The relationship between anthropometric measurements and fractures in women

doi:10.1016/S8756-3282(96)00196-2

Bone

Volume 19, Issue 4, October 1996, Pages 407-413

https://doi.org/10.1016/S8756-3282(96)00196-2 Get rights and content

Abstract

In a population-based, retrospective study involving post-menopausal women, we investigated the relation between fracture prevalence (risk) and present as well as previous body height and weight. A questionnaire was mailed to 46,353 postmenopausal women aged 50–80 years and there were 29,802 (64.3%) responses. Questions were asked about body height and weight and fractures after the age of 25 and at what year they had occurred. The fractures were grouped according to whether they had occurred within 5 years or 10 years prior to responding to the questionnaire. Main outcome was relative risk (RR) of having sustained a fracture of the hip, radius, or spine within 5 years or within 10 years prior to responding to the questionnaire. RRs for hip and spine fractures were negatively associated with current body mass index, current weight, and weight gain since the age of 25 years. Moreover, the RRs of these fractures were positively associated with current height, height at the age of 25, and height loss since the age of 25 years, with the exception of fracture of the spine and current height. RRs for radius fracture were negatively associated with current body mass index and height loss since the age of 25. Moreover, the RRs for radius fracture were positively associated with current weight and height, weight gain since the age of 25, and weight and height at the age of 25. Height at the age of 25 was a consistent risk factor for all fracture types. The RR of the highest quartile (greatest height) vs. the lowest was 2.5 for having a hip fracture during the past 5 years and 2.3 during the past 10 years, which corresponds to a RR of 1.4 for an increase in 1 SD (5.4 cm) in height at age 25. The RR for spine fracture increased about fivefold in women having sustained ≥3 cm height reduction compared with those who had maintained height. We conclude that tall women have a greater relative risk of experiencing fragility fractures. By using height, women at risk of a later fracture can be selected already at the age of 25 years for later follow-up. Height loss, being strongly associated with fragility fractures, indicates the presence of an already existing osteoporotic condition that should receive evaluation and treatment.

References (39)

F. Doyle et al.
Relation between bone mass and muscle weight
Lancet
(1970)
T.A. Hutchinson et al.
Postmenopausal oestrogens protect against fractures of hip and distal radius: A case-control study
Lancet
(1979)
M. Kleerekoper et al.
Outcome variables in clinical trials
Bone
(1992)
H.E. Meyer et al.
Height and body mass index in Oslo, Norway, compared to other regions of Europe: Do they explain differences in the incidence of hip fracture?
Bone
(1995)
G.A. Colditz et al.
Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women
Am J Epidemiol
(1986)
C. Cooper et al.
Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain
BMJ
(1988)
C. Cooper et al.
Incidence of clinically diagnosed vertebral fractures: A population based study in Rochester, Minnesota 1985–1989
J Bone Miner Res
(1992)
S.R. Cummings et al.
Racial differences in hip axis lengths might explain racial differences in rates of hip fracture
Osteopor Int
(1994)
S.R. Cummings et al.
Risk factors for hip fracture in white women
N Engl J Med
(1995)
S.R. Cummings et al.
Epidemiology of osteoporosis and osteoporotic fractures
Epidemiol Rev
(1985)

J.W. Davis et al.

Evidence for both generalized and regional low bone mass among elderly women

J Bone Miner Res

(1994)

I. Elffors et al.

The variable incidence of hip fracture in Southern Europe. The MEDOS study

Osteopor Int

(1994)

M.E. Farmer et al.

Anthropometric indicators and hip fracture. The NHANES 1 epidemiologic follow-up study

J Am Geriatr Soc

(1989)

K.G. Faulkner et al.

Simple measurement of femoral geometry predicts hip fracture-the study of osteoporosis fractures

J Bone Miner Res

(1993)

S.L. Greenspan et al.

Fall severity and bone mineral density as risk factors for hip fractures in ambulatory elderly

JAMA

(1994)

J.A. Grisso et al.

Risk factor for falls as a cause of hip fracture in women: The Northeast Hip Fracture Study Group

N Engl J Med

(1991)

Gunnes, M., Mellstrom, D., and Johnell, O. How well can a previous fracture predict a new fracture?...

W.C. Hayes et al.

