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Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study

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Abstract

Summary

To compare the absolute risk of fracture to the risk of other conditions by race/ethnicity, we studied 83,724 women, aged 70–79. The projected number of fractures was similar to or exceeded the combined number of cardiovascular events and breast cancers. Osteoporosis prevention efforts should target women of all ethnicities.

Introduction

The relative risk of fracture is lower in non-white compared to white women but the absolute risk of fracture in comparison to other common chronic conditions is uncertain.

Methods

We performed a prospective cohort study of 83,724 women, age 50–79 years. Cardiovascular disease (CVD), invasive breast cancer and all fractures were identified over an average of 7.7 ± 2.6 years.

Results

The incidence of fracture, breast cancer, stroke and CVD varied across ethnicity. The annualized (%) incidence of fracture was greatest in whites (2.4%) and American Indians (2.8%) and lowest among blacks (1.3%). The majority of hip fractures occurred in white women. The projected number of women who will experience a fracture in one year exceeded the combined number of women who would experience invasive breast cancer or a broad category of CVD events in all ethnic groups except blacks. In 10,000 black women, an estimated 153 women would experience CVD, and 35 women, breast cancer compared to 126 women expected to fracture in one year.

Conclusion

The annual risk of suffering a fracture is substantial in women of all ethnicities. Osteoporosis prevention efforts should target all women irrespective of their race/ethnic backgrounds.

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Acknowledgments

The National Heart Lung and Blood Institute has representation on the WHI Steering Committee which governed the design and conduct of the study, the interpretation of the data and preparation and approval of manuscripts. The National Heart Lung and Blood Institute Project office reviewed and approved the manuscript.

Funding

The WHI program is funded by the National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. The sponsor played a role in the design and analysis of the WHI. Additional support was obtained from NHLBI contract HHSN268200764318C.

Conflicts of interest

Dr. Cauley has received research support from Merck & Company, Eli Lilly & Company, Pfizer Pharmaceuticals and Novartis Pharmaceuticals. She has also received consulting fees from Eli Lilly & Company, and Novartis Pharmaceuticals. Dr. Robbins reports that he has worked on grants with industry support but that he has received no salary support. Dr. Jackson has received research support from and is on the speaker’s bureau for Procter & Gamble Pharmaceuticals, has received research and conference support from Novartis, and has received an honorarium as a Continuing Medical Education speaker for Aventis/Alliance for Better Bone Health. Drs. Wampler, Barnhart, Allison, Chen, Hendrix and Ms. Wu, have no conflicts to report.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA

    J. A. Cauley

  2. Noqsi Native Research, Ltd., Pine, CO, 80470, USA

    N. S. Wampler

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    J. M. Barnhart

  4. Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA

    L. Wu

  5. University of California, San Diego, La Jolla, CA, 92093, USA

    M. Allison

  6. Division of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, 85716, USA

    Z. Chen

  7. School of Medicine, Wayne State University, Detroit, MI, 48202, USA

    S. Hendrix

  8. Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, 95817, USA

    J. Robbins

  9. Department of Internal Medicine and Physical Medicine, Ohio State University, Columbus, OH, 43210, USA

    R. D. Jackson

Authors
  1. J. A. Cauley
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  2. N. S. Wampler
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  3. J. M. Barnhart
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  4. L. Wu
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  5. M. Allison
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  6. Z. Chen
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  7. S. Hendrix
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  8. J. Robbins
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  9. R. D. Jackson
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Corresponding author

Correspondence to J. A. Cauley.

Additional information

This article is discussed in an editorial that is available at http://dx.doi.org/10.1007/s00198-008-0673-4.

Appendix

Appendix

We wish to thank all WHI investigators and participants for their contributions. The following list is a short list of WHI investigators.

Program Office: Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller (National Heart, Lung, and Blood Institute, Bethesda, MD).

Clinical Coordinating Centers: Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, Anne McTiernan (Fred Hutchinson Cancer Research Center, Seattle, WA); Sally Shumaker (Wake Forest University School of Medicine, Winston-Salem, NC); Evan Stein (Medical Research Labs, Highland Heights, KY); Steven Cummings (University of California at San Francisco, San Francisco, CA).

Clinical Centers: Sylvia Wassertheil-Smoller (Albert Einstein College of Medicine, Bronx, NY); Jennifer Hays (Baylor College of Medicine, Houston, TX); JoAnn Manson (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA); Annlouise R. Assaf (Brown University, Providence, RI); Lawrence Phillips (Emory University, Atlanta, GA); Shirley Beresford (Fred Hutchinson Cancer Research Center, Seattle, WA); Judith Hsia (George Washington University Medical Center, Washington, DC); Rowan Chlebowski (Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA); Evelyn Whitlock (Kaiser Permanente Center for Health Research, Portland, OR); Bette Caan (Kaiser Permanente Division of Research, Oakland, CA); Jane Morley Kotchen (Medical College of Wisconsin, Milwaukee, WI); Barbara V. Howard (MedStar Research Institute/Howard University, Washington, DC); Linda Van Horn (Northwestern University, Chicago/Evanston, IL); Henry black (Rush Medical Center, Chicago, IL); Marcia L. Stefanick (Stanford Prevention Research Center, Stanford, CA); Dorothy Lane (State University of New York at Stony Brook, Stony Brook, NY); Rebecca Jackson (The Ohio State University, Columbus, OH); Cora E. Lewis (University of Alabama at Birmingham, Birmingham, AL); Tamsen Bassford (University of Arizona, Tucson/Phoenix, AZ); Jean Wactawski-Wende (University at Buffalo, Buffalo, NY); John Robbins (University of California at Davis, Sacramento, CA); F. Allan Hubbell (University of California at Irvine, CA); Howard Judd (University of California at Los Angeles, Los Angeles, CA); Robert D. Langer (University of California at San Diego, LaJolla/Chula Vista, CA); Margery Gass (University of Cincinnati, Cincinnati, OH); Marian Limacher (University of Florida, Gainesville/Jacksonville, FL); David Curb (University of Hawaii, Honolulu, HI); Robert Wallace (University of Iowa, Iowa City/Davenport, IA); Judith Ockene (University of Massachusetts/Fallon Clinic, Worcester, MA); Norman Lasser (University of Medicine and Dentistry of New Jersey, Newark, NJ); Mary Jo O’Sullivan (University of Miami, Miami, FL); Karen Margolis (University of Minnesota, Minneapolis, MN); Robert Brunner (University of Nevada, Reno, NV); Gerardo Heiss (University of North Carolina, Chapel Hill, NC); Lewis Kuller (University of Pittsburgh, Pittsburgh, PA); Karen C. Johnson (University of Tennessee, Memphis, TN); Robert Brzyski (University of Texas Health Science Center, San Antonio, TX); Gloria E. Sarto (University of Wisconsin, Madison, WI); Denise Bonds (Wake Forest University School of Medicine, Winston-Salem, NC); Susan Hendrix (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI).

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Cauley, J.A., Wampler, N.S., Barnhart, J.M. et al. Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study. Osteoporos Int 19, 1717–1723 (2008). https://doi.org/10.1007/s00198-008-0634-y

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