Risk factors for fracture in nonosteoporotic men and women

Context and Objective: It is not known which factors are associated with fracture in nonosteoporotic elderly. The aim of this study was to assess the association between fall-related risk factors and fracture risk in men and women without osteoporosis. Design: This study was part of the ongoing Dubbo Osteoporosis Epidemiology Study, which was designed as a prospective population-based cohort investigation. Participants: At baseline, 924 women and 723 men aged 60 + yr did not have osteoporosis [ bone mineral density ( BMD) T-scores > - 2.5]. The individuals have been followed for up to 15 yr. Main Outcome Measures: Atraumatic fractures were prospectively identified through radiologists' reports. Risk Factors: At baseline, femoral neck BMD ( FNBMD) was measured by dual energy x-ray absorptiometry ( DXA); history of fall, postural stability, and quadriceps strength was obtained. Results: During the follow-up period, among the nonosteoporotic group, 221 women and 105 men had sustained a fracture, accounting for 55 and 74% of total fractures in the entire Dubbo Osteoporosis Epidemiology Study sample, respectively. The following factors were independent risk factors for any fracture: in women, age per SD ( hazard ratio, 1.2; 95% CI, 1.0 - 1.3), postural sway per SD ( 1.1, 1.0 - 1.2), FNBMD per SD ( 1.6, 1.3 - 1.9), fall in the previous 12 months ( 2.1, 1.6 - 2.7), and prior fracture ( 1.8, 1.2 - 2.7); in men, age ( 1.4, 1.1 - 1.6), postural sway ( 1.2, 1.0 - 1.3), FNBMD ( 1.2, 1.0 - 1.5), and fall in the previous 12 months ( 1.9, 1.2 - 3.0). Exposure to at least one of the risk factors could account for 49% ( women) and 39% ( men) of any fractures in this population. Conclusion: In nonosteoporotic elderly, the combination of low BMD, advancing age, fall during the last 12 months, and prior fracture could identify a subgroup of individuals with high risk of fracture.