Model provides risk factors for hip fractures in older women

Nov 27 2007

Experts say there are around 329,000 hip fractures in postmenopausal women in the United States each year and up to 24% of hip fracture patients over 50 die within one year of the injury because of complications related to the injury itself or the extended recovery period.

These fractures they say are linked to a high rate of illness and death and are also very costly in terms of public health systems.

Many in the public health system see the prevention of hip fracture as a high priority and now scientists at the University of California at Davis School of Medicine in Sacramento have come up with a model of the clinical risk factors for hip fracture in postmenopausal women.

By using data on 93,676 women who participated in the observational component of the Women’s Health Initiative (WHI), they identified eleven risk factors that can easily be identified during a routine physical examination.

These factors are age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use and treated diabetes.

These risk factors were then validated using data on 68,132 women who participated in a clinical trial.

The model also also tested in a subset of 10,750 women who had undergone dual-energy x-ray absorptiometry scans for bone mass density assessment, which is used to predict risk of hip fracture.

A follow-up of on average 7.6 years, found there were 1,132 hip fractures among women participating in the observational study, while during an average follow-up of 8.0 years, 791 hip fractures occurred among women participating in the clinical trial.

Dr. John Robbins, who led the study says more research is needed to define the clinical implications and to confirm treatment benefits for those defined as being at an increased risk for hip fracture.

He says however that ultimately the decision on who to further screen for osteoporosis and who to treat will need to be based on available resources and major social and political judgments.

The American Academy of Orthopaedic Surgeons (AAOS) says following a hip fracture, most patients will require extended periods of rehabilitation and may need assistance with independent living.

The AAOS also says they will need walking aids for several months, and many will permanently need canes or walkers.

The researchers say the study illustrates how clinical factors that can easily be obtained during a routine physical can be used to compute a score, which in turn helps predict risk of hip fracture; patients at high risk for hip fracture can then be considered for preventive treatment.

The research is published in the Journal of the American Medical Association.