Abstract
Summary
Risk factors for hip fracture were studied in 7,495 randomly selected men during 30 years; 451 men had a hip fracture. High degree of leisure-time, but not work-related, physical activity, high occupational class, and high body mass index (BMI) protected against hip fracture. Smoking, tall stature, interim stroke, and dementia increased the risk.
Purpose
The purpose was to prospectively study risk factors for hip fracture in men.
Methods
We studied midlife determinants of future hip fractures in 7,495 randomly selected men aged 46–56 years in Gothenburg, Sweden. The subjects were investigated in 1970–1973 and followed for over 30 years. Questionnaires were used regarding lifestyle factors, psychological stress, occupational class, and previous myocardial infarction, stroke, and diabetes mellitus. Alcohol problems were assessed with the aid of registers. Using the Swedish hospital discharge register, data were collected on intercurrent stroke and dementia diagnoses and on first hip fractures (X-ray-verified).
Results
Four hundred fifty-one men (6%) had a hip fracture. Age, tall stature, low occupational class, tobacco smoking, alcoholic intemperance, and interim stroke or dementia were independently associated with the risk of hip fracture. There were inverse associations with leisure-time physical activity, BMI, and coffee consumption. The gradient of risk for one standard deviation of multivariable risk decreased with time since measurement yet was a good alternative to dual energy X-ray absorptiometry measurements.
Conclusions
High degree of leisure-time physical activity, high occupational class, and high BMI protected against hip fracture. However, work-related physical activity was not protective. Smoking, tall stature, and interim stroke or dementia increased the risk.
Similar content being viewed by others
References
Cummings SR, Black DM, Rubin SM (1989) Lifetime risk of hip “Colles”, or vertebral fracture and coronary heart disease among white post menopausal women. Arch Intern Med 149:2445–2448
Maggi S, Kelsey JL, Litvak J, Heyse SP (1991) Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporosis Int 1:232–241
Villa ML, Nelson L (1996) Race, ethnicity, and osteoporosis. In: Marcus R, Felman D, Kelsey JL (eds) Osteoporosis. Academic, San Diego, pp 435–437
Obrant KJ, Bengner U, Johnell O, Nilsson BE, Sernbo I (1989) Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif Tissue Int 44:157–167
Naessén T, Parker R, Persson I, Zack M, Adami HO (1989) Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden 1965–1983. Am J Epidemiol 130:289–299
Larsson S, Eliasson P, Hansson LI (1989) Hip fractures in Northern Sweden 1973–1984: a comparison of urban and rural populations. Acta Ortop Scand 60:567–571
Jarnlo GB, Jacobsson B, Ceder L, Thorngren KG (1989) Hip fracture incidence in Lund, Sweden, 1966–1986. Acta Ortop Scand 60:278–282
Rehnberg L, Olerud C (1990) Incidence of hip fractures in the elderly: Uppsala County, 1980–1987. Acta Ortop Scand 61:148–151
Nilsson R, Löfman O, Berglund K, Larsson L, Toss G (1991) Increased hip-fracture incidence in the county of Östergötland, Sweden, 1940–1986, with forecasts up to the year 2000: an epidemiological study. Int J Epidemiol 20:1018–1024
Kanis JA, Odén A, Johnell O, De Laet C, Jönsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473
Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18:827–835
Wilhelmsen L, Berglund G, Elmfeldt D, Tibblin G, Wedel H, Pennert K, Vedin A, Wilhelmsson C, Werkö L (1986) The multifactor primary prevention trial in Göteborg, Sweden. Eur Heart J 7:279–288
Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Circulation 38:1104–1115
Wilhelmsen L, Tibblin G, Aurell M, Bjure J, Ekström-Jodal B, Grimby G (1976) Physical activity, physical fitness and risk of myocardial infarction. Adv Cardiol 18:217–230
