Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 2001 Jul;91(7):1089–1093. doi: 10.2105/ajph.91.7.1089

Effects of alcohol-related disease on hip fracture and mortality: a retrospective cohort study of hospitalized Medicare beneficiaries.

Z Yuan 1, N Dawson 1, G S Cooper 1, D Einstadter 1, R Cebul 1, A A Rimm 1
PMCID: PMC1446699  PMID: 11441736

Abstract

OBJECTIVES: This study investigated the effect of alcohol-related disease on hip fracture and mortality. METHODS: A retrospective cohort design was used. The study cohort consisted of hospitalized Medicare beneficiaries with alcohol-related disease (n = 150,119) and randomly matched controls without alcohol-related disease (n = 726,218) identified through the 1988-1989 inpatient claims file. Incidence rates of hip fracture and mortality were examined. RESULTS: During the study period, 20,620 patients developed hip fracture, with 6973 cases among patients with alcohol-related disease and 13,647 cases among patients without alcohol-related disease. After adjustment for potential confounders, patients with alcohol-related disease had a 2.6-fold increased risk of hip fracture relative to patients without alcohol-related disease (95% confidence interval = 2.5, 2.6). Patients with alcohol-related disease had a higher risk of mortality at 1 year after hip fracture. CONCLUSIONS: Alcohol-related disease increases the risk of hip fracture significantly and reduces long-term survival. The present results suggest that patients hospitalized for alcohol-related disease should be targeted for hip fracture prevention programs.

