Gender differences in the incidence of and risk factors for hip fracture: A 16-year longitudinal study in a southern European population.
OBJECTIVE
To analyze independently in men and women the incidence rate of and risk factors for hip fracture in a southern European population. Illiteracy, dementia, clinically significant depression and disability were factors to receive special emphasis.


METHODS
A community sample of 4803 individuals aged over 55 years was assessed in a two-phase case-finding study in Zaragoza, Spain, and was followed up for 16 years. Medical history and psychiatric history were collected with standardized instruments, including the History and Aetiology Schedule, the Geriatric Mental State (GMS) scale, and a Risk Factors Questionnaire. Operational criteria were used to define covariates, including diagnostic criteria for both dementia and depression. The statistical analysis included calculations of incidence rate, IR; women/men incidence rate ratio (IRR); and Hazard Ratios (HR) in multivariate Cox proportional hazards regression models.


METHODS
Cases of hip fracture (International Classification of Diseases, WHO) identified in the treating hospitals, validated by blinded researchers.


RESULTS
Hip fractures were more frequent among women than men (IRR=3.1). Illiteracy (HR=1.55) and depression (HR=1.44) increased the risk in women, and smoking (HR=2.13) and disability in basic activities of daily living (HR=3.14) increased the risk in men. Dementia was associated with an increased risk in an univariate analysis, but the association disappeared (power=85% in men, 95% in women) when disability was included in the multivariate models.


CONCLUSIONS
The IR of hip fractures was three times higher among women. Illiteracy and clinically significant depression among women and active smoking and disability (HR=3.14) among men independently increased the risk, but dementia did not.
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain. Electronic address: elobo@unizar.es.
Elena
E
Lobo
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Archivos, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.
Guillermo
G
Marcos
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.
Javier
J
Santabárbara
Servicio de Cirugía Digestiva, Dr. Josep Trueta University Hospital, Avda. de França s/n, 17007 Girona, Spain.
Helena
H
Salvador-Rosés
Servicio de Ortopedia y Traumatología, Asepeyo Sant Cugat Hospital, Av. Alcalde Barnils, 54-60, 08174 Sant Cugat del Vallés, Barcelona, Spain.
Luis
L
Lobo-Escolar
Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Psiquiatría, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain; Departamento de Psiquiatría, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain.
Concepción
C
De la Cámara
Servicio de Traumatología y Cirugía Ortopédica, Hospital General de la Defensa, Vía Ibérica, 1, 50009 Zaragoza, Spain.
Alberto
A
Aso
Servicio de Cirugía Ortopédica y Traumatológica, Hospital San Jorge, Avda. Martínez de Velasco 36, 22004 Huesca, Spain.
Antonio
A
Lobo-Escolar
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D000067010:Literacy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics; D012907:Smoking / Q000453:epidemiology; D013030:Spain; D011795:Surveys and Questionnaires
Dementia; Depression; Disability; Gender; Hip fracture; Risk factors