TORONTO — Risk factors for fractures in later life are already present in middle age, and their early identification can provide a window of opportunity for intervention, Dr. Anna H. Holmberg said at a world congress on osteoporosis.
Diabetes and mental health problems were among the factors found to be predictive of an increased likelihood of later-life fractures in the Malmö Preventive Project, which was a prospective study that followed 22,444 men and 10,902 women from 1974 through 1999. The primary focus of the project was cardiovascular health, but the investigators also collected data on all low-energy, or fragility, fractures as well as fractures of the forearm, vertebrae, proximal humerus, and ankle, said Dr. Holmberg of the department of orthopedics, Malmö (Sweden) University Hospital.
During follow-up, which averaged 19 years for men and 15 years for women, 1,262 men (5.6%) had 1,975 low-energy fractures, while 1,257 women (11.5%) had 1,805 low-energy fractures.
Among men, the risk factor with the highest impact on later fragility fracture was diabetes, with a relative risk (RR) of 2.38. Other strong risk factors among men were prior hospitalization for mental health problems (RR 1.92), poor appetite (RR 1.72), sleep disturbances (RR 1.53), and poor self-rated health (RR 1.25).
An indirect measure of alcohol consumption, serum γ-glutamyl transferase level, also was associated with an increased fracture risk in men at all sites except the forearm. High body mass index in men was protective against fractures in general (RR 0.88), Dr. Holmberg said at the meeting, which was sponsored by the International Osteoporosis Foundation.
Diabetes also was a strong risk factor for fractures in general among women (RR 1.87), and specifically was a significant risk factor for vertebral, ankle, and hip fractures. Previous fracture also was a risk factor for fracture in general (RR 2.00), and for all fracture types except that of the proximal humerus. Hormone therapy decreased fracture risk by 30%, she noted.