Impact near the hip dominates fracture risk in elderly nursing home residents who fall

Calcif Tissue Int

(1993)

W.C. Hayes et al.

Biomechanics of fractures

Cited by (81)

Women with fracture, unidentified by FRAX, but identified by cortical porosity, have a set of characteristics that contribute to their increased fracture risk beyond high FRAX score and high cortical porosity
2018, Bone
Citation Excerpt :
The increased risk for fracture in these women, suggest that the strength gained by larger bone size, did not offset the strength lost by the thinner cortices with higher cortical porosity [24]. Larger bone size is associated with higher cortical porosity [13,32] and taller individuals who on average have longer and wider bones, have increased risk for fracture [33,34]. The increased porosity combined with relatively thinner cortices, may partly explain why taller individuals, despite of their larger bone size, have increased risk for fracture [13,32].
The Fracture Risk Assessment Tool (FRAX) is widely used to identify individuals at increased risk for fracture. However, cortical porosity is associated with risk for fracture independent of FRAX and is reported to improve the net reclassification of fracture cases. We wanted to test the hypothesis that women with fracture who are unidentified by high FRAX score, but identified by high cortical porosity, have a set of characteristics that contribute to their fracture risk beyond high FRAX score and high cortical porosity. We quantified FRAX score with femoral neck areal bone mineral density (FN aBMD), and femoral subtrochanteric architecture, in 211 postmenopausal women aged 54–94 years with non-vertebral fractures, and 232 fracture-free controls in Tromsø, Norway, using StrAx software. Of 211 fracture cases, FRAX score > 20% identified 53 women (sensitivity 25.1% and specificity 93.5%), while cortical porosity cut-off > 80th percentile identified 61 women (sensitivity 28.9% and specificity 87.9%). The 43 (20.4%) additional fracture cases identified by high cortical porosity alone, had lower FRAX score (12.3 vs. 26.2%) than those identified by FRAX alone, they were younger, had higher FN aBMD (806 vs. 738 mg/cm²), and fewer had a prior fracture (23.3 vs. 62.9%), all p < 0.05. They had higher cortical porosity (48.7 vs. 42.1%), thinner cortices (3.75 vs. 4.12 mm), lower cortical and total volumetric BMD (942 vs. 1053 and 586 vs. 699 mg HA/cm³), larger medullary and total cross-sectional areas (245 vs. 190 and 669 vs. 593 mm²), and higher cross-sectional moment of inertia (2619 vs. 2388 cm⁴) all p < 0.001. When the fracture cases and controls with high cortical porosity were compared, cases had higher cortical porosity, lower cortical vBMD, lower total vBMD, smaller cortical CSA/Total CSA, larger medullary CSA and larger total CSA than controls (all p ≤ 0.05). Thus, fracture cases, unidentified by FRAX, but identified by cortical porosity, had an architecture where the positive impact of larger bone size did not offset the negative effect of thinner cortices with increased porosity. A measurement of cortical porosity may be a marker of other characteristics that capture additional fracture risk components, not captured by FRAX.
Consensus statement: Recommendations for the management of metabolic bone disease in human immunodeficiency virus patients
2014, Enfermedades Infecciosas y Microbiologia Clinica
Proporcionar unas recomendaciones prácticas para el manejo de la enfermedad metabólica ósea en pacientes con virus de la inmunodeficiencia humana (VIH).
Miembros de diferentes sociedades científicas relacionadas con el metabolismo óseo y con la enfermedad VIH: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM) y Sociedad Española de Fractura Osteoporótica (SEFRAOS).
Se realizó una búsqueda sistemática en PubMed de la evidencia disponible para cada aspecto, y se revisaron artículos escritos en inglés y en castellano con fecha de inclusión hasta 28 de mayo de 2013. Las recomendaciones se formularon según el sistema GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Los autores trabajaron por grupos en la formulación de cada apartado de las recomendaciones y posteriormente el documento global se discutió en una reunión conjunta. Todos los autores revisaron el documento escrito final y lo consensuaron.
El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y el tratamiento de la enfermedad metabólica ósea en pacientes con VIH.
To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients.
Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM), and Sociedad Española de Fractura Osteoporótica (SEFRAOS).
A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content.
The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients.
Low BMD is an independent predictor of fracture and early menopause of mortality in post-menopausal women-A 34-year prospective study
2013, Maturitas
Identify risk factors for fragility fractures and mortality in women aged 48.
Prospective population-based observational study on 390 white north European women aged 48 at study start. At study start, we measured bone mineral density (BMD) by single-photon absorptiometry (SPA) in the distal forearm, anthropometry by standard equipment and registered menopausal status, health and lifestyle factors. Menopause before age 47 was defined as early menopause. Incident fragility fractures and mortality were recorded until the women reached age 82. Potential risk factors for fragility fracture and mortality were evaluated with Cox's proportional hazard regression analysis. Data are presented as risk ratios (RR) with 95% confidence intervals in brackets.
Incidence of fragility fractures and mortality.
In the univariate analysis, low BMD and early menopause predicted fractures. In the multivariate analysis, only BMD remained as an independent risk factor with a RR of 1.36 (1.15, 1.62) per standard deviation (SD) decrease in baseline BMD. In the univariate analysis, early menopause and smoking predicted mortality, and remained as independent risk factors in the multivariate analysis with RR 1.62 (1.09, 2.39) for early menopause and 2.16 (1.53, 3,06) for smoking.
Low BMD at age 48 is an independent predictor for fragility fractures. The predictive ability of early menopause is at least partially attributed to other associated risk factors. Early menopause and smoking were found in this study to be independent predictors for mortality.
Different effects of age, adiposity and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women
2012, Bone
Citation Excerpt :