Rosengren A, Wilhelmsen L, Pennert K, Berglund G, Elmfeldt D (1987) Alcoholic intemperance, coronary heart disease and mortality in middle-aged Swedish men. Acta Med Scand 222:201–213
Rosengren A, Wedel H, Wilhelmsen L (1988) Coronary heart disease and mortality in middle aged men from different occupational classes in Sweden. BMJ 297:1497–1500
Cox DR (1972) Regression models and life tables. J Royal Stat Soc Series B 34:187–220
Breslow NE, Day NE (1987) Statistical methods in cancer research. Vol. II: the design and analysis of cohort studies. IARC, Lyon
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Joakimsen RM, Fönnebo V, Magnus JH, Störmer J, Tollan A, Sögaard AJ (1998) The Tromsö Study: physical activity and the incidence of fractures in a middle-aged population. J Bone Miner Res 13:1149–1157
Kujala UM, Kaprio J, Kannus P, Sarna S, Koskenvuo M (2000) Physical activity and osteoporotic hip fracture risk in men. Arch Intern Med 160:705–708
Hoidrup S, Sörensen TIA, Ströger U, Lauritzen JB, Schroll M, Grönbaeck M (2001) Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women. Am J Epidemiol 154:60–68
Michaelsson K, Olofsson H, Jensevik K, Larsson S, Mallmin H, Berglund L, Vessby B, Melhus H (2007) Leisure physical activity and the risk of fracture in men. PLoS Medicine 4:1094–1100
Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208
Cumming RG, Nevitt MC, Cummings SR (1997) Epidemiology of hip fractures. Epidemiol Rev 19:244–257
Forsén L, Björndal A, Bjartveit K, Edna TH, Holmen J, Jessen V, Westberg G (1994) Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture. J Bone Miner Res 9:1671–1678
West J, Hippisley-Cox J, Coupland CA, Price GM, Groom LM, Kendrick D, Webber E (2004) Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status? Public Health 118:576–581
Marmot MG (2006) Status syndrome: a challenge to medicine. JAMA 295:1304–1307
Kiel DP, Felson DT, Hannan MT, Anderson JJ, Wilson PW (1990) Caffeine and the risk of hip fracture: the Framingham Study. Am J Epidemiol 132:675–684
Hernandez-Avila M, Colditz GA, Stampfer MJ, Rosner B, Speizer FE, Willett WC (1991) Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women. Am, J Clin Nutr 54:157–163
Harris SS, Dawson-Hughes B (1994) Caffeine and bone loss in healthy postmenopausal women. Am J Clin Nutr 60:573–578
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773
Hallström H, Wolk A, Glynn A, Michaelsson K (2006) Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int 17:1055–1064
Cooper C, Atkinson EJ, Wahner HW, O’Fallon WM, Riggs BL, Judd HL, Melton LJ 3rd (1992) Is caffeine consumption a risk factor for osteoporosis? J Bone Miner Res 7:465–471
Barrett-Connor E, Chang JC, Edelstein SL (1994) Coffee-associated osteoporosis offset by daily milk consumption. The Rancho Bernardo Study. JAMA 271:280–283
Meyer HE, Pedersen JI, Lopken EB, Tverdal A (1997) Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 145:117–123
Buizert PJ, van Schoor NM, Lips P, Deeg DJ, Eekhoff EM (2008) Lipid levels: a link between cardiovascular disease and osteoporosis? J Bone Miner Res (in press)
Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaelsson K (2007) Cardiovascular diseases and fracture risk of hip fracture in women. Osteoporos Int 18:1355–1363
Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49:S70–S73 Review
Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 7:737–742
Acknowledgements
The Bank of Sweden Tercentenary Fund, The Swedish Heart and Lung Foundation, and The Göteborg Medical Society supported this study.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trimpou, P., Landin-Wilhelmsen, K., Odén, A. et al. Male risk factors for hip fracture—a 30-year follow-up study in 7,495 men. Osteoporos Int 21, 409–416 (2010). https://doi.org/10.1007/s00198-009-0961-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-009-0961-7