title: Clinical and demographic factors associated with fractures among older Americans.
abstract: Medicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.
  
  
  BACKGROUND
  This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies.
  
  
  METHODS
  We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005.
  
  
  RESULTS
  For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture.
  
  
  CONCLUSIONS
  This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1530 3rd Avenue South, RPHB 517, Birmingham, AL 35294-0022, USA. taylor_aj@bellsouth.net
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: L C
authors.initials: LC
authors.lastname: Gary
authors.forename: T
authors.initials: T
authors.lastname: Arora
authors.forename: D J
authors.initials: DJ
authors.lastname: Becker
authors.forename: J R
authors.initials: JR
authors.lastname: Curtis
authors.forename: M L
authors.initials: ML
authors.lastname: Kilgore
authors.forename: M A
authors.initials: MA
authors.lastname: Morrisey
authors.forename: K G
authors.initials: KG
authors.lastname: Saag
authors.forename: R
authors.initials: R
authors.lastname: Matthews
authors.forename: H
authors.initials: H
authors.lastname: Yun
authors.forename: W
authors.initials: W
authors.lastname: Smith
authors.forename: E
authors.initials: E
authors.lastname: Delzell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology