Physical Fitness More Important Than Nutrition to Prevent Hip Fracture

Linda Little

September 27, 2005

Sept. 27, 2005 (Nashville) — Lack of physical fitness may play a more important role than nutrition in preventing hip fractures in elderly women, according to Swiss researchers.

Their prospective study of 7,788 women older than 70 years revealed that women who lacked mobility and strength were more apt to fall and fracture their hips. The study was presented here at the American Society for Bone and Mineral Research (ASBMR) 27th annual meeting.

"A high risk of falling predicts a three times greater incidence of hip fractures," said coauthor Marc-Antoine Krieg, MD, adjuvant professor of internal medicine at the University of Lausanne in Switzerland. "Physical activity may be more important at this age."

It is very important to advise women to stay in shape as they age, Dr. Krieg said. "The risk of falling in elderly women may be more important than high calcium intake."

The study questioned the women about their intake of dairy products and protein — factors that influence risk of falling — and mobility. The women also were given grip strength tests and a chair test during which they were asked to get out of the chair three times without using their hands or arms as support.

The women were then followed for 3.5 years to determine the rate of fractures.

To determine a score for potential falls, the women were asked five questions: getting up in the middle of the night, whether they experience dizziness or instability, if they have difficulty standing up and sitting down, use of a walker or crutches, and whether they lean on walls or furniture to get around. High risk for falling was defined as a score greater than 1.

To determine a score for mobility, they were asked whether they walk outside, sit most of the day, climb stairs, are able to get in and out of a car, cross a street, and use public transportation. (Mobility score of <5 was "unsatisfactory.")

The analysis found that the global risk of falls at one year was 28% in the low-risk group, 36% in the medium-risk group, and 46% in the high-risk group. While 98% of the women in the low-risk group successfully performed the chair test, only 53% of the women in the high-risk group were able to perform the test. Women in low-risk group had a mean grip strength of 20.8 kg while those in the high-risk group had a mean grip strength of 17 kg.

There was little difference in the women's calcium and protein intake. Women at low risk ate 494 mg of calcium per day, while women in the high-risk group ate 489 mg. All the women ate about 14 g of protein a day.

After three and a half years, the rate of hip fractures for women in the low-risk group was 3 per 10,000 women per year, those at medium risk had 4 fractures per 10,000 women per year, and women at high risk had a rate of 9.7 per 10,000 women per year.

The data show that while the diets of these women were similar, their inactivity placed them at risk for hip fracture, Elizabeth Shane, MD, president-elect of ASBMR, told Medscape. "Women who are inactive fall more and have more fractures.

"Inactivity seems to have trumped the diet in importance," she said. "Not that diet isn't important, but physical and muscle strength are very important. Being inactive and having a low calcium intake is a double hit, placing women at an even high risk for fractures."

ASBMR 27th Annual Meeting: Poster SA332. Presented Sept. 24, 2005.

Reviewed by Gary D. Vogin, MD

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