title: Accumulation of risk factors associated with poor bone health in older adults.
abstract: Clustering of factors linked with poor bone health is common in older adults and is associated with lower bone density and increased fracture risk in women.
  
  
  OBJECTIVE
  Many factors are associated with bone mineral density, which in turn is strongly linked with risk of fragility fracture. We assessed how commonly clustering of risk factors occurs and related such clustering to bone mineral density in a population of older community-dwelling men and women.
  
  
  METHODS
  This is a cross-sectional study with 498 men and 498 women aged 59 to 72 years, who were participants in the Hertfordshire Cohort Study, in whom incident fracture was recorded. Physical activity, diet quality, history of prior fracture, family history of fracture, cigarette and alcohol consumption and comorbidities were obtained through baseline questionnaire. Measurements of grip strength and bone mineral density of the lumbar spine and total femur were also taken.
  
  
  RESULTS
  Clustering of risk factors was common, with over 30% having two or more. In women, a graded association between the number of risk factors and low bone density was seen, and strong relationships were also seen between the number of risk factors and incident fracture; women with three or more risk factors had an adjusted hazard ratio (HR) of incident fracture of 5.98 (1.67, 21.43; p = 0.006) compared to women with no risk factors; women with two risk factors had an adjusted HR of 2.97 (1.14, 7.74; p = 0.03) and those with one, 2.28 (0.90, 5.75; p = 0.08).
  
  
  CONCLUSIONS
  Clustering of risk factors for poor bone health is common in community-dwelling older adults and is associated with increased risk of fracture and adverse bone health in women.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Zhang
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Jameson
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.|National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.|National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care: Wessex, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Avan Aihie
authors.initials: AA
authors.lastname: Sayer
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.|National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Sian
authors.initials: S
authors.lastname: Robinson
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.|NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK. emd@mrc.soton.ac.uk.|Victoria University, Wellington, New Zealand. emd@mrc.soton.ac.uk.
authors.forename: Elaine
authors.initials: E
authors.lastname: Dennison
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D015519:Bone Density / Q000502:physiology; D001847:Bone Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise / Q000502:physiology; D005260:Female; D005269:Femur / Q000502:physiology; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
keywords: Alcohol; Bone mineral density; Clustering; Lifestyle; Smoking