Differences in Risk Factor Patterns Between Cervical and Trochanteric Hip Fractures

Abstract

The two types of hip fracture--cervical and trochanteric femoral fractures--are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case-control study in Swedish women, 50-81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15-1.32) compared with an OR of 1.06 (95% CI 0.97-1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0. 91-0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12-1.95) for trochanteric fractures and 1.22 (95% CI 0.98-1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0. 55 (95% CI 0.33-0.92) compared with 1.00 (95% CI 0.71-1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions.

Hip fractures in the Portuguese archaeological record

“…In modern epidemiological studies, intracapsular fractures are generally more common than extracapsular fractures (Kannus et al, 1996;Michaëlsson et al, 1999;Zhang et al, 2000), but not always (Maghraoui et al, 2005). These two types of hip fracture are usually considered together in aetiological studies (Michaëlsson et al, 1999).…”

Proximal hip geometry and hip fracture risk assessment in a Korean population

“…These parameters also effectively predicted IT and FN fractures after correction for demographic parameters and BMDs. While a number of studies have evaluated hip fractures as a homogeneous condition, IT and FN fractures are two distinct entities that have different risk factors, treatments, and prognoses [3][4][5][6]. In our study, this point was addressed by separate analysis of the data in each type of hip fracture.…”

“…These two fractures are distinct entities and subject to different surgical treatment. Furthermore, the two fracture types differ in etiology, risk factors, and patient characteristics [3][4][5][6].…”

Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures

“…In addition, the magnitude of the association between frailty and increased risk of hip fracture appeared slightly greater for trochanteric hip fractures than for femoral neck fractures. Previous studies comparing differences in risk factor patterns between femoral neck and trochanteric fractures (22)(23)(24) have consistently reported that women with trochanteric fractures are more likely to be older and have poorer health status and lower bone density.…”