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American Journal of Epidemiology Advance Access published online on October 12, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi295
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received February 7, 2005
Accepted June 9, 2005

ORIGINAL CONTRIBUTIONS

Risk Factors for Pelvis Fracture in Older Persons

Jennifer L. Kelsey 1*, Mila M. Prill 2, Theresa H. M. Keegan 3, Charles P. Quesenberry Jr.4, and Steven Sidney 4

1 Division of Epidemiology, Stanford University School of Medicine, Stanford, CA; Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
2 Division of Epidemiology, Stanford University School of Medicine, Stanford, CA; Department of Epidemiology, Emory University School of Public Health, Atlanta, GA
3 Division of Epidemiology, Stanford University School of Medicine, Stanford, CA; Northern California Cancer Center, Union City, CA
4 Division of Research, Kaiser Permanente, Oakland, CA

* To whom correspondence should be addressed.
Jennifer L. Kelsey, E-mail: jennifer.kelsey{at}umassmed.edu


  Abstract

From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged ≥45 years at five Kaiser Permanente medical centers in Northern California. Most information on potential risk factors was obtained by means of an interviewer-administered questionnaire. Number of fractures since age 45 years and a maternal history of hip fracture were associated with increased risks. Several factors thought to protect against loss of bone mass, including recent use of menopausal hormone therapy (adjusted odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.33, 0.91) and high body mass index (weight (kg)/height (m)2; per 5-unit increase, adjusted OR = 0.65, 95% CI: 0.52, 0.81), were associated with decreased risks, while cigarette smoking (adjusted OR = 2.17, 95% CI: 1.34, 3.52) and hysterectomy (adjusted OR = 1.75, 95% CI: 1.15, 2.66) were associated with increased risks. Various conditions related to propensity to fall were associated with increased risks. Most indicators of frailty, including use of walking aids and needing help with or being unable to perform various activities of daily living, conferred increased risks. Thus, low bone mass, frailty, and probably a propensity to fall appear to be associated with increased risk of pelvis fracture.

Keywords: accidental falls; aged; estrogen replacement therapy; fractures; frail elderly; osteoporosis; pelvis.
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