The Journal of Bone and Joint Surgery (American) 85:1936-1943 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Colles Fracture, Spine Fracture, and Subsequent Risk of Hip Fracture in Men and Women
A Meta-Analysis
Patrick Haentjens, MD, PhD,
Philippe Autier, MD, MPH,
John Collins, MD,
Brigitte Velkeniers, MD, PhD,
Dirk Vanderschueren, MD, PhD and
Steven Boonen, MD, PhD
Investigation performed at the Department of Orthopaedics and Traumatology and the Department of Internal Medicine, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels; Center for Research in Epidemiology and Health Information Systems Luxemburg, Grand Duchy of Luxemburg; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; and Divisions of Endocrinology and Geriatric Medicine, Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
Patrick Haentjens, MD, PhD
Brigitte Velkeniers, MD, PhD
Department of Orthopaedics and Traumatology (P.H.) and Department of Internal Medicine (B.V.), Academisch Ziekenhuis, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. E-mail address for P. Haentjens: orthsp{at}az.vub.ac.be
Philippe Autier, MD, MPH
Center for Research in Epidemiology and Health Information Systems Luxemburg, Rue Dicks 18, L-1471 Luxemburg, Grand Duchy of Luxemburg
John Collins, MD
Department of Obstetrics and Gynecology, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
Dirk Vanderschueren, MD, PhD
Steven Boonen, MD, PhD
Divisions of Endocrinology (D.V.) and Geriatric Medicine (S.B.), Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Brusselse straat 69, B-3000 Leuven, Belgium
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding. J. Collins was awarded the Francqui Foundation International Chair 2000-2001, Vrije Universiteit Brussel and Katholieke Universiteit Leuven, Belgium. S. Boonen and D. Vanderschueren are both Senior Clinical Investigators of the Fund for Scientific Research-Flanders, Belgium (F.W.O.-Vlaanderen). The authors did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Read in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Dallas, Texas, February 14, 2002.
Background: In postmenopausal women, a history of any fracture is an important risk factor for a future hip fracture. Whether similar findings apply to aging men remains to be established. We conducted a systematic review and meta-analysis of the literature to compare men and women with respect to the relative risk of hip fracture after a wrist or spine fracture.
Methods: Studies published in full from January 1982 through September 2002 in English, French, or German were identified from the PubMed database and from reference lists of retrieved articles. We included cohort studies that reported fractures associated with minimal trauma of the wrist or spine as a risk factor for a subsequent hip fracture among (white) women and men who were fifty years old or older. Data were extracted by two independent reviewers and were checked for accuracy in a second review. Differences in assessments were resolved by consensus of the two reviewers.
Results: Nine cohort studies were included in this meta-analysis: five studies were conducted in the United States and four, in Europe. After homogeneity of association was demonstrated across all studies, a fixed-effects meta-analysis was used to calculate pooled relative risks with 95% confidence intervals. Among postmenopausal women, the relative risks for a future fracture of the hip after a fracture of the wrist or spine were 1.53 (95% confidence interval, 1.34 to 1.74; p < 0.001) and 2.20 (95% confidence interval, 1.92 to 2.51; p < 0.001), respectively. In older men, these relative risks were 3.26 (95% confidence interval, 2.08 to 5.11; p < 0.001) and 3.54 (95% confidence interval, 2.01 to 6.23; p < 0.001), respectively. Fractures of the distal part of the radius increased the relative risk of hip fracture significantly more in men than in women (p = 0.002). The impact of a spine fracture, conversely, did not differ between genders (p = 0.11). Sensitivity analyses with use of random-effects methodology confirmed these findings to be robust.
Conclusions: This meta-analysis suggests that a previous spine fracture has an equally important impact on the risk of a subsequent hip fracture in both genders. The prospective association between a Colles fracture and a subsequent hip fracture, however, is significantly stronger among men than among postmenopausal women. Men with a Colles fracture are at high risk for a future hip fracture and should be evaluated as candidates for preventive measures.
Level of Evidence: Prognostic study, Level I-2 (systematic review of Level-I studies). See Instructions to Authors for a complete description of levels of evidence.
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