For ankle fractures, our findings of an increased risk with increasing adiposity are consistent with results from two retrospective case–control studies, [27,28] a retrospective cross-sectional study, [29] and two prospective studies;[30,31] however results from another prospective study were null [32]. For wrist fracture mixed findings have been reported, with the findings from two case–control studies consistent with a reduction in risk with increasing adiposity, [27,33] but no significant association was reported in two other case–control studies and in two prospective studies [32,34–36]. Physical activity has previously been associated with a reduced risk of hip fracture [1,25,37,38].
While increasing age, decreasing body mass index (BMI), and physical inactivity are known to increase hip fracture risk, whether these factors have similar effects on other common fractures is not well established. We used prospectively-collected data from a large cohort to examine the role of these factors on the risk of incident ankle, wrist and hip fractures in postmenopausal women. 1,155,304 postmenopausal participants in the Million Women Study with a mean age of 56.0 (SD 4.8) years, provided information about lifestyle, anthropometric, and reproductive factors at recruitment in 1996–2001. All participants were linked to National Health Service cause-specific hospital records for day-case or overnight admissions. During follow-up for an average of 8.3 years per woman, 6807 women had an incident ankle fracture, 9733 an incident wrist fracture, and 5267 an incident hip fracture. Adjusted absolute and relative risks (RRs) for incident ankle, wrist, and hip fractures were calculated using Cox regression models. Age-specific rates for wrist and hip fractures increased sharply with age, whereas rates for ankle fracture did not. Cumulative absolute risks from ages 50 to 84 years per 100 women were 2.5 (95%CI 2.2–2.8) for ankle fracture, 5.0 (95%CI 4.4–5.5) for wrist fracture, and 6.2 (95%CI 5.5–7.0) for hip fracture. Compared with lean women (BMI < 20 kg/m²), obese women (BMI ≥ 30 kg/m²) had a three-fold increased risk of ankle fracture (RR = 3.07; 95%CI 2.53–3.74), but a substantially reduced risk of wrist fracture and especially of hip fracture (RR = 0.57; 0.51–0.64 and 0.23; 0.21–0.27, respectively). Physical activity was associated with a reduced risk of hip fracture but was not associated with ankle or wrist fracture risk. Ankle, wrist and hip fractures are extremely common in postmenopausal women, but the associations with age, adiposity, and physical activity differ substantially between the three fracture sites.
Anthropometry, physical activity and hip fractures in the elderly
2011, Injury
Citation Excerpt :
Furthermore, increased physical activity at leisure was related to lower hip fracture incidence, independently from anthropometric characteristics. A positive association between high body stature and hip fracture has been reported by other investigators in different populations.7,11,15,18 Indeed, certain investigators have attributed a fraction of the increase in hip fracture incidence observed during the past decades to the increasing average stature of the population during the past century.24
Hip fractures constitute a major and growing public health problem amongst the elderly worldwide. We examined the association of anthropometry and physical activity with hip fracture incidence in a cohort of elderly Europeans, participants in the European Prospective Investigation into Cancer and nutrition (EPIC) study.
The study population consisted of 27 982 volunteers (10 553 men and 17 429 women) aged 60 years and above from five European countries. Information on anthropometry, physical activity, medical history and other characteristics was collected at baseline. During a median follow-up of 8 years, 261 incident hip fractures (203 women and 58 men) were recorded. Data were analysed through Cox proportional hazard regression with adjustment for potential confounders.
A higher body mass index (BMI) was associated with lower hip fracture risk (hazard ratio (HR) per increasing sex-specific-quintile: 0.85, 95% confidence interval (95% CI): 0.77–0.94). Body height was associated with increased hip fracture risk (HR per 5 cm: 1.13, 95% CI: 1.01–1.25). Waist-to-hip ratio was not related to hip fracture risk. Increasing levels of leisure-time physical activity were related to lower risk (HR per increasing tertile: 0.84, 95% CI: 0.70–0.99, p for trend: 0.039).
In a prospective cohort study of elderly Europeans, we found evidence that high body stature increased and high BMI decreased the incidence of hip fractures. After adjustment for BMI, waist-to-hip ratio was not associated with hip fracture risk. Leisure-time physical activity appears to play a beneficial role in the prevention of hip fractures.
Height loss, vertebral fractures, and the misclassification of osteoporosis
2011, Bone
Citation Excerpt :
Similar to studies by Siminoski et al., our study showed that the relationship between height loss and prevalent vertebral fractures was significant [14]. Our study also agreed with the cross-sectional studies by Tobias et al., and Gunnes et al. which determined that prevalent vertebral fracture rates increased with greater height loss [15,16]. In the study by Tobias et al. where they included 509 women, the difference in height loss between the two groups was 0.31 in.
The presence of a vertebral fracture identifies a patient who has clinical osteoporosis. However, approximately 2/3 to 3/4 of VFs are asymptomatic. Vertebral Fracture Assessment is a method derived from dual-energy X-ray absorptiometry (DXA) to assess vertebral fractures. The objectives of this study were 1) to determine the association between the degree of height loss in older men and women and the risk of a vertebral fracture, and 2) to determine if the knowledge of vertebral fractures will alter the classification of osteoporosis based on bone mineral density alone.
231 men and women over the age of 65 underwent DXA scan of their spine and hip (including bone mineral density and Vertebral Fracture Assessment), measurement of their height, and a questionnaire.
We found that height loss was significantly associated with a vertebral fracture (p = 0.0160). The magnitude of the association translates to a 19% increase in odds for 1/2 in. and 177% for 3 in. Although 45% had osteoporosis by either bone mineral density or fracture criteria, 30% would have been misclassified if bone mineral density criteria were used alone.
Height loss is an indicator for the presence of vertebral fractures. Bone mineral density criteria alone may misclassify older patients who have osteoporosis.

