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Lower risk of hip fractures among Swedish women with large hips?

Journal article
Authors Sofia Klingberg
Kirsten Mehlig
Valter Sundh
B. L. Heitmann
Lauren Lissner
Published in Osteoporosis International
Volume 29
Issue 4
Pages 927-935
ISSN 0937-941X
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine, Public Health Epidemiology Unit
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 927-935
Language en
Keywords Body mass index, Hip circumference, Hip fractures, Longitudinal, hormone replacement therapy, bone-mineral density, body-mass index, postmenopausal women, older women, association, circumference, metaanalysis, mortality, obesity, Endocrinology & Metabolism
Subject categories Orthopedics

Abstract

In women, a large hip circumference (HC) related to lower hip fracture risk, independent of age and regardless if HC was measured long before or closer to the fracture. In older women, body mass index (BMI) explained the protection. In postmenopausal women, HC has been suggested to inversely associate with hip fracture while this has not been investigated in middle-aged women. We examined the association between HC, measured at two different time points, and hip fracture in a Swedish female population-based sample monitored for incident hip fractures over many years. Baseline HC, measured in 1968 or 1974 (n = 1451, mean age 47.6 years), or the HC measures that were the most proximal before event or censoring (n = 1325, mean age 71.7 years), were used to assess the effects of HC on hip fracture risk in women participating in the Prospective Population Study of Women in Gothenburg. HC was parameterized as quintiles with the lowest quintile (Q1) as reference. Incident hip fractures over 45 years of follow-up (n = 257) were identified through hospital registers. Higher quintiles of HC at both baseline and proximal to event were inversely associated with hip fracture risk in age-adjusted models, but only baseline HC predicted hip fractures independently of BMI and other covariates (HR (95% CI) Q2, 0.85 (0.56-1.27); Q3, 0.59 (0.36-0.96); Q4, 0.57 (0.34-0.96); Q5, 0.58 (0.31-1.10)). A large HC is protective against hip fracture in midlife and in advanced age, but the association between proximal HC and hip fracture was explained by concurrent BMI suggesting that padding was not the main mechanism for the association. The independent protection seen in middle-aged women points to other mechanisms influencing bone strength.

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