| Fractures are a major public health problem in older people, yet little is known about the etiology of fractures at sites other than the hip. These three papers seek to identify risk factors for fractures and assess the effectiveness of the drug, alendronate (ALN), in type 2 diabetic women, a group at an increased risk for fracture. The first two papers use data from a case-control study, conducted at five Northern California Kaiser Permanente centers, of incident distal forearm, foot, proximal humerus, shaft of the tibia/fibula, and pelvis fractures in persons age 45 years and older. The first paper examines whether foot problems are risk factors for fractures. The odds of a foot fracture increased by 8% while the odds of a forearm fracture decreased by 6% with each additional foot problem. Diabetes, which is often associated with foot problems, was associated with an increased risk of proximal humerus fracture. The second paper assesses both extrinsic circumstances of falls and personal characteristics of fallers that affect risk for fractures among those who fall. The type of shoes worn and the activity at the time of the fall influenced the risk for fracture, as did the height and direction of the fall. Breaking the fall decreased the risk for all fractures except the distal forearm, and increasing amounts of leisure-time physical activity and current use of hormone therapy were associated with a decreased risk of fracture of most of these sites. The third paper uses data from a randomized controlled trial, the Fracture Intervention Trial, conducted at 11 community-based clinical centers in the United States to assess whether ALN increases bone mineral density (BMD) among older women with type 2 diabetes and low BMD. Three years of ALN treatment was associated with increased BMD in diabetics at all skeletal sites studied, while diabetics in the placebo group experienced a decrease in BMD at most sites. The magnitude of change in BMD with ALN treatment was similar in diabetics and non-diabetics. The results of these papers suggest various ways in which risks for fractures in older individuals can be reduced. |
