Diet and hip fracture risk: a case-control study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment.
BACKGROUND
The role of diet as a risk factor for osteoporotic fractures is unclear. Earlier studies have yielded conflicting results.


METHODS
In two counties in central Sweden we investigated the association between dietary intake and the risk of proximal femoral fractures in a case-control study nested in a cohort. Women born in 1914-1948 were asked to fill out a food frequency questionnaire when invited to attend for mammographic screening between the years 1987 and 1990. More than 65,000 women completed the questionnaire. Those who had participated in the enquiry and subsequently sustained a first hip fracture were defined as cases. For every case, four individually matched controls, by age and county of residence, were selected from the cohort. A second questionnaire concerning confounding factors was mailed to controls and cases. In all, 247 cases and 893 controls could finally be included. Monthly intake of foods and daily intake of nutrients were calculated.


RESULTS
When highest quartile of intake was compared to lowest, intakes of iron (adjusted odds ratio [OR] of 3.3, 95% confidence interval [CI]: 1.6-6.9), magnesium (adjusted OR = 2.7, 95% CI: 1.3-6.0) and vitamin C (adjusted OR = 1.9, 95% CI: 1.2-3.1) were found to be independent risk factors for hip fracture. High calcium intake did not protect against hip fracture. Smoking, low physical activity in leisure time, low body mass index, earlier fracture of the distal forearm and diabetes were all risk factors while postmenopausal hormone replacement therapy protected against hip fracture.


CONCLUSIONS
This large study indicates new dietary risk factors for hip fracture. The association between high dietary intake of iron, magnesium and vitamin C and risk of hip fracture has not been reported previously. Further clinical and experimental studies are needed to confirm these findings and to investigate their mechanism of action.
Department of Orthopaedics, Central Hospital, Västerås, Sweden.
K
K
Michaëlsson
L
L
Holmberg
H
H
Mallmin
S
S
Sörensen
A
A
Wolk
R
R
Bergström
S
S
Ljunghall
D000328:Adult; D000368:Aged; D001205:Ascorbic Acid / Q000008:administration & dosage; D002136:Calcium, Dietary / Q000008:administration & dosage; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008274:Magnesium / Q000008:administration & dosage; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
D002136:Calcium, Dietary; D007501:Iron; D008274:Magnesium; D001205:Ascorbic Acid