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Azevedo DC, Hoff LS, Kowalski SC, de Andrade CAF, Trevisani VFM, de Melo AKG. Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study. Adv Rheumatol 2024; 64:8. [PMID: 38233892 DOI: 10.1186/s42358-024-00350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. METHODS This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. RESULTS A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). CONCLUSION Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.
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Affiliation(s)
- Daniela Castelo Azevedo
- Data Science and Epidemiology, Clínica Mais 60 Saúde, Rua Juiz de Fora, 1071 - Barro Preto, Belo Horizonte, MG, 30180-060, Brazil.
| | | | - Sergio Candido Kowalski
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medical Clinic, Universidade Federal do Paraná, Curitiba, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca (ENSP)/ Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Faculty of Medicine, Vassouras University, Rio de Janeiro, RJ, Brazil
| | - Virgínia Fernandes Moça Trevisani
- Department of Emergency Medicine and Evidence Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Rheumatology, Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Ana Karla Guedes de Melo
- Department of Rheumatology, Hospital Universitário Lauro Wanderley/Universidade Federal da Paraíba, João Pessoa, PB, Brazil
- Evidence Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Vaishya R, Iyengar KP, Jain VK, Vaish A. Demystifying the Risk Factors and Preventive Measures for Osteoporosis. Indian J Orthop 2023; 57:94-104. [PMID: 38107819 PMCID: PMC10721752 DOI: 10.1007/s43465-023-00998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 12/19/2023]
Abstract
Background Osteoporosis is a major health problem, globally. It is characterized by structural bone weakness leading to an increased risk of fragility fractures. These fractures commonly affect the spine, hip and wrist bones. Consequently, Osteoporosis related proximal femur and vertebral fractures represent a substantial, growing social and economic burden on healthcare systems worldwide. Indentification of the risk factors, clinical risk assessment, utilization of risk assessment tools and appropriate management that play a crucial role in reducing the burden of Osteoporosis by tackling modifiable risk factors. Methods This chapter explores various risk factors that are associated with Osteoporosis and provides an overview of various clinical and diagnostic risk assessment tools with a particular emphasis on evidence-based strategies for their prevention. Conclusion The role of emerging technologies such as Artificial Intelligence (AI) and perspectives such as newer diagnostic modalities, monitoring and surveillance approaches in prevention of risk factors in the pathogenesis of Osteoporosis is highlighted.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076 India
| | | | - Vijay Kumar Jain
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076 India
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Lamo-Espinosa JM, Mariscal G, Gómez-Álvarez J, San-Julián M. Incidence and risk factors for stroke after hip fracture: a meta-analysis. Sci Rep 2023; 13:17618. [PMID: 37848510 PMCID: PMC10582073 DOI: 10.1038/s41598-023-44917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023] Open
Abstract
Hip fractures represent a high burden and are associated with mortality in up to 30% of the cases. Stroke complications can be devastating and increase mortality and disability in elderly patients. This study aimed to determine the overall incidence and risk factors for stroke in patients with hip fractures. A systematic search of the literature using PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases was carried out. Studies have reported the incidence of stroke in patients > 50 years of age with hip fractures. Data were extracted according to PRISMA guidelines (PROSPERO: CRD42023384742). Data were combined using Review Manager version 5.4. A random-effects model was adopted if a significant heterogeneity was observed. The primary outcome was the incidence of stroke in patients with hip fractures. The secondary outcomes of interest included the influence on the incidence of demographic factors, associated conditions, habits, and analytical parameters. Of the 635 initially retrieved studies, 18 were included, with 256,197 patients. The mean age of the patients ranged from 55 to 84 years old. The overall incidence of stroke in patients with hip fracture was 6.72% (95% CI 4.37-9.07%. The incidence of stroke by region was highest in the American continent (8.09%, 95% CI 3.60-12.58%; P > 0.001). Regarding associated conditions diabetes significantly increased the risk of stroke (OR 1.80, 95% CI 1.41-2.30). Respect to patient characteristics, BMI greater than 24.4 and female gender did not significantly increase the risk of stroke: (OR 1.07, 95% CI 0.74-1.56) and (OR 1.15, 95% CI 0.91-1.46). Lastly, lower albumin concentrations were a risk factor for stroke in patients with hip fracture (MD - 3.18, 95% CI - 4.06 to 2.31). In conclusion, the incidence of stroke after hip fracture was 6.72%. The incidence of stroke increases over time, and the closely associated risk factors are diabetes and low albumin level.
