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Cigarette Smoking, Alcohol Consumption, and Risk of Hip Fracture in Women
John A. Baron, MD;
Bahman Y. Farahmand, BSc;
Elisabete Weiderpass, MD;
Karl Michaëlsson, MD;
Akke Alberts, MD;
Ingemar Persson, MD;
Sverker Ljunghall, MD
Arch Intern Med. 2001;161:983-988.
Background Previous studies regarding the impact of cigarette smoking on the risk
of hip fracture in postmenopausal women have been inconsistent, suggesting
different effects in different groups. The effect of alcohol intake on fracture
risk is puzzling: moderate alcohol intake appears to increase bone density,
and its association with hip fracture is not clear.
Methods To assess the associations of cigarette smoking and alcohol consumption
with hip fracture risk among postmenopausal women, we conducted an analysis
of a population-based case-control study from Sweden. Cases were postmenopausal
women, aged 50 to 81 years, who sustained a hip fracture after minor trauma
between October 1, 1993, and February 28, 1995; controls were randomly selected
from a population-based register during the same period. A mailed questionnaire
requesting information on lifestyle habits and medical history was used 3
months after the hip fracture for cases and simultaneously for controls. Age-adjusted
odds ratios (ORs) and 95% confidence intervals (CIs) were computed by means
of logistic regression.
Results Of those eligible, 1328 cases (82.5%) and 3312 controls (81.6%) responded.
Compared with never smokers, current smokers had an increased risk of hip
fracture (age-adjusted OR, 1.66; 95% CI, 1.41-1.95). Duration of smoking—particularly
postmenopausal smoking—was more important than the amount smoked. Former
smokers had a small increase in risk (age-adjusted OR, 1.15; 95% CI, 0.97-1.37)
that decreased with the duration of cessation. The age-adjusted OR for women
consuming alcohol was 0.80 (95% CI, 0.69-0.93).
Conclusions Cigarette smoking is a risk factor for hip fracture among postmenopausal
women; risk decreases after cessation. Alcohol consumption has a weak inverse
association with risk.
From the Departments of Medicine and Community and Family Medicine,
Dartmouth Medical School, Hanover, NH (Dr Baron); Division of Epidemiology,
Stockholm County Council, Stockholm, Sweden (Mr Farahmand); Department of
Orthopaedics, Karolinska Hospital, Stockholm (Dr Alberts); Department of Medical
Epidemiology, Karolinska Institutet, Stockholm (Drs Weiderpass and Persson);
Unit of Field and Intervention Studies, International Agency for Research
on Cancer, Lyon, France (Dr Weiderpass); and Departments of Orthopaedics (Dr
Michaëlsson) and Internal Medicine (Dr Ljunghall), University Hospital,
Uppsala, Sweden.
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