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Osteoporosis International

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Open Access 01-04-2018 | Original Article

Lower risk of hip fractures among Swedish women with large hips?

Authors: S. Klingberg, K. Mehlig, V. Sundh, B. L. Heitmann, L. Lissner

Published in: Osteoporosis International | Issue 4/2018

Abstract

Summary

In women, a large hip circumference (HC) related to lower hip fracture risk, independent of age and regardless if HC was measured long before or closer to the fracture. In older women, body mass index (BMI) explained the protection.

Introduction

In postmenopausal women, HC has been suggested to inversely associate with hip fracture while this has not been investigated in middle-aged women. We examined the association between HC, measured at two different time points, and hip fracture in a Swedish female population-based sample monitored for incident hip fractures over many years.

Methods

Baseline HC, measured in 1968 or 1974 (n = 1451, mean age 47.6 years), or the HC measures that were the most proximal before event or censoring (n = 1325, mean age 71.7 years), were used to assess the effects of HC on hip fracture risk in women participating in the Prospective Population Study of Women in Gothenburg. HC was parameterized as quintiles with the lowest quintile (Q1) as reference. Incident hip fractures over 45 years of follow-up (n = 257) were identified through hospital registers.

Results

Higher quintiles of HC at both baseline and proximal to event were inversely associated with hip fracture risk in age-adjusted models, but only baseline HC predicted hip fractures independently of BMI and other covariates (HR (95% CI) Q2, 0.85 (0.56–1.27); Q3, 0.59 (0.36–0.96); Q4, 0.57 (0.34–0.96); Q5, 0.58 (0.31–1.10)).

Conclusions

A large HC is protective against hip fracture in midlife and in advanced age, but the association between proximal HC and hip fracture was explained by concurrent BMI suggesting that padding was not the main mechanism for the association. The independent protection seen in middle-aged women points to other mechanisms influencing bone strength.

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Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, Epidemiology IOFWGo, Quality of L (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. https://doi.org/10.1007/s00198-012-1964-3 CrossRefPubMedPubMedCentral

Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M (2014) Complications of hip fractures: a review. World J Orthop 5(4):402–411. https://doi.org/10.5312/wjo.v5.i4.402 CrossRefPubMedPubMedCentral

Santesso N, Carrasco-Labra A, Brignardello-Petersen R (2014) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 3:CD001255. https://doi.org/10.1002/14651858.CD001255.pub5

Johansson H, Kanis JA, Oden A, McCloskey E, Chapurlat RD, Christiansen C, Cummings SR, Diez-Perez A, Eisman JA, Fujiwara S, Gluer CC, Goltzman D, Hans D, Khaw KT, Krieg MA, Kroger H, LaCroix AZ, Lau E, Leslie WD, Mellstrom D, Melton LJ 3rd, O'Neill TW, Pasco JA, Prior JC, Reid DM, Rivadeneira F, van Staa T, Yoshimura N, Zillikens MC (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29(1):223–233. https://doi.org/10.1002/jbmr.2017 CrossRefPubMed

Tang X, Liu G, Kang J, Hou Y, Jiang F, Yuan W, Shi J (2013) Obesity and risk of hip fracture in adults: a meta-analysis of prospective cohort studies. PLoS One 8(4):e55077. https://doi.org/10.1371/journal.pone.0055077 CrossRefPubMedPubMedCentral

Meyer HE, Willett WC, Flint AJ, Feskanich D (2016) Abdominal obesity and hip fracture: results from the Nurses’ health study and the health professionals follow-up study. Osteoporos Int 27(6):2127–2136. https://doi.org/10.1007/s00198-016-3508-8 CrossRefPubMed

Sogaard AJ, Holvik K, Omsland TK, Tell GS, Dahl C, Schei B, Falch JA, Eisman JA, Meyer HE (2014) Abdominal obesity increases the risk of hip fracture. A population-based study of 43 000 women and men aged 60–79 years followed for 8 years. Cohort of Norway. J Intern Med 277(3):306–317. https://doi.org/10.1111/joim.12230 CrossRefPubMed

Parker ED, Pereira MA, Virnig B, Folsom AR (2008) The association of hip circumference with incident hip fracture in a cohort of postmenopausal women: the Iowa Women’s health study. Ann Epidemiol 18(11):836–841. https://doi.org/10.1016/j.annepidem.2008.07.007 CrossRefPubMedPubMedCentral

Robinovitch SN, McMahon TA, Hayes WC (1995) Force attenuation in trochanteric soft tissues during impact from a fall. J Orthop Res 13(6):956–962. https://doi.org/10.1002/jor.1100130621 CrossRefPubMed

10.

Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138(3):160–169. https://doi.org/10.1093/oxfordjournals.aje.a116842 CrossRefPubMed

11.

