Risk factors for fracture in nonosteoporotic men and women.

Abstract

It is not known which factors are associated with fracture in nonosteoporotic elderly. The aim of this study was to assess the association between fall-related risk factors and fracture risk in men and women without osteoporosis. This study was part of the ongoing Dubbo Osteoporosis Epidemiology Study, which was designed as a prospective population-based cohort investigation. At baseline, 924 women and 723 men aged 60+ yr did not have osteoporosis [bone mineral density (BMD) T-scores > -2.5]. The individuals have been followed for up to 15 yr. Atraumatic fractures were prospectively identified through radiologists' reports. At baseline, femoral neck BMD (FNBMD) was measured by dual energy x-ray absorptiometry (DXA); history of fall, postural stability, and quadriceps strength was obtained. During the follow-up period, among the nonosteoporotic group, 221 women and 105 men had sustained a fracture, accounting for 55 and 74% of total fractures in the entire Dubbo Osteoporosis Epidemiology Study sample, respectively. The following factors were independent risk factors for any fracture: in women, age per sd (hazard ratio, 1.2; 95% CI, 1.0-1.3), postural sway per sd (1.1, 1.0-1.2), FNBMD per sd (1.6, 1.3-1.9), fall in the previous 12 months (2.1, 1.6-2.7), and prior fracture (1.8, 1.2-2.7); in men, age (1.4, 1.1-1.6), postural sway (1.2, 1.0-1.3), FNBMD (1.2, 1.0-1.5), and fall in the previous 12 months (1.9, 1.2-3.0). Exposure to at least one of the risk factors could account for 49% (women) and 39% (men) of any fractures in this population. In nonosteoporotic elderly, the combination of low BMD, advancing age, fall during the last 12 months, and prior fracture could identify a subgroup of individuals with high risk of fracture.