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Affiliation(s)
| | - Gonzalo Mariscal
- Institute for Research on Muscuoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, Valencia, Spain.
| | - Jorge Gómez-Álvarez
- Hip, Tumors and Pediatric Orthopedic Unit, University Clinic of Navarra, Navarra, Spain
| | - Mikel San-Julián
- Hip, Tumors and Pediatric Orthopedic Unit, University Clinic of Navarra, Navarra, Spain
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4
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Zhu K, Hunter M, James A, Lim EM, Walsh JP. Relationships between longitudinal changes in body composition and bone mineral density in middle-to-older aged Australians. Osteoporos Int 2023; 34:1601-1611. [PMID: 37233793 PMCID: PMC10427547 DOI: 10.1007/s00198-023-06773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023]
Abstract
There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD). In 3671 participants aged 46-70 years at baseline, ∆lean mass was a stronger determinant than ∆fat mass of ∆BMD over 6 years. Maintained or increased lean mass may slow down age-related bone loss. PURPOSE There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD) with ageing. We examined these in the Busselton Healthy Ageing Study. METHODS We studied 3671 participants (2019 females) aged 46-70 years at baseline with body composition and BMD assessments by dual-energy x-ray absorptiometry at baseline and after ~6 years. Relationships between changes in total body mass (∆TM), lean mass (∆LM) and fat mass (∆FM) with ∆BMD at total hip, femoral neck and lumbar spine were evaluated using restricted cubic spline modelling (accounting for baseline covariates) and mid-quartile least square means were compared. RESULTS ∆TM was positively associated with ∆BMD of total hip and femoral neck in both sexes, and spine in females; in females but not males, associations plateaued at ∆TM above ~5kg for all sites. In females, ∆LM was positively associated with ∆BMD of all three sites with plateauing of the relationship at ∆LM above ~1kg. Women in the highest quartile of ∆LM (Q4, mid-quartile value +1.6 kg) had 0.019-0.028 g/cm2 less reduction in BMD than those in the lowest quartile (Q1, -2.1 kg). In males, ∆LM was positively associated with ∆BMD of total hip and femoral neck; men in Q4 (+1.6 kg) had 0.015 and 0.011 g/cm2 less bone loss, respectively, compared with Q1 (-2.7 kg). ∆FM was positively associated with ∆BMD of total hip only in both sexes. CONCLUSION ∆LM is a stronger determinant than ∆FM of ∆BMD. Maintained or increased LM is associated with less age-related bone loss.
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Affiliation(s)
- K Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia.
- Medical School, University of Western Australia, Crawley, WA, Australia.
| | - M Hunter
- Busselton Population Medical Research Institute, Busselton, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - A James
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - E M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - J P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
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de Almeida Marques Bernabé R, de Souza Vieira M, Felício de Souza V, Gomes Fontana L, Albergaria BH, Marques-Rocha JL, Guandalini VR. Muscle strength is associated with fracture risk obtained by fracture risk assessment tool (FRAX) in women with breast cancer. BMC Cancer 2022; 22:1115. [PMID: 36320019 PMCID: PMC9623985 DOI: 10.1186/s12885-022-10203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Women with breast cancer are at risk for the development of sarcopenia and occurrence of fractures. The initial and periodic screening of these conditions can prevent the risks of disability, poor quality of life, and death. The present study investigated the association between sarcopenia phenotypes and fracture risk, assessed by the Fracture Risk Assessment Tool (FRAX) in women with breast cancer. Methods Cross-sectional study. It included women aged between 40 and 80 years, diagnosed with Luminal subtype breast cancer, with time of diagnosis ≤ 12 months, who had not started endocrine therapy, did not have metastasis, had not been treated for another malignancy, and had no recurrences. Sociodemographic, habits and lifestyle, clinical, anthropometric, and body composition variables were considered. Muscle strength, skeletal muscle mass, and physical performance were investigated using handgrip strength (HGS), appendicular skeletal muscle mass index (ASMI), and Timed Up and Go test (TUGT), respectively. Fracture risk was assessed using FRAX. Multiple linear regression models were conducted to verify the association between exposure variables and sarcopenia phenotypes. A significance level of p < 0.05 was adopted for all tests using the SPPS 25.0 program. Results Sixty-two women with a mean age of 58.1 ± 10.4 years were evaluated. Of these, 66.1% self-declared to be non-white, 41.9% and 71.0% did not consume alcohol or smoke, respectively, and 61.3% were insufficiently active. A total of 45.2% had clinical stage II carcinoma and 65.5% had the invasive breast carcinoma histological subtype. There was a predominance of adequacy of HGS (88.7%), ASMI (94.5%), and TUGT (96.8%), as well as low risk of hip fractures (85.5%) and major fractures (82.3%). HGS remained associated with FRAX hip fractures (p = 0.007) and FRAX major fractures (p = 0.007) in the adjusted models, while ASMI was associated with body mass (p < 0.001). Conclusions Low muscle strength was the sarcopenia phenotype that remained associated with fracture risk in women with breast cancer, independently of sociodemographic factors, level of physical activity, and clinical factors. In addition to the assessment of probable sarcopenia, this measurement may point out the risk of fractures.
