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American Journal of Epidemiology Vol. 135, No. 5: 477-489
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Risk Factors for Fractures of the Distal Forearm and Proximal Humerus
1Division of Epidemiology, Stanford University School of Medicine HRP Buflding, Stanford, CA 94305-5092
2General Internal Medicine Section, Department of Medicine, VA Medical Center, University of California San Francisco, CA
3Department of Epidemiology and Bwstatistics, University of California San Francisco, CA
4Division of General Internal Medicine, Department of Medicine, University of California San Francisco, CA
5Investigators in the Study of Osteoporobc Fractures Research Group' University of California San Francisco
The Study of Osteoporotic Fractures is a prospective cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryland, Minnesota, Oregon, and Pennsylvania. A total of 171 women suffered fractures of the distal forearm, and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up. Most fractures at both sites occurred as a result of a fall. Low bone mineral density was a strong predictor of these fractures; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile, the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus. Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity, number of falls in the year before baseline, and frequent walking. Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status, insulin-dependent diabetes mellitus, infrequent walking, and several indicators of neuromuscular weakness such as inability to stand with feet in a tandem position for more than a few seconds. These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function, while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function.
fractures; humeral fractures; osteoporosis; prospective studies; radius fractures; ulna fractures
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