Effect of seasonality and weather on fracture risk in individuals 65 years and older

SummaryIn this large population-based study, fracture rates for hips, distal forearms, proximal humeri, and ankles were higher in winter than in other seasons, although the winter peak was small for hip fractures (p < 0.05 at all sites). Younger age between 65 and 80, living in warmer states and male gender were associated with increased winter morbidity due to fractures.IntroductionThe objective was to investigate seasonal variation in the incidence of four common fractures, and explore the association of weather with risk.MethodsPopulation-based analysis of individuals age 65 and older, including fractures of the hip, the distal forearm, the proximal humerus and the ankle. Weather information was obtained from the US National Oceanic and Atmospheric Administration website.ResultsFor all fractures, rates were highest in winter and lowest in summer (p < 0.05 at all sites). Winter peaks were more pronounced in warm climate states, in men, and in those younger than 80 years old. In winter, total snowfall was associated with a reduced risk of hip fracture (−5% per 20 inches) but an increased risk of non-hip fractures (6–12%; p < 0.05 at all sites). In summer, hip fracture risk tended to be lower during sunny weather (− 3% per 2 weeks of sunny days; p = 0.13), while other fractures were increased (15%–20%; p < 0.05) in sunny weather.ConclusionFractures contribute considerably to winter morbidity in older individuals. Younger age between 65 and 80, living in warmer states and male gender are risk factors for increased winter morbidity due to fractures. Weather affects hip fracture risk differently than the other fractures studied.

[1]  M. Holick,et al.  The Photobiology of Vitamin D and Its Consequences for Humans a , 1985 .

[2]  G E Dallal,et al.  Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. , 1997, The New England journal of medicine.

[3]  L. Melton,et al.  Population-based study of the contribution of weather to hip fracture seasonality. , 1995, American journal of epidemiology.

[4]  D. Sargent,et al.  Contribution of Weather to the Seasonality of Distal Forearm Fractures: A Population-Based Study in Rochester, Minnesota , 1999, Osteoporosis International.

[5]  its Panel on Folate,et al.  STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES , 1998 .

[6]  R. Keller,et al.  Basic Epidemiology of Fractures of the Upper and Lower Limb among Americans over 65 Years of Age , 1996, Epidemiology.

[7]  Paul Wilkinson,et al.  Vulnerability to winter mortality in elderly people in Britain: population based study , 2004, BMJ : British Medical Journal.

[8]  J. Brody,et al.  Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987. , 1991, American journal of epidemiology.

[9]  B. Dawson-Hughes,et al.  Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. , 1998, The American journal of clinical nutrition.

[10]  M. Karagas,et al.  The epidemiology of peripheral fractures. , 1996, Bone.

[11]  R. Lew,et al.  Effects of Vitamin D and Calcium Supplementation on Falls: A Randomized Controlled Trial , 2003, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[12]  E S Fisher,et al.  Overcoming potential pitfalls in the use of Medicare data for epidemiologic research. , 1990, American journal of public health.

[13]  R. Doll,et al.  Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial , 2003, BMJ : British Medical Journal.

[14]  A. Silman,et al.  Risk factors, falls, and fracture of the distal forearm in Manchester, UK. , 1996, Journal of epidemiology and community health.

[15]  François Duboeuf,et al.  Vitamin D3 and Calcium to Prevent Hip Fractures in Elderly Women , 1992 .

[16]  H. Bischoff-Ferrari,et al.  Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. , 2006, Archives of internal medicine.

[17]  C. Zetterberg,et al.  Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations. , 1987, Acta orthopaedica Scandinavica.

[18]  M. Chapuy,et al.  VITAMINE D3 AND CALCIUM TO PREVENT HIP FRACTURE S IN ELDERLY WOMEN , 1992 .

[19]  J. Kelsey,et al.  Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture. , 2004, American journal of epidemiology.

[20]  T M Allan,et al.  Composition of Seasonality of Disease , 1991, Scottish medical journal.