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Affiliation(s)
- Rayne de Almeida Marques Bernabé
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Mariana de Souza Vieira
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Vanusa Felício de Souza
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Luana Gomes Fontana
- grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Ben-Hur Albergaria
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 - Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - José Luiz Marques-Rocha
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Valdete Regina Guandalini
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
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Zhao Q, Khedkar SV, Johnson KC. Weight Loss Interventions and Skeletal Health in Persons with Diabetes. Curr Osteoporos Rep 2022; 20:240-248. [PMID: 36040543 PMCID: PMC9522834 DOI: 10.1007/s11914-022-00744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE OF REVIEW Weight loss is recommended for improving glycemic control and reducing cardiovascular risk factors in persons with diabetes. However, both diabetes and weight loss have been associated with detrimental skeletal health. This review aims to summarize recent study findings on the effects of lifestyle interventions for weight loss on skeletal health among persons with type 2 diabetes (T2D). RECENT FINDINGS A few large-scale observational studies have demonstrated an increased fragility fracture risk associated with weight loss among persons with T2D. Randomized control trials in persons with T2D also have shown that intentional lifestyle interventions for weight loss are associated with a greater decrease in bone mineral density (BMD) and an increase in the risk of fracture. The biological mechanisms underlying the compromised bone health during lifestyle interventions for weight loss are complex and not yet conclusive. However, there is evidence to suggest that bone loss and increased fracture risk during intentional weight loss may be mitigated by some intervention approaches, such as high protein intake, calcium supplementation, and resistance and balance training. There is still a lack of studies investigating the effects of different interventions for weight loss on skeletal health among persons with T2D. However, certain types of diet and physical activity intervention combined with bone monitoring and fracture risk prediction may help achieve weight loss goals and maintain skeletal health among persons with T2D during intentional weight loss.
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Affiliation(s)
- Qi Zhao
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Sonal V Khedkar
- College of Medicine, University of Tennessee Health Science Center, Memphis, 38163, TN, USA
| | - Karen C Johnson
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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Kjeldgaard HK, Meyer HE, O'Flaherty M, Apalset EM, Dahl C, Emaus N, Fenstad AM, Furnes O, Gjertsen JE, Hoff M, Schei B, Søgaard AJ, Tell GS, Holvik K. Impact of Total Hip Replacements on the Incidence of Hip Fractures in Norway During 1999-2019. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. J Bone Miner Res 2022; 37:1936-1943. [PMID: 35877138 PMCID: PMC9804722 DOI: 10.1002/jbmr.4660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Abstract
The knowledge about why hip fracture rates in Norway have declined is sparse. Concurrent with decreasing hip fracture rates, the rates of total hip replacements (THRs) have increased. We wanted to investigate if hip fracture rates continued to decline, and whether the increase in THRs had any influence on this decline, assuming that living with a hip prosthesis precludes fracture of the operated hip. Information on hip fractures in Norway 1999-2019 was available from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database and population size were available in official population tables from Statistics Norway. Primary THRs (for any cause except hip fracture) 1989-2019 were obtained from the Norwegian Arthroplasty Register. We calculated the annual age-standardized incidence rates of hip fracture by sex for the period 1999-2019. The hip fracture rates in a scenario with no hip prostheses were calculated by subtracting 0.5 persons from the population at risk for each prevalent hip prosthesis, considering that each person has two hips at risk of fracture. We estimated how much of the decline could be attributed to the increased prevalence of hip prostheses. From 1999 to 2019, age-standardized incidence rates of hip fracture decreased by 27% in women and 20% in men. The rates remained stable in those under 70 years and decreased in those 70 years and above. Excluding replaced hips from the population at risk led to higher incidence rates, and this impact was considerably larger at higher ages. The increased prevalence of hip prostheses over the period accounted for approximately 18% (20% in women and 11% in men) of the observed decline in hip fracture rates. In conclusion, the incidence of hip fractures continued to decline, and the increasing number of people living with hip prostheses contributed significantly to the observed declining time trends. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Helena Kames Kjeldgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Ellen M Apalset
- Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway
| | - Anne Johanne Søgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Han S, Park J, Jang HD, Nah S, Boo J, Han K, Hong JY. Incidence of hip fracture in underweight individuals: a nationwide population-based cohort study in Korea. J Cachexia Sarcopenia Muscle 2022; 13:2473-2479. [PMID: 35852000 PMCID: PMC9530551 DOI: 10.1002/jcsm.13046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hip fracture is a major public health problem worldwide and being underweight is a risk factor for fractures. Few studies have investigated the association between being underweight and hip fracture in the general population. The present study investigated the incidence of hip fracture in a large population cohort based on detailed information about the degree of underweight. METHODS A nationwide retrospective cohort study of adults ≥40 years of age included 962,533 subjects who were not overweight or obese in 2009. The incidence and risk of hip fracture occurring between 2010 and 2018 was assessed based on the degree of underweight. Based on body mass index (BMI), the study population was categorized into normal (18.50-22.99 kg/m2 ), mild (17.00-18.49 kg/m2 ), moderate (16.00-16.99 kg/m2 ), and severe underweight (<16.00 kg/m2 ) groups. Cox proportional hazards analyses were performed to calculate the hazard ratio (HR) for the hip fracture based on the degree of underweight in reference to the normal weight. RESULTS Compared with subjects who were normal weight, those who were classified as mild underweight (1.03/1000 person-years (PY) increase in incidence rate (IR); adjusted HR (aHR) 1.61; 95% confidence interval (CI) 1.48-1.76), moderate underweight (2.04/1000 PY increase in IR; aHR 1.85; 95% CI 1.65-2.08), or severe underweight (4.58/1000 PY increase in IR; aHR 2.33; 95% CI 2.03-2.66) were at significantly increased risk of hip fracture. CONCLUSIONS The severity of underweight was significantly associated with risk of hip fracture. The subdivision of underweight helps to estimate fracture risk more accurately.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jiwon Park
- Department of Orthopedics, Korea University Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Joonhyeok Boo
- Department of Orthopedics, Korea University Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
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9
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Han S, Park J, Jang HD, Han K, Lee C, Kim W, Hong JY. Changes in Underweight Status and Risk of Hip Fracture: A Korean Nationwide Population-Based Cohort Study. J Clin Med 2022; 11:jcm11071913. [PMID: 35407521 PMCID: PMC8999678 DOI: 10.3390/jcm11071913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Being underweight is associated with a high risk of hip fracture. However, the impact of change in underweight status on the risk of hip fracture is unknown. This study is performed to investigate the relationship between change in underweight status and risk of hip fracture. This study included 1,713,225 subjects aged ≥40 years who underwent two consecutive national health screenings between 2007 and 2009. We prospectively assessed the risk of hip fracture between 2010 and 2018 according to changes in underweight status. We divided the participants into four groups according to the change in underweight status: consistent non-underweight (non-underweight to non-underweight), became non-underweight (underweight to non-underweight), became underweight (non-underweight to underweight), and consistent underweight (underweight to underweight). Compared with the consistent non-underweight group, the became non-underweight (0.74/1000 person years (PY) increase in incidence rate (IR); adjusted hazard ratio (HR) 1.72; 95% confidence interval (CI) 1.42−2.07), became underweight (1.71/1000 PY increase in IR; adjusted HR 2.22; 95% CI 1.96−2.53), and consistent underweight (1.3/1000 PY increase in IR; adjusted HR 2.18; 95% CI 1.89−2.53) groups had a significantly increased risk of hip fracture (p < 0.001). Change in underweight status was significantly associated with a risk of hip fracture.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Jiwon Park
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea;
| | - Choungah Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea;
| | - Wonseok Kim
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
- Correspondence: ; Tel.: +82-31-412-6577
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