11 Factors Help ID Hip Fracture Risk
Researchers Design Survey to Predict Fracture Risk in Older Women
Nov. 27, 2007 -- A new diagnostic model could help identify older women at
risk for hip fractures, even when those women show little evidence of
Bone density scanning is the best single test for identifying hip fracture
risk in older people. But by some estimates, more than half of hip fractures
occur among those who do not meet the diagnostic criteria for osteoporosis.
In an effort to address this, University of California at Davis researcher
John Robbins, MD, and colleagues developed an 11-question survey designed to
predict a postmenopausal (aged 50-79) woman's five-year risk of suffering a hip
fracture. They did this by evaluating data from almost 95,000 older women
participating in the Women's Health Initiative, an ongoing national health
The survey is available in the form of an Internet calculator, which can be
found at the web site of the Fred
Hutchinson Cancer Research Center.
The factors evaluated in the calculator to predict risk of hip fracture
within five years were:
- Race/ethnic group
- General health
- Physical activity
- Personal history of a fracture at age 55 or older
- Parent history of a fracture after age 40
- Current smoking
- Current corticosteroid use
- Treated diabetes
The study is published in the Nov. 28 issue of The Journal of the
American Medical Association.
"Bone density scanning is important, but that is just one dimension of
hip fracture risk," Robbins tells WebMD. "About half of fractures can
be explained by low bone density and about half cannot. That is why we need
other ways to evaluate risk."
Race, Weight, and Hip Fractures
As a group, African-Americans have a lower risk for osteoporosis and hip
fracture than whites. Being overweight is also protective while being
underweight is a risk factor for hip fracture.
These associations have long been known, but Robbins says clinicians often
place too much importance in them, ignoring other important factors associated
with age-related fracture.
"All things being equal, an African-American woman does have a lower
risk than a Caucasian woman, but if all things aren't equal that isn't
true," he says. "An African-American woman who has broken her wrist or
has a parent who broke a hip may have a risk that is equal to or greater than a
Robbins says he hopes the new model will raise awareness among doctors and
their elderly female patients about the multiple factors of hip fracture
Because the study included only women, it is not clear if the identified
risk factors are equally important in men.
Osteoporosis and High-Trauma Fractures
In a separate study, reported in the same issue of The Journal of the
American Medical Association, low bone density was found to be linked to
trauma-related, non-spinal fractures in older adults -- such as those resulting
from car crashes.
It had been widely assumed that these trauma-associated fractures were not
indicative of low bone-mineral density in the elderly, but researchers from the
San Francisco Coordinating Center found the opposite to be true.
They write that the findings highlight the importance of evaluating elderly
patients who have suffered trauma-related fractures for osteoporosis.
In an editorial accompanying the study, Mayo Clinic researcher Sundeep
Khosla, MD, echoes the sentiment. "Fractures previously defined as due to
high trauma, such as those from a blunt injury in a motor vehicle crash or a
fall from a chair, can no longer be dismissed as being unrelated to
osteoporosis," Khosla writes. "Older patients who sustain such
fractures should be considered for bone mineral density testing and, if
clinically indicated, [receive] further evaluation for osteoporosis."