[21]  R W Sanson-Fisher,et al.  Accidents in older people living at home: a community‐based study assessing prevalence, type, location and injuries , 2000, Australian and New Zealand journal of public health.

[22]  M. Borrie,et al.  Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. , 1990, Age and ageing.

[23]  S. Holmberg,et al.  Statistical analysis of femoral neck fractures based on 3053 cases. , 1987, Clinical orthopaedics and related research.

[24]  D. Fink,et al.  SCREENING FOR BREAST CANCER , 1976, The Lancet.

[25]  P. Drinka,et al.  TYPE OF FALL AND RISK OF HIP AND WRIST FRACTURES: THE STUDY OF OSTEOPOROTIC FRACTURES , 1994, Journal of the American Geriatrics Society.

[26]  M. Parker,et al.  Falls, hip fractures and the weather , 1994, European Journal of Epidemiology.

[27]  W. Ray,et al.  Identification of fractures from computerized Medicare files. , 1992, Journal of clinical epidemiology.

[28]  S. Emans,et al.  Prevalence of vitamin D deficiency among healthy adolescents. , 2004, Archives of pediatrics & adolescent medicine.

[29]  E. Fisher,et al.  RACIAL DIFFERENCES IN FRACTURE RISK , 1994, Epidemiology.

[30]  Bess Dawson-Hughes,et al.  Effect of Vitamin D on falls: a meta-analysis. , 2004, JAMA.

[31]  M. Karagas,et al.  Patterns of fracture among the United States elderly: geographic and fluoride effects. , 1996, Annals of epidemiology.

[32]  M. Friger,et al.  Seasonal variation in hospital admissions for community-acquired pneumonia: a 5-year study. , 1999, The Journal of infection.

[33]  M. Holick,et al.  Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. , 1988, The Journal of clinical endocrinology and metabolism.

[34]  M. Passeri,et al.  Seasonal variation in the incidence of hip fractures in Emilia-Romagna and Parma. , 1993, Bone.

[35]  L. Valenti,et al.  The seasonality of hip fracture and its relationship with weather conditions in New South Wales. , 2010, Australian journal of public health.

[36]  Marija Bulajic-Kopjar,et al.  Seasonal variations in incidence of fractures among elderly people , 2000, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[37]  E. Fisher,et al.  The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. , 1992, American journal of public health.

[38]  J. Gore,et al.  Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. , 1998, Journal of the American College of Cardiology.

[39]  Z. Ráliš Epidemic of fractures during period of snow and ice. , 1981, British medical journal.

[40]  Birkenhäger Jc,et al.  Fractures of the proximal end of the femur , 1982 .

[41]  J. O'Loughlin,et al.  Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. , 1993, American journal of epidemiology.

[42]  G. Andersson,et al.  Fractures of the proximal end of the femur in Göteborg, Sweden, 1940-1979. , 1982, Acta orthopaedica Scandinavica.

[43]  S. Kivelä,et al.  Seasonal variation in hospital admissions for chronic obstructive pulmonary disease in Finland. , 1996, Arctic medical research.

[44]  S. Allison,et al.  UNDERNUTRITION, HYPOTHERMIA, AND INJURY IN ELDERLY WOMEN WITH FRACTURED FEMUR: AN INJURY RESPONSE TO ALTERED METABOLISM? , 1983, The Lancet.

[45]  A. Levy,et al.  Inclement Weather and the Risk of Hip Fracture , 1998, Epidemiology.

[46]  M. Karagas,et al.  Fracture risk in the U.S. Medicare population. , 1999, Journal of clinical epidemiology.

[47]  L. Bouter,et al.  Different risk profiles for hip fractures and distal forearm fractures: A prospective study , 2005, Osteoporosis International.

[48]  G. Colditz,et al.  The effect of climate on fractures and deaths due to falls among white women. , 1990, Accident; analysis and prevention.

[49]  R. Baumgartner,et al.  A two-year longitudinal study of falls in 482 community-dwelling elderly adults. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[50]  T. Miles,et al.  Regional variation in the incidence of hip fracture. US white women aged 65 years and older. , 1990, JAMA.