Healthier Lifestyles May Help Explain Long-Term Hip Fracture Decline

By Thomas Crocker
Tuesday, December 1, 2020
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A new study finds that decreases in two osteoporosis risk factors — smoking and heavy alcohol use — help account for a steady drop in hip fracture rates in the U.S. over 40 years.

Many researchers theorized that the introduction of drugs to bolster bones and prevent fractures, such as bisphosphonates, in recent decades was responsible for fewer hip fractures, but that does not tell the whole story, according to Douglas Kiel, MD, MPH, Director of the Musculoskeletal Research Center and Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research, and Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

“The decline in hip fractures started before many medications were FDA-approved,” Dr. Kiel says. “In addition, the healthcare system does a terrible job of treating people to prevent fractures, and our use of available drugs is abysmal.”

Using data from the long-running Framingham Heart Study, Dr. Kiel and colleagues at Harvard Medical School and the NIH found another factor at play — changing lifestyles.

Back to Basics

The researchers analyzed data from 10,552 individuals from 1970 to 2010 and found that age-adjusted hip fracture rates fell 4.4% each year. That coincided with a decrease in the smoking rate from 38% to 15% and a decline in heavy drinking from 7% to 4.5%. Other hip fracture risk factors were static. The study appeared in JAMA Internal Medicine.

The association between fewer hip fractures and less smoking and heavy drinking makes sense, given what researchers and clinicians know about their detrimental effects on bone health. Dr. Kiel hopes the study’s findings prompt clinicians to focus on primary prevention of osteoporosis.

“In clinic visits, physicians would probably be more effective at preventing terrible outcomes by spending extra time on smoking cessation, fall prevention or getting individuals into alcohol treatment than on a typical physical exam,” Dr. Kiel says. “Building time for primary osteoporosis prevention into the general health care of middle-aged and older adults is valuable.”

Arrested Momentum

A decades-long decline in hip fractures in the U.S. has stalled. Focusing on prevention in the most vulnerable patients could be a solution, according to an author of a recent study on the topic.

“We have a problem because our population is older and the decline in hip fractures is not happening anymore,” says Douglas Kiel, MD, MPH, Director of the Musculoskeletal Research Center and Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research, and Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “While smoking and drinking are certainly worth paying attention to, poor prescribing practices for preventing fractures are not to be discounted. Treating patients who’ve had a fracture is the low-hanging fruit. They are the most fragile, vulnerable individuals.”

Dr. Kiel says primary care physicians could have a significant impact by prioritizing prevention of subsequent hip fractures. That includes encouraging lifestyle modifications and prescribing medications that are proven to strengthen bones.