Bone density and risk of hip fracture in men and women: cross sectional analysis

wbldb

De Laet, Chris E. D. H.¹; van Hout, Ben A.²; Burger, Huibert¹; Hofman, Albert¹; Pols, Huibert A P³

Bone density and risk of hip fracture in men and women: cross sectional analysis

BMJ. July 26, 1997;315(7102):221-225

Affiliations

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

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

³Department of Internal Medicine III, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, Netherlands
Abstract

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.
Links

DOI: 10.1136/bmj.315.7102.221

PubMed: 9253270

WoS: A1997XN51700024
History

Accepted: 1997-04-25

Cited Works (10)

Year	Entry
1993	Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. June 1993;94(6):646-650.
1994	Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int. September 1994;4(5):277-282.
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.
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, Alendronate Phase III Osteoporosis Treatment Study. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. NEJM. November 30, 1995;333(22):1437-1443.
1993	Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman J. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. October 30, 1993;307(6912):1111-1115.
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.

Cited By (32)

Year	Entry
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.
2000	Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. November 2000;27(5):585-590.
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.
2008	Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N. A reference standard for the description of osteoporosis. Bone. March 2008;42(3):467-475.
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.
2021	Unal M. Raman spectroscopic determination of bone matrix quantity and quality augments prediction of human cortical bone mechanical properties. J Biomech. April 15, 2021;119:110342.
1998	De Laet CEDH, Van Hout BA, Burger H, Weel AEAM, Hofman A, Pols HAP. Hip fracture prediction in elderly men and women: validation in the rotterdam study. J Bone Miner Res. October 1998;13(10):1587-1593.
1998	Melton LJ III, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. December 1998;13(12):1915-1923.
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. January 1999;14(1):111-119.
2001	Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell KL, Beck TJ, Reeve J. Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res. July 2001;16(7):1318-1328.
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.
2013	Gourion-Arsiquaud S, Lukashova L, Power J, Loveridge N, Reeve J, Boskey AL. Fourier transform infrared imaging of femoral neck bone: reduced heterogeneity of mineral-to-matrix and carbonate-to-phosphate and more variable crystallinity in treatment-naive fracture cases compared with fracture-free controls. J Bone Miner Res. January 2013;28(1):150-161.
2015	Granke M, Makowski AJ, Uppuganti S, Does MD, Nyman JS. Identifying novel clinical surrogates to assess human bone fracture toughness. J Bone Miner Res. July 2015;30(7):1290-1300.
2022	Perri G, Hill TR, Mathers JC, Walsh JS, Gossiel F, Winther K, Frölich J, Folkestad L, Cold S, Eastell R. Long-term selenium-yeast supplementation does not affect bone turnover markers: a randomized placebo-controlled trial. J Bone Miner Res. November 2022;37(11):2165-2173.
2000	Kanis JA, Glüer C-C; Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. March 2000;11(3):192-202.
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.
2004	Rivadeneira Ramírez F. Osteoporosis: From Genes to Phenotypes [PhD thesis]. Erasmus University Rotterdam; 2004.
2007	Young CM. Do in-Line Dance, Progressively Loaded Squats and Foot Stomping Affect the Parameters of Fracture Risk in Postmenopausal Women? [Master's thesis]. Brisbane, Australia: Griffith University; 2007.
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.
2009	Ruppel ME. Alterations in the Mineral and Collagen Matrix of Bisphosphonate-Treated Bone and Osteoblasts [PhD thesis]. Stony Brook, NY: Stony Brook University; May 2009.
2005	Manske SL. Magnetic Resonance Imaging as an Instrument to Assess the Association Between Femoral Neck Bone Geometry and Strength of the Proximal Femur [Master's thesis]. Vancouver, BC: University of British Columbia; October 2005.
2011	Ebacher V. Experimental Study of Deformation and Microcracking in Human Cortical Bone [PhD thesis]. Vancouver, BC: University of British Columbia; May 2011.
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.