Nutrition, Bone Mass, and Subsequent Risk of Hip Fracture in White Women

The interrelationships between nutritional status, concurrent bone density, bone dimensions, and risk of subsequent hip fracture were investigated using data from the first National Health and Nutrition Examination Survey and its three follow-up studies. A cohort of 890 White women aged 45 years or older who received nutritional and bone measurements in the baseline survey in 1971-75 were recontacted in 1982-84, 1986, and 1987. Height, weight, serum albumin, total energy intake, bone density, and bone dimensions were measured at baseline. Thirty-three incident hip fractures were identified during 12,190 person-years of follow-up. Total energy intake and serum albumin were little correlated with concurrent bone density and bone dimensions. Serum albumin, total energy intake, and weight tended to be inversely associated with risk of hip fracture. The multivariable relative risks were 0.75 (95% confidence interval [CI] = 0.57-0.98) for one standard deviation increment of serum albumin, 0.67 (95% CI = 0.42-1.07) for dietary energy intake, and 0.61 (95% CI = 0.38-0.97) for weight, respectively. Height was positively, but not significantly associated with risk of hip fracture. Nutritional effects on hip fracture were independent of concurrent bone density and bone dimensions. Higher bone density was protective of subsequent hip fracture (relative risk = 0.55, 95% CI = 0.36-0.83, for one standard deviation increment of bone density) independent of effects related to concurrent nutritional status. Thus, poor nutritional status and reduced bone density appeared to increase the risks of subsequent hip fracture independently.