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Osteoporosis International

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01-02-2012 | Original Article

Risk factors for fracture in elderly men: a population-based prospective study

Authors: M. Frost, B. Abrahamsen, T. Masud, K. Brixen

Published in: Osteoporosis International | Issue 2/2012

Abstract

Summary

Risk factors for fractures were assessed in a random sample of 4,696 elderly men followed for 5.4 years. Results highlighted the importance of assessment of falls and dizziness as well as novel risk factors including frequent urination and erectile dysfunction.

Introduction

Knowledge about risk factors for fracture in men is limited. The aim of this study was to evaluate factors potentially associated with fracture risk in men.

Methods

A questionnaire enquiring about potential risk factors for fractures in men was posted to a random sample of 9,314 men aged 60–74 years. A completed questionnaire was returned by 4,696 (50.4%). Follow-up on incident fractures over 5.4 years was performed using public registries.

Results

During the study, 203 individuals experienced a first clinical fracture, of which 85 patients were considered osteoporotic (9 in humerus, 10 vertebral, 32 in the hip and 34 in the forearm). Cox proportional hazard regression models were used to evaluate risk factors for any and osteoporotic fractures. The following variables were found to be associated with increased risk of any fracture in adjusted models family history of a hip fracture (HR; 95%CI: 1.56; 1.05–2.33), falls (2–4/year: 2.10; 1.35–3.27, >4/year: 2.46; 1.12–5.41, both compared to no falls), dizziness (2.36; 1.51–3.71), erectile dysfunction (1.41; 1.06–1.87) and frequent urination (2.06; 1.26–3.39). Similarly, falls (2.36; 1.45–3.86), dizziness (2.83; 1.52–5.25), erectile dysfunction (2.01; 1.30–3.09) and pulmonary illness (1.90; 1.03–3.53) were associated with increased risk of osteoporotic fractures in adjusted models.

Conclusion

These results underline the importance of assessment of dizziness, falls and those with a family history of hip fracture. Frequent urination and erectile dysfunction were independently associated with increased fracture risk. Although the mechanism of association is unknown, these variables are likely to be indicators of frailty or hypogonadism.

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van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522PubMedCrossRef

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRef

Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222PubMedCrossRef

Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650PubMedCrossRef

Stevens JA, Sogolow ED (2005) Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 11:115–119PubMedCrossRef

Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 80:243–248PubMedCrossRef

De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ III, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338PubMedCrossRef

Hoidrup S, Prescott E, Sorensen TI, Gottschau A, Lauritzen JB, Schroll M, Gronbaek M (2000) Tobacco smoking and risk of hip fracture in men and women. Int J Epidemiol 29:253–259PubMedCrossRef

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 Med 4:e199PubMedCrossRef

10.

Lewis CE, Ewing SK, Taylor BC, Shikany JM, Fink HA, Ensrud KE, Barrett-Connor E, Cummings SR, Orwoll E (2007) Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res 22:211–219PubMedCrossRef

11.

Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Eisman JA, McCloskey EV, Mellstrom D, Melton LJ III, Pols HA, Reeve J, Silman AJ, Tenenhouse A (2004) A family history of fracture and fracture risk: a meta-analysis. Bone 35:1029–1037PubMedCrossRef

12.

Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ 339:b4229PubMedCrossRef

13.

Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673PubMedCrossRef

14.

Vestergaard P, Rejnmark L, Mosekilde L (2009) Hypertension is a risk factor for fractures. Calcif Tissue Int 84:103–111PubMedCrossRef

15.

Abrahamsen B, Brixen K (2009) Mapping the prescriptiome to fractures in men—a national analysis of prescription history and fracture risk. Osteoporos Int 20:585–597PubMedCrossRef

16.

Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, Goltzman D (2007) Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 167:188–194PubMedCrossRef

17.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRef

18.

Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19(10):1431–1444PubMedCrossRef

19.

Geusens P, Dinant G (2007) Integrating a gender dimension into osteoporosis and fracture risk research. Gend Med 4(Suppl B):S147–S161PubMedCrossRef

20.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383PubMedCrossRef

21.

Benichou J (2001) A review of adjusted estimators of attributable risk. Stat Meth Med Res 10:195–216CrossRef

22.

Keles I, Aydin G, Orkun S, Basar MM, Batislam E (2005) Two clinical problems in elderly men: osteoporosis and erectile dysfunction. Arch Androl 51:177–184PubMedCrossRef

23.

Meier C, Nguyen TV, Handelsman DJ, Schindler C, Kushnir MM, Rockwood AL, Meikle AW, Center JR, Eisman JA, Seibel MJ (2008) Endogenous sex hormones and incident fracture risk in older men: the Dubbo Osteoporosis Epidemiology Study. Arch Intern Med 168:47–54PubMedCrossRef

24.

Leblanc ES, Nielson CM, Marshall LM, Lapidus JA, Barrett-Connor E, Ensrud KE, Hoffman AR, Laughlin G, Ohlsson C, Orwoll ES (2009) The effects of serum testosterone, estradiol, and sex hormone binding globulin levels on fracture risk in older men. J Clin Endocrinol Metab 94:3337–3346PubMedCrossRef

25.

Amin S, Zhang Y, Felson DT, Sawin CT, Hannan MT, Wilson PW, Kiel DP (2006) Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study. Am J Med 119:426–433PubMedCrossRef

26.

Asplund R (2006) Hip fractures, nocturia, and nocturnal polyuria in the elderly. Arch Gerontol Geriatr 43:319–326PubMedCrossRef

27.

Temml C, Ponholzer A, Gutjahr G, Berger I, Marszalek M, Madersbacher S (2009) Nocturia is an age-independent risk factor for hip fractures in men. Neurourol Urodyn 28:949–952PubMedCrossRef

28.

Dam TT, Harrison S, Fink HA, Ramsdell J, Barrett-Connor E (2010) Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma. Osteoporos Int 21(8):1341–1349PubMedCrossRef

29.

Vestergaard P, Rejnmark L, Mosekilde L (2007) Fracture risk in patients with chronic lung diseases treated with bronchodilator drugs and inhaled and oral corticosteroids. Chest 132:1599–1607PubMedCrossRef

30.

Olofsson H, Byberg L, Mohsen R, Melhus H, Lithell H, Michaelsson K (2005) Smoking and the risk of fracture in older men. J Bone Miner Res 20:1208–1215PubMedCrossRef

31.

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 16:737–742PubMedCrossRef

Title: Risk factors for fracture in elderly men: a population-based prospective study
Authors: M. Frost
B. Abrahamsen
T. Masud
K. Brixen
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 2/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1575-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for fracture in elderly men: a population-based prospective study

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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