Filip R, Raszewski G (2009) Bone mineral density and bone turnover in relation to serum leptin, alpha-ketoglutarate and sex steroids in overweight and obese postmenopausal women. Clin Endocrinol 70(2):214–220. https://doi.org/10.1111/j.1365-2265.2008.03313.x CrossRef

12.

Bengtsson C, Blohme G, Hallberg L, Hällström T, Isaksson B, Korsan-Bengtsen K, Rybo G, Tibblin E, Tibblin G, Westerberg H (1973) The study of women in Gothenburg 1968–1969—a population study. General design, purpose and sampling results. Acta Med Scand 193(4):311–318PubMed

13.

Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11(1):450. https://doi.org/10.1186/1471-2458-11-450 CrossRefPubMedPubMedCentral

14.

Li R, Hertzmark E, Louie M, Chen L, Spiegelman D (2011) The SAS LGTPHCURV9 Macro. http://www.hsph.harvard.edu/faculty/donna-spiegelman/software. Accessed 2012 Oct 15

15.

Siiteri PK (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45(1 Suppl):277–282. https://doi.org/10.1093/ajcn/45.1.277 CrossRefPubMed

16.

Corrao G, Zambon A, Nicotra F, Conti V, Nappi RE, Merlino L (2008) Issues concerning the use of hormone replacement therapy and risk of fracture: a population-based, nested case–control study. Br J Clin Pharmacol 65(1):123–129. https://doi.org/10.1111/j.1365-2125.2007.02904.x CrossRefPubMed

17.

Michaelsson K, Baron JA, Farahmand BY, Johnell O, Magnusson C, Persson PG, Persson I, Ljunghall S (1998) Hormone replacement therapy and risk of hip fracture: population based case–control study. The Swedish hip fracture study group. BMJ 316(7148):1858–1863. https://doi.org/10.1136/bmj.316.7148.1858 CrossRefPubMedPubMedCentral

18.

Gilsanz V, Chalfant J, Mo AO, Lee DC, Dorey FJ, Mittelman SD (2009) Reciprocal relations of subcutaneous and visceral fat to bone structure and strength. J Clin Endocrinol Metab 94(9):3387–3393. https://doi.org/10.1210/jc.2008-2422 CrossRefPubMedPubMedCentral

19.

Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM, Study of Osteoporotic Fractures Research G (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62(7):744–751CrossRefPubMed

20.

Dodds RM, Roberts HC, Cooper C, Sayer AA (2015) The epidemiology of sarcopenia. J Clin Densitom 18(4):461–466. https://doi.org/10.1016/j.jocd.2015.04.012 CrossRefPubMedPubMedCentral

21.

DiPietro L, Welch GA, Davis DR, Drane JW, Macera CA (1993) Body mass and risk of hip fracture among a national cohort of postmenopausal white women: a reanalysis. Obes Res 1(5):357–363. https://doi.org/10.1002/j.1550-8528.1993.tb00013.x CrossRefPubMed

22.

Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the leisure world study. Epidemiology 2(1):16–25. https://doi.org/10.1097/00001648-199101000-00004 CrossRefPubMed

23.

Armstrong ME, Spencer EA, Cairns BJ, Banks E, Pirie K, Green J, Wright FL, Reeves GK, Beral V, Million Women Study C (2011) Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women. J Bone Miner Res 26(6):1330–1338. https://doi.org/10.1002/jbmr.315 CrossRefPubMed

24.

Prieto-Alhambra D, Premaor MO, Fina Aviles F, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C, Nogues X, Compston JE, Diez-Perez A (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27(2):294–300. https://doi.org/10.1002/jbmr.1466 CrossRefPubMed

25.

Gonnelli S, Caffarelli C, Nuti R (2014) Obesity and fracture risk. Clin Cases Miner Bone Metab 11(1):9–14PubMedPubMedCentral

26.

Broy SB, Cauley JA, Lewiecki ME, Schousboe JT, Shepherd JA, Leslie WD (2015) Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 1: hip geometry. J Clin Densitom 18(3):287–308. https://doi.org/10.1016/j.jocd.2015.06.005 CrossRefPubMed

27.

Lissner L, Björkelund C, Heitmann BL, Seidell JC, Bengtsson C (2001) Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res 9(10):644–646. https://doi.org/10.1038/oby.2001.85 CrossRefPubMed

28.

Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008 CrossRefPubMedPubMedCentral

29.

Jonasson G, Sundh V, Ahlqwist M, Hakeberg M, Björkelund C, Lissner L (2011) A prospective study of mandibular trabecular bone to predict fracture incidence in women: a low-cost screening tool in the dental clinic. Bone 49(4):873–879. https://doi.org/10.1016/j.bone.2011.06.036 CrossRefPubMed

Title: Lower risk of hip fractures among Swedish women with large hips?
Authors: S. Klingberg
K. Mehlig
V. Sundh
B. L. Heitmann
L. Lissner
Publication date: 01-04-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 4/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-017-4363-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lower risk of hip fractures among Swedish women with large hips?

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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