Full Text

The Full Text of this article is available as a PDF (77.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams W. L., Yuan Z., Barboriak J. J., Rimm A. A. Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States. JAMA. 1993 Sep 8;270(10):1222–1225. [PubMed] [Google Scholar]
  2. Barrett J. A., Baron J. A., Karagas M. R., Beach M. L. Fracture risk in the U.S. Medicare population. J Clin Epidemiol. 1999 Mar;52(3):243–249. doi: 10.1016/s0895-4356(98)00167-x. [DOI] [PubMed] [Google Scholar]
  3. Blair S. N., Jacobs D. R., Jr, Powell K. E. Relationships between exercise or physical activity and other health behaviors. Public Health Rep. 1985 Mar-Apr;100(2):172–180. [PMC free article] [PubMed] [Google Scholar]
  4. Burger H., de Laet C. E., van Daele P. L., Weel A. E., Witteman J. C., Hofman A., Pols H. A. Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol. 1998 May 1;147(9):871–879. doi: 10.1093/oxfordjournals.aje.a009541. [DOI] [PubMed] [Google Scholar]
  5. Chavassieux P., Serre C. M., Vergnaud P., Delmas P. D., Meunier P. J. In vitro evaluation of dose-effects of ethanol on human osteoblastic cells. Bone Miner. 1993 Aug;22(2):95–103. doi: 10.1016/s0169-6009(08)80221-8. [DOI] [PubMed] [Google Scholar]
  6. Cohen M., Kern J. C., Hassett C. Identifying alcoholism in medical patients. Hosp Community Psychiatry. 1986 Apr;37(4):398–400. doi: 10.1176/ps.37.4.398. [DOI] [PubMed] [Google Scholar]
  7. Cooper C., Barker D. J., Wickham C. Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. BMJ. 1988 Dec 3;297(6661):1443–1446. doi: 10.1136/bmj.297.6661.1443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cooper G. S., Yuan Z., Rosenthal G. E., Chak A., Rimm A. A. Lack of gender and racial differences in surgery and mortality in hospitalized Medicare beneficiaries with bleeding peptic ulcer. J Gen Intern Med. 1997 Aug;12(8):485–490. doi: 10.1046/j.1525-1497.1997.00087.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cumming R. G., Klineberg R. J. Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol. 1994 Mar 1;139(5):493–503. doi: 10.1093/oxfordjournals.aje.a117032. [DOI] [PubMed] [Google Scholar]
  10. Cumming R. G., Nevitt M. C., Cummings S. R. Epidemiology of hip fractures. Epidemiol Rev. 1997;19(2):244–257. doi: 10.1093/oxfordjournals.epirev.a017956. [DOI] [PubMed] [Google Scholar]
  11. Cummings S. R., Black D. M., Rubin S. M. Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989 Nov;149(11):2445–2448. [PubMed] [Google Scholar]
  12. Cummings S. R., Nevitt M. C., Browner W. S., Stone K., Fox K. M., Ensrud K. E., Cauley J., Black D., Vogt T. M. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767–773. doi: 10.1056/NEJM199503233321202. [DOI] [PubMed] [Google Scholar]
  13. Dawson N. V., Dadheech G., Speroff T., Smith R. L., Schubert D. S. The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service. J Gen Intern Med. 1992 Jan-Feb;7(1):38–45. doi: 10.1007/BF02599100. [DOI] [PubMed] [Google Scholar]
  14. Farmer M. E., White L. R., Brody J. A., Bailey K. R. Race and sex differences in hip fracture incidence. Am J Public Health. 1984 Dec;74(12):1374–1380. doi: 10.2105/ajph.74.12.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Felson D. T., Kiel D. P., Anderson J. J., Kannel W. B. Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol. 1988 Nov;128(5):1102–1110. doi: 10.1093/oxfordjournals.aje.a115052. [DOI] [PubMed] [Google Scholar]
  16. Fisher E. S., Baron J. A., Malenka D. J., Barrett J., Bubolz T. A. Overcoming potential pitfalls in the use of Medicare data for epidemiologic research. Am J Public Health. 1990 Dec;80(12):1487–1490. doi: 10.2105/ajph.80.12.1487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fisher E. S., Whaley F. S., Krushat W. M., Malenka D. J., Fleming C., Baron J. A., Hsia D. C. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992 Feb;82(2):243–248. doi: 10.2105/ajph.82.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Grisso J. A., Kelsey J. L., Strom B. L., O'Brien L. A., Maislin G., LaPann K., Samelson L., Hoffman S. Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group. N Engl J Med. 1994 Jun 2;330(22):1555–1559. doi: 10.1056/NEJM199406023302202. [DOI] [PubMed] [Google Scholar]
  19. Hemenway D., Azrael D. R., Rimm E. B., Feskanich D., Willett W. C. Risk factors for hip fracture in US men aged 40 through 75 years. Am J Public Health. 1994 Nov;84(11):1843–1845. doi: 10.2105/ajph.84.11.1843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hernandez-Avila M., Colditz G. A., Stampfer M. J., Rosner B., Speizer F. E., Willett W. C. Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women. Am J Clin Nutr. 1991 Jul;54(1):157–163. doi: 10.1093/ajcn/54.1.157. [DOI] [PubMed] [Google Scholar]
  21. Holbrook T. L., Barrett-Connor E., Wingard D. L. Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet. 1988 Nov 5;2(8619):1046–1049. doi: 10.1016/s0140-6736(88)90065-7. [DOI] [PubMed] [Google Scholar]
  22. Huang Z., Himes J. H., McGovern P. G. Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol. 1996 Jul 15;144(2):124–134. doi: 10.1093/oxfordjournals.aje.a008899. [DOI] [PubMed] [Google Scholar]
  23. Høidrup S., Grønbaek M., Gottschau A., Lauritzen J. B., Schroll M. Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen Centre for Prospective Population Studies. Am J Epidemiol. 1999 Jun 1;149(11):993–1001. doi: 10.1093/oxfordjournals.aje.a009760. [DOI] [PubMed] [Google Scholar]
  24. Jacobsen S. J., Goldberg J., Miles T. P., Brody J. A., Stiers W., Rimm A. A. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990 Jul;80(7):871–873. doi: 10.2105/ajph.80.7.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Jónsson B., Ringsberg K., Josefsson P. O., Johnell O., Birch-Jensen M. Effects of physical activity on bone mineral content and muscle strength in women: a cross-sectional study. Bone. 1992;13(2):191–195. doi: 10.1016/8756-3282(92)90011-k. [DOI] [PubMed] [Google Scholar]
  26. Kellie S. E., Brody J. A. Sex-specific and race-specific hip fracture rates. Am J Public Health. 1990 Mar;80(3):326–328. doi: 10.2105/ajph.80.3.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Kelsey J. L., Hoffman S. Risk factors for hip fracture. N Engl J Med. 1987 Feb 12;316(7):404–406. doi: 10.1056/NEJM198702123160709. [DOI] [PubMed] [Google Scholar]
  28. Lau E., Donnan S., Barker D. J., Cooper C. Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. BMJ. 1988 Dec 3;297(6661):1441–1443. doi: 10.1136/bmj.297.6661.1441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Malmivaara A., Heliövaara M., Knekt P., Reunanen A., Aromaa A. Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol. 1993 Sep 15;138(6):384–394. doi: 10.1093/oxfordjournals.aje.a116871. [DOI] [PubMed] [Google Scholar]
  30. Marottoli R. A., Berkman L. F., Cooney L. M., Jr Decline in physical function following hip fracture. J Am Geriatr Soc. 1992 Sep;40(9):861–866. doi: 10.1111/j.1532-5415.1992.tb01980.x. [DOI] [PubMed] [Google Scholar]
  31. McCusker J., Cherubin C. E., Zimberg S. Prevalence of alcoholism in general municipal hospital population. N Y State J Med. 1971 Apr 1;71(7):751–754. [PubMed] [Google Scholar]
  32. Oldridge N. B., Yuan Z., Stoll J. E., Rimm A. R. Lumbar spine surgery and mortality among Medicare beneficiaries, 1986. Am J Public Health. 1994 Aug;84(8):1292–1298. doi: 10.2105/ajph.84.8.1292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Perry H. M., 3rd, Horowitz M., Fleming S., Kaiser F. E., Patrick P., Morley J. E., Cushman W., Bingham S., Perry H. M., Jr Effect of recent alcohol intake on parathyroid hormone and mineral metabolism in men. Alcohol Clin Exp Res. 1998 Sep;22(6):1369–1375. [PubMed] [Google Scholar]
  34. Sampson H. W., Hebert V. A., Booe H. L., Champney T. H. Effect of alcohol consumption on adult and aged bone: composition, morphology, and hormone levels of a rat animal model. Alcohol Clin Exp Res. 1998 Nov;22(8):1746–1753. [PubMed] [Google Scholar]
  35. Silverman S. L., Madison R. E. Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am J Public Health. 1988 Nov;78(11):1482–1483. doi: 10.2105/ajph.78.11.1482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Turner L. W., Wang M. Q., Fu Q. Risk factors for hip fracture among southern older women. South Med J. 1998 Jun;91(6):533–540. doi: 10.1097/00007611-199806000-00005. [DOI] [PubMed] [Google Scholar]
  37. Wark J. D. Osteoporotic fractures: background and prevention strategies. Maturitas. 1996 Mar;23(2):193–207. doi: 10.1016/0378-5122(95)00974-4. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES