Hip fracture prediction in elderly men and women:​ validation in the rotterdam study

De Laet, Chris E. D. H.; Van Hout, Ben A.; Burger, Huibert; Weel, Angelique E. A. M.; Hofman, Albert; Pols, Huibert A. P.

Affiliations

¹Department of Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands

²Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands

³Department of Internal Medicine III, Erasmus University Medical School, Rotterdam, The Netherlands

Abstract

The aim of our study was to validate a hip fracture risk function, composed of age and femoral neck bone mineral density (BMD). This estimate of the 1-year cumulative risk was previously developed on the basis of Dutch hip fracture incidence data and BMD in men and women. A cohort of 7046 persons (2778 men) aged 55 years and over was followed for an average of 3.8 years. The 1-year hip fracture risk estimate was calculated for each participant according to the risk function and categorized as low (<0.1%), moderate (0.1 to <1%), or high (≥1%). Observed first hip fracture incidence was then analyzed for each of these risk categories by age and gender. Additionally, we calculated the relative risk per standard deviation (SD) decrease in femoral neck BMD in this population. At baseline, 2360 individuals were categorized as low risk, 2567 as moderate risk, and 378 as high risk. During follow-up, 110 first hip fractures were observed corresponding to an incidence rate of 4.1/1000 person-years (pyrs) (95% confidence interval 3.4–5.0). The observed incidence rate in the low risk group was 0.2/1000 pyrs (0.1–0.9), 2.7/1000 pyrs (1.8–3.9) in the moderate risk group, and 18.4/1000 pyrs (12.4–27.2) in the high risk group. Below the age of 70 years, incidence was low in all categories, and very few individuals were considered at high risk. Above the age of 70 years, the observed incidence was high in the high risk group, while in the low and moderate risk groups, the incidence remained low even over 80 years of age. In women, the age-adjusted relative risk for hip fractures was 2.5 per SD decrease in femoral neck BMD (1.8–3.6), while in men this relative risk was 3.0 per SD (1.7–5.4). In conclusion, we observed a similar relation of hip fracture with femoral neck BMD in men and women and were able to predict accurately hip fracture rates over a period of almost 4 years.

Links

DOI: 10.1359/jbmr.1998.13.10.1587

PubMed: 9783547

WoS: 000076216800009

History

Received: 1997-12-17

Revised: 1998-05-11

Accepted: 1998-06-13

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Year	Entry
2017	Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N; The National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. December 2017;12(1):1-24.
2008	Nyman JS, Ni Q, Nicolella DP, Wang X. Measurements of mobile and bound water by nuclear magnetic resonance correlate with mechanical properties of bone. Bone. January 2008;42(1):193-199.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
2021	Rogmark C, Fedorowski A, Hamrefors V. Physical activity and psychosocial factors associated with risk of future fractures in middle-aged men and women. J Bone Miner Res. May 2021;36(5):852-860.
2007	Nyman JS, Roy A, Tyler JH, Acuna RL, Gayle HJ, Wang X. Age‐related factors affecting the postyield energy dissipation of human cortical bone. J Orthop Res. May 2007;25(7):646-655.
2000	Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. July 2000;58(1):396-399.
2001	Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, Johnell O. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int. August 2001;12(7):519-528.