Weight Change and Fractures in Older Women

doi:10.1001/archinte.1997.00440290041004

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Vol. 157 No. 8, 28 APRIL 1997

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Weight Change and Fractures in Older Women

Kristine E. Ensrud, MD, MPH; Jane Cauley, DrPH; Ruth Lipschutz, MPH; Steven R. Cummings, MD

Arch Intern Med. 1997;157(8):857-863.

Abstract

Background
The effect of change in weight in later years on risk of osteoporoticfractures is uncertain. Prior studies have assessed the relationshipbetween weight change and risk of hip fracture only and havenot examined whether the association between weight loss andincreased risk of hip fracture is because of voluntary or involuntaryweight loss.

Objectives
To determine the association between weight change in lateryears and the risk of fractures in elderly women and to assessthe effect of weight loss intention on this relationship.

Methods
The association between weight change and fracture risk wasassessed in 6754 ambulatory, non-black women aged 65 years orolder enrolled in the Study of Osteoporotic Fractures who hadmeasurements of weight performed at both the baseline and fourthexaminations (mean, 5.7 years between examinations). These 6754women were followed up for all incident nonspine fractures andfrailty fractures (defined as fractures of the proximal femur,pelvis, and proximal humerus) occurring after the fourth examination(average follow-up, 19.5 months). All incident fractures wereconfirmed by radiographic report.

Results
During an average of 19.5 months after the fourth examination,264 women (4%) had at least 1 nonspine fracture, including 83women who suffered frailty fractures. After adjustment for age,women who lost weight between the baseline and fourth examinationshad an increased risk of subsequent nonspine fracture (relativerisk [RR] per 10% decrease in weight, 1.32; 95% confidence interval[CI],1.11-1.55). This observed increase in the risk of nonspinefracture was entirely caused by an increase in the risk of frailtyfracture (age-adjusted RR per 10% decrease in weight, 1.86;95% CI, 1.42- 2.43). Weight change was not significantly relatedto other types of nonspine fractures (age-adjusted RR per 10%decrease in weight, 1.09; 95% CI, 0.90-1.33). Further adjustmentfor cigarette smoking, physical activity, estrogen use, medicalconditions, health status, body weight, femoral neck bone mass,and rate of change in calcaneal bone mass did not substantiallyalter the association between weight change and frailty fracture(multivariate RR per 10% decrease in weight, 1.68; 95% CI, 1.17-2.41).Weight change was an even stronger predictor of risk of frailtyfracture in those women who were not trying to lose weight (multivariateRR per 10% decrease in weight, 1.81; 95% CI, 1.26-2.61).

Conclusions
Involuntary weight loss in later years substantially increasesthe risk of frailty fracture including hip fracture in elderlywomen. Weight change is not related to risk of other nonspinefractures in older women.

Arch Intern Med. 1997;157:857-863

Author Affiliations

for the Study of Osteoporotic Fractures Research Group

From the Section of General Internal Medicine, Department of Medicine, Minneapolis Veterans Affairs Medical Center and Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Ensrud); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (Dr Cauley); and Department of Epidemiology, Prevention Sciences Group (Ms Lipschutz and Dr Cummings) and Division of General Internal Medicine (Dr Cummings), University of California, San Francisco. A complete list of the members of the Study of Osteoporotic Fractures Research Group appears on page 860.

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