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Hip Fracture in Women without Osteoporosis

Bone and Mineral Research Unit, Department of Medicine (S.A.W., L.M.M., E.S.O) and Department of Public Health and Preventive Medicine (L.M.M.), Oregon Health and Science University, Portland, Oregon 97239; Department of Medicine and Division of Epidemiology, University of Minnesota (K.E.E.), Minneapolis, Minnesota 55454; Section of General Internal Medicine, Minneapolis Veterans Affairs Medical Center (K.E.E.), Minneapolis, Minnesota 55417; Departments of Epidemiology (J.A.C.) and Orthopedic Surgery (M.T.V.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Epidemiology and Biostatistics; University of California at San Francisco (D.M.B.), San Francisco, California 94105; Kaiser Permanente Center for Health Research Northwest/Hawaii Division (T.A.H.), Portland, Oregon 97227; and Departments of Medicine and Epidemiology and Preventive Medicine, University of Maryland School of Medicine, and Medical Service, Maryland VA Health Care System (M.C.H.), Baltimore, Maryland 21201

Address all correspondence and requests for reprints to: Stacey Wainwright, M.D., Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Mail Code CR113, Portland, Oregon 97239. E-mail: s_wainwright{at}comcast.net.

The proportion of fractures that occur in women without osteoporosis has not been fully described, and the characteristics of nonosteoporotic women who fracture are not well understood. We measured total hip bone mineral density (BMD) and baseline characteristics including physical activity, falls, and strength for 8065 women aged 65 yr or older participating in the Study of Osteoporotic Fractures and then followed these women for hip fracture for up to 5 yr after BMD measurement.

Among all participants, 17% had osteoporosis (total hip BMD T-score –2.5). Of the 243 women with incident hip fracture, 54% were not osteoporotic at start of follow-up. Nonosteoporotic women who fractured were less likely than osteoporotic women with fracture to have baseline characteristics associated with frailty. Nevertheless, among nonosteoporotic participants, several characteristics increased fracture risk, including advancing age, lack of exercise in the last year, reduced visual contrast sensitivity, falls in the last year, prevalent vertebral fracture, and lower total hip BMD.

These findings call attention to the many older women who suffer hip fracture but do not have particularly low antecedent BMD measures and help begin to identify risk factors associated with higher bone density levels.

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