other sites [30].”
BackgroundGoto, T., Koyama, Y., Kondo, T., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-006416 · Cited by 24 · see citing works
Wang, S. V., Schneeweiß, S., Maclure, M., & Gagne, J. J. (2014) · American Journal of Epidemiology · doi:10.1093/aje/kwu162 · Cited by 25 · see citing works
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Gallagher, P., & O’Mahony, D. (2008) · Reviews in Clinical Gerontology · doi:10.1017/s095925980800261x · Cited by 21 · see citing works
Solmi, M., Lähteenvuo, M., Correll, C. U., Tanskanen, A. J., Tiihonen, J., & Taipale, H. T. (2022) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac152 · Cited by 20 · see citing works
Asoudeh, F., Salari-Moghaddam, A., Larijani, B. A., et al. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1888691 · Cited by 18 · see citing works
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Wakasugi, M., Yokoseki, A., Wada, M., Momotsu, T., Sato, K., Kawashima, H., Nakamura, K., Onodera, O., & Narita, I. (2021) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-021-01272-9 · Cited by 19 · see citing works
“All models were analyzed unadjusted and adjusted for potential covariates identified a priori: (i) sex and age-adjusted; (ii) Model 1 (adjusted for known osteoporosis risk factors, i.e., sex, age, BMI, smoking status, daily drinker, prior fracture, parental history of fracture); (iii) Model 2 (additionally controlled…”
BackgroundInfluentialPolypharmacy and bone fracture risk in patients with type 2 diabetes: The Fukuoka Diabetes Registry
Komorita, Y., Ohkuma, T., Iwase, M., Fujii, H., Oku, Y., Higashi, T., Oshiro, A., Sakamoto, W., Yoshinari, M., Nakamura, U., et al. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.109097 · Cited by 15 · see citing works
Müller, M., Ricklin, M. E., Weiler, S., Exadaktylos, A. K., & Arampatzis, S. (2017) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13192 · Cited by 13 · see citing works
Shen, S., Liu, Y., Qiu, H., Tsai, K., Wu, H., Liang, W., Shu, M., & Chou, F. H. (2019) · PLoS ONE · doi:10.1371/journal.pone.0221948 · Cited by 7 · see citing works
Veronese, N., Smith, L., Zigoura, E., Barbagallo, M., Dominguez, L. J., Barone, A., Cella, A., Cooper, C. C., Rizzoli, R., Reginster, J., et al. (2021) · Archives of Osteoporosis · doi:10.1007/s11657-021-01015-3 · Cited by 6 · see citing works
“, higher oxidative stress and inflammatory levels) [40] that can increase fracture risk [41].”
BackgroundMcMullan, I., Bunting, B. P., McDonough, S., Tully, M. A., & Casson, K. (2019) · Journal of Frailty Sarcopenia and Falls · doi:10.22540/jfsf-04-102 · Cited by 4 · see citing works
Hertz, F. B., Jensen, A., Knudsen, J. D., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019997 · Cited by 3 · see citing works
Saavedra, P., Henríquez, M. S., Eslava, A. T., et al. (2005) · Revista Española de Enfermedades Metabólicas Óseas · doi:10.1016/s1132-8460(05)72673-8
Smoking, Alcohol, and Bone Health
Kiel, D. P. (2004) · Humana Press eBooks · doi:10.1007/978-1-59259-740-6_28 · Cited by 2 · see citing works
- Authors
- Jacqmin-Gadda, H., Fourrier, A., Commenges, D., & Dartigues, J.-F.
- Affiliations
- Inserm (FR)
- Venue
- Epidemiology
- Published
- 1998-07
- Volume
- 9
- Issue
- 4
- Pages
- 417-423
- ISSN
- 1044-3983 (ISSN-L)
- OpenAlex
- W4232758555
- Cited by
- 52
- References
- 0
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 1 · 2015: 1 · 2014: 5 · 2013: 1 · 2012: 4
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epidemiology (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
- Keywords
- fracture risk factors, hip fracture, older adults, fluoridated water, fluoride exposure, polypharmacy, anxiolytics, antidepressants, alcohol consumption, tobacco use, dose-response relationship
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