Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study (original) (raw)

Abstract:

The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially ‘reversible’ risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.

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Authors and Affiliations

1. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK, , , , , , GB
   J. Kanis
2. Department of Orthopaedics and Community Health Sciences, Malmo¨ General Hospital, Malmo¨, Sweden, , , , , , SE
   O. Johnell & B. Gullberg
3. WHO Collaborating Centre for the Epidemiology of Rheumatic Conditions, Huddinge University Hospital, Huddinge, Sweden, , , , , , SE
   E. Allander & L. Elffors
4. Department of Community Health Sciences, Lund University, Malmo¨, Sweden, , , , , , SE
   J. Ranstam
5. Afdeling Rheumatologie, Academisch Ziekenhuis, Pellenberg, Belgium, , , , , , BE
   J. Dequeker
6. Istanbul Universitesi, Istanbul Tip Fakultesi, Fiziksel Tip ve Rehabilitasyon, Istanbul, Turkey, , , , , , TR
   G. Dilsen
7. Institute of Medical Pathology, University of Siena, Siena, Italy, , , , , , IT
   C. Gennari
8. Rua Gaspar Correia 87, Porto, Portugal, , , , , , PT
   A. Lopes Vaz
9. Th. Garofalidis Research Center, Accident Hospital, Kifissia, Greece, , , , , , GR
   G. Lyritis
10. Policlinico Umberto I, II Clinica Medica, Rome, Italy, , , , , , IT
    G. Mazzuoli
11. Centre Viggo Petersen, Ho^pital Lariboisiere, Paris, France, , , , , , FR
    L. Miravet
12. Instituto di Clinica Medica Generale, e Terapia Medica, Parma, Italy, , , , , , IT
    M. Passeri
13. Department of Medicine, University Hospital of Seville, Seville, Spain, , , , , , ES
    R. Perez Cano
14. Departmento de Medicina Interna, Fundacion Jimenez Diaz, Madrid, Spain, , , , , , ES
    A. Rapado
15. Service d’Endocrinologie, CHU Toulouse Purpan, Toulouse Cedex, France, , , , , , FR
    C. Ribot

Authors

1. J. Kanis
2. O. Johnell
3. B. Gullberg
4. E. Allander
5. L. Elffors
6. J. Ranstam
7. J. Dequeker
8. G. Dilsen
9. C. Gennari
10. A. Lopes Vaz
11. G. Lyritis
12. G. Mazzuoli
13. L. Miravet
14. M. Passeri
15. R. Perez Cano
16. A. Rapado
17. C. Ribot

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Received: 15 May 1997 / Accepted: 27 April 1998

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Kanis, J., Johnell, O., Gullberg, B. et al. Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study .Osteoporos Int 9, 45–54 (1999). https://doi.org/10.1007/s001980050115

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• Issue date: January 1999
• DOI: https://doi.org/10.1007/s001980050115