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January 2008 Issue

Nelson Watts, MD, specializes in osteoporosis.
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Common Predictors of Hip Fractures Identified

Published January 2008

When she was 45 years old, Christine Cox fell and broke her wrist and damaged her elbow. She was surprised when the orthopedist who operated on her elbow told her that her bones were thinning.

That initial fall nearly 40 years ago was the first of many times Cox has fallen and fractured bones in her legs, shoulder, pelvis and hip.

Cox, like one in five people who fracture their hip, had to recover in a nursing home.

She says that being able to predict hip fracture risk would allow women like her to take earlier precautions.

To help more women avoid hip fractures, 11 researchers across the country have developed a diagnostic model that may help identify postmenopausal women at risk for hip fractures before they show signs of osteoporosis.

The researchers, including Nelson Watts, MD, director of the UC Bone Health and Osteoporosis Center, evaluated clinical risk factors associated with hip fractures using data from more than 94,000 women (ages 50 to 79) of various ethnic backgrounds participating in the Women’s Health Initiative, an ongoing national health study.

Detailed in the Nov. 28, 2007, issue of the Journal of the American Medical Association (JAMA), the team identified 11 factors that were predictive of hip fractures in five years:

  • Age
  • Weight
  • Height
  • Race/ethnicity
  • General health
  • Physical activity
  • Personal history of a fracture after age 55
  • Parent history of a fracture
  • Current smoking
  • Current corticosteroid use
  • Treated diabetes

“Bone density testing is the best single test we have for determining hip fracture risk,” says Watts.

“However, we need other ways to identify risk because more than half of hip fractures actually occur in those whose bone density score doesn’t meet the criterion for osteoporosis.”

Osteoporosis, or weakening of the bones, is responsible for two million fractures annually, including more than 300,000 hip fractures.

Watts says that knowing a patient’s risk for hip fractures will allow her and her doctor to develop a personalized treatment plan, including medical intervention and lifestyle changes.

“I’ve been asking patients about many of these risk factors for years,” says Watts. “But now we have scientific evidence of their importance, as well as how to use the combination of factors to determine hip fracture risk.”   

Watts adds that identifying risk is important because osteoporosis is a “silent” disease.

“People don’t feel bad until they experience a complication like a fracture and they sometimes stop taking their medication or make poor lifestyle choices—that’s why it’s important for people to be proactive about bone health,” he says.

Cox says it’s wonderful that women can know their hip fracture risk ahead of time.

“It gives them time to do something about it because no one wants to end up with multiple broken bones,” she says.

The JAMA study was led by John Robbins, MD, of 
the University of California at Davis.

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