Objective: To determine the relative contribution of decline in bone density to the increase in risk of hip fracture with age in men and women.
Design: Incidence data of hip fracture from the general population were combined with the bone density distribution in a sample from the same population and with a risk estimate of low bone density known from literature.
Setting: The Netherlands.
Subjects: All people with a hospital admission for a hip fracture in 1993, and bone density measured in a sample of 5814 men and women aged 55 years and over in a district of Rotterdam.
Main outcome measure: One year cumulative risk of hip fracture by age, sex, and bone density measured at the femoral neck.
Results: A quarter of all hip fractures occurred in men. Men reached the same incidence as women at five years older. Controlled for age, the risk of hip fracture by bone density was similar in men and women. The risk of hip fracture increased 13-fold from age 60 to 80; decrease in bone density associated with age contributed 1.9 (95% confidence interval 1.5 to 2.4) in women and 1.6 (1.3 to 1.8) in men.
Conclusions: The risk of hip fracture by age and bone density is similar in men and women. The decrease in bone density associated with age makes a limited contribution to the exponential increase of the risk of hip fracture with age.
|1992||Steiger P, Cummings SR, Black DM, Spencer NE, Genant HK. Age‐related decrements in bone mineral density in women over 65. J Bone Miner Res. June 1992;7(6):625-632.|
|1995||Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M, Seeman E, Recker RR, Capizzi T, Santora AC, Lombardi A, Shah RV, Hirsch LJ, Karpf DB; Group APIOTS. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. NEJM. November 30, 1995;333(22):1437-1443.|
|1995||Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM; Study of Osteoporotic Fractures Research Group. Risk factors for hip fracture in white women. NEJM. March 23, 1995;332(12):767-773.|
|1996||Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. December 7, 1996;348(9041):1535-1541.|
|1993||Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palmero L, Scott J, Vogt TM; Study of Osteoporotic Fractures Research Group. Bone density at various sites for prediction of hip fractures. Lancet. January 9, 1993;341(8837):72-75.|
|1988||Hui SL, Slemenda CW, Johnston CC Jr. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. June 1988;81(6):1804-1809.|
|1996||Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.|
|2006||Augat P, Schorlemmer S. The role of cortical bone and its microstructure in bone strength. Age Ageing. September 2006;35(suppl 2):ii27-ii31.|
|1999||Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J. Regional differences in cortical porosity in the fractured femoral neck. Bone. January 1999;24(1):57-64.|
|2000||Jordan GR, Loveridge N, Bell KL, Power J, Rushton N, Reeve J. Spatial clustering of remodeling osteons in the femoral neck cortex: a cause of weakness in hip fracture? Bone. March 2000;26(3):305-313.|
|2004||Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JPTM, Pols HAP. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. January 2004;34(1):195-202.|
|2004||Akkus O, Adar F, Schaffler MB. Age-related changes in physicochemical properties of mineral crystals are related to impaired mechanical function of cortical bone. Bone. March 2004;34(4):443-453.|
|2006||Allen MR, Iwata K, Sato M, Burr DB. Raloxifene enhances vertebral mechanical properties independent of bone density. Bone. November 2006;39(5):1130-1135.|
|2006||Thomas CDL, Feik SA, Clement JG. Increase in pore area, and not pore density, is the main determinant in the development of porosity in human cortical bone. J Anat. August 2006;209(2):219-230.|
|1999||Bell KL, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M, Meggitt BF, Reeve J. Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res. 1999;14(1):111-119.|
|2010||Keaveny TM, Kopperdahl DL, Melton LJ III, Hoffmann PF, Amin S, Riggs BL, Khosla S. Age‐dependence of femoral strength in white women and men. J Bone Miner Res. May 2010;25(5):994-1001.|
|2001||Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. December 2001;12(12):989-995.|
|2008||Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. April 2008;19(4):385-397.|
|2008||Ruppel ME, Miller LM, Burr DB. The effect of the microscopic and nanoscale structure on bone fragility. Osteoporos Int. September 2008;19(9):1251-1265.|
|2010||Chen H, Zhou X, Shoumura S, Emura S, Bunai Y. Age- and gender-dependent changes in three-dimensional microstructure of cortical and trabecular bone at the human femoral neck. Osteoporos Int. April 2010;21(4):627-636.|
|2008||Xu Q. Evaluation of Bone Quality Using Novel Image Analyses and Mechanical Testing Methods [PhD thesis]. Louisville, KY: University of Louisville; August 2008.|
|2007||Wagner EB. Musculoskeletal Adaptation to Partial Weight Suspension: Studies of Lunar and Mars Loading [PhD thesis]. Cambridge, MA: Massachusetts Institute of Technology; September 2007.|
|2014||Bradke BS. The Role of Cortical and Cancellous Bone Quality on Vertebral Fragility [PhD thesis]. Troy, NY: Rensselaer Polytechnic Institute; April 2014.|
|2016||Manhard MK. Advancements of MRI Measurements of Bound and Pore Water Concentration of Cortical Bone for Evaluation of Fracture Risk [PhD thesis]. Nashville, TN: Vanderbilt University; August 2016.|