View all citing articles on Scopus

View full text

Original articleThe relationship between anthropometric measurements and fractures in women

Abstract

Lancet

Lancet

Bone

Bone

Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women

Am J Epidemiol

Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain

BMJ

Incidence of clinically diagnosed vertebral fractures: A population based study in Rochester, Minnesota 1985–1989

J Bone Miner Res

Racial differences in hip axis lengths might explain racial differences in rates of hip fracture

Osteopor Int

Risk factors for hip fracture in white women

N Engl J Med

Epidemiology of osteoporosis and osteoporotic fractures

Epidemiol Rev

Evidence for both generalized and regional low bone mass among elderly women

J Bone Miner Res

The variable incidence of hip fracture in Southern Europe. The MEDOS study

Osteopor Int

Anthropometric indicators and hip fracture. The NHANES 1 epidemiologic follow-up study

J Am Geriatr Soc

Simple measurement of femoral geometry predicts hip fracture-the study of osteoporosis fractures

J Bone Miner Res

Fall severity and bone mineral density as risk factors for hip fractures in ambulatory elderly

JAMA

Risk factor for falls as a cause of hip fracture in women: The Northeast Hip Fracture Study Group

N Engl J Med

Impact near the hip dominates fracture risk in elderly nursing home residents who fall

Calcif Tissue Int

Biomechanics of fractures

Original article
The relationship between anthropometric measurements and fractures in women