Keywords: hip fracture, women, medications, cohort study

Background:

Hip fractures are a major cause of disability and mortality among older women. Established risk factors include age-related decline in physical function, balance, and bone strength. However, the long-term impact of commonly prescribed medications on hip fracture risk remains incompletely understood. Clarifying medication-associated risks may support fracture prevention strategies in primary care.

Research questions:

Is baseline regular medication use associated with the risk of subsequent hip fracture during long-term follow-up among women aged 70 years and older?

Method:

This observational cohort study was embedded in a population-based hip fracture prevention project in Sweden. In 2001, 1,248 women aged 70–100 years were recruited; 414 women in the intervention group provided complete baseline data on regular oral medications. Hip fracture outcomes were identified through radiology department fracture registries from 2002 to 2025. Cox proportional hazards regression models estimated hazard ratios (HRs) for time to first hip fracture across more than 20 medication classes, adjusting for age and established fracture risk factors. Follow-up continued until first hip fracture, death, or end of study.

Results:

Among the 414 women with complete medication data (mean age 79.4 years), 85 (21%) sustained a hip fracture during follow-up (mean follow-up 124 months). Increasing age was strongly associated with hip fracture risk (HR per year 1.10, 95% CI 1.06–1.15; p<0.001). Additional significant risk factors included body height >167 cm (HR 2.2, 95% CI 1.2–4.0; p=0.009), body weight <60 kg (HR 1.9, 95% CI 1.2–3.1; p=0.01), and corticosteroid use (HR 2.7, 95% CI 1.2–6.1; p=0.02). No other medication classes showed significant associations.

Conclusions:

Age was the dominant determinant of hip fracture risk. Among medications, only corticosteroid use was independently associated with increased risk. Body height and low body weight were also significant predictors, consistent with existing literature data.

Points for discussion:

Do the results surprise you?

Could early mortality in frailer participants have obscured potential associations between some medications and hip fracture risk?