Two recent studies present ways to predict and possibly prevent hip fractures, a nationwide epidemic that caused older people to spend 3 million days in the hospital in 1987 alone. One study points to the connection between the use of a hypertension drug and a reduced risk of hip fracture. Another study describes how the measurement of bone mass in women can predict the risk of hip fracture. Most hip fractures result from osteoporosis, a bone thinning condition affecting older people and characterized by decreased bone mass.
Use of the hypertension drug thiazide is associated with a 30% decrease in the incidence of hip fractures among users. According to researchers, a study of the incidence of hip fractures in 9,518 men and women over 65 years old showed that thiazide use had a protective effect against hip fracture, independent of other risk factors. According to the report, thiazides lower the urinary excretion of calcium, which may contribute to increased bone density. The drug's efficacy, however, remains to be proven in future clinical trials.
The second study revealed that a decrease in bone mass can demonstrate a risk of hip fractures in women over age 65. Researchers measured bone mineral density in the heelbones and in two places on the forearms of 9,704 older women and then obtained information on new hip fractures in the next 1 to 3 years. They found that hip fractures were highly correlated with low bone density in any of the three sites studied. These bone density measurements may be useful in identifying persons at high risk. The research also found that the risk of hip fracture increased nearly threefold with each 10year increase of age over 65, independent of bone density. Other factors associated with age also contribute to risk.
These findings suggest that physicians may want to measure bone density as part of their clinical evaluation of older patients who have other known risk factors for osteoporosis. Such risk factors can include early (premature) menopause, a small skeletal frame, a family history of osteoporosis, and a life-long history of poor calcium intake. Once the condition is found or likely to develop, modest doses of vitamin D, adequate calcium intake, and regular weightbearing exercise are recommended. The use of estrogen should be discussed with one's physician.
For more information, contact Margo Warren, National Institute on Aging; 301-496-1752.