Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.

The authors prospectively studied the association between quantity and type of alcohol intake and risk of hip fracture among 17,868 men and 13,917 women. Analyses were based on pooled data from three population studies conducted in 1964-1992 in Copenhagen, Denmark. During follow-up, 500 first hip fractures were identified in women and 307 in men. A low to moderate weekly alcohol intake (1-27 drinks for men and 1-13 drinks for women) was not associated with hip fracture. Among men, the relative risk of hip fracture gradually increased for those who drank 28 drinks or more per week (relative risk (RR) = 1.75, 95% confidence interval (CI) 1.06-2.89 for 28-41 drinks; RR = 5.28, 95% CI 2.60-10.70 for 70 or more drinks) as compared with abstainers. Women who drank 14-27 drinks per week had an age-adjusted relative risk of hip fracture of 1.44 (95% CI 1.03-2.03), but the association weakened after adjustment for confounders (RR = 1.32, 95% CI 0.92-1.87). The risk of hip fracture differed according to the type of alcohol preferred: preferrers of beer had a higher risk of hip fracture (RR = 1.46, 95% CI 1.11-1.91) than preferrers of other types of alcoholic beverages. The corresponding relative risks for preferrers of wine and spirits were 0.77 (95% CI 0.58-1.03) and 0.82 (95% CI 0.58-1.14), respectively. In conclusion, an alcohol intake within the current European drinking limits does not influence the risk of hip fracture, whereas an alcohol intake of more than 27 drinks per week is a major risk factor for men.

Objective: This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns. Design: A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1. Setting: Copenhagen County, Denmark. Subjects: A random sample of 7316 adults participated in health examinations conducted either in 1982 -1984, 1987, or 1991 -1992. Results: The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase) ¼ 0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR ¼ 1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs. Conclusions: This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.

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The authors prospectively studied the effect of leisure-time physical activity level on hip fracture risk along with the influence of within-subject changes in activity levels, while taking possible confounding by other health behaviors and poor health into account. Analyses were based on pooled data from three population studies conducted in Copenhagen, Denmark. Among 13,183 women and 17,045 men, 1,121 first hip fractures were identified during follow-up. In comparison with being sedentary, the relative risk (RR) of hip fracture associated with being moderately physically active 2-4 hours per week was 0.72 (95% confidence interval (CI): 0.59, 0.89) in women and 0.75 (95% CI: 0.55, 1.03) in men after adjustment for confounders. Being in the most active leisure activity category did not decrease the risk of hip fracture further. Adjustment for poor health affected the risk estimates only modestly. Subjects who, during follow-up, reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level (multivariate adjusted RR = 2.19, 95% CI: 1.00, 4.84 and RR = 1.89, 95% CI: 1.21, 2.95, for reduction from the highest and intermediate levels, respectively). There was no evidence of a fracture-protective effect from increasing physical activity. In conclusion, moderate levels of physical activity appear to provide protection against later hip fracture. Decline in the physical activity level over time is an important risk factor for hip fracture.