Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study

Abstract

The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.

Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies

“…(29) Further, in data provided by Feskanich and colleagues for the Nurses' Health Study, milk accounted for 54% of dairy calcium intake, although this may be lower in some European countries where cheese is a stronger contributor to dairy calcium intake. (30)(31)(32) However, a lower dairy intake from milk in Europe would not have affected the results of this meta-analysis provided that milk intake is a relevant predictor of hip fracture risk overall.…”

Tea Polyphenols Inhibit Rat Osteoclast Formation and Differentiation

“…The health benefits associated with tea consumption with respect to the prevention of cancers and cardiovascular disease have been investigated intensively (4); additionally, tea consumption reportedly protects against hip fracture (5,6). Older women who drank tea exhibited higher BMD measurements than did women who did not drink tea (7).…”

Associations between dietary flavonoid intakes and bone health in a scottish population

“…Human studies on dietary flavonoids and bone health have focused on tea because tea has been reported to protect against hip fracture. (11,12) Cellular models and animal studies have found associations between bone health and flavonoids (13)(14)(15) ; therefore, the aim of this study was to examine whether dietary flavonoids (ie, flavonols, flavones, flavanones, catechins, and procyanidins) were associated with markers of bone health in a large cohort of Scottish women. aged 45 to 54 years who first visited our unit between 1990 and 1994.…”