Fractures in older people are common and have a large impact on quality of life. Nevertheless, little is known of the epidemiology of fractures of sites other than the hip, or of risk factors in groups other than white females. The proposal describes a case-control study of fractures of the distal forearm, foot, proximal humerus, pelvis and shaft of the tibia and fibula among females and males of age 45 years and older in an ethnically diverse population. Cases will be identified over a 4-year period from the membership of six medical centers of the Kaiser Permanente Medical Care Program of Northern California. One common control group will be used for the five case groups. Controls will be accrued over the same 4-year period as the cases, and they will be selected at random from within strata defined by age and gender from the membership of these same six medical centers. Most information on potential risk factors will be obtained by a standardized questionnaire administered by trained interviewers. The questionnaire will cover demographic characteristics, medical history, fracture history, functional status, current health status, lower extremity neuropathy, vision and hearing, anthropometry, reproductive history, physical activity, cigarette smoking, selected aspects of diet, selected aspects of the home environment, recent stressful life events, social networks, cognitive function, and a detailed description of the events immediately surrounding the fracture. Tests for visual acuity and lower extremity neuropathy will be applied. Medical records will be reviewed for medications prescribed and illnesses experienced. Bone mineral density, fat mass, and lean body mass will be measured by dual energy x-ray absorptiometry (DEXA) in a sample of cases of distal forearm fracture and of controls. Statistical analysis will include comparing characteristics of cases with fracture of each site with the control group as well as with each other. Characteristics of falls leading to fractures will be compared with falls among the controls not leading to fracture. Numbers of distal forearm and foot fractures should be large enough to generally consider all racial/ethnic groups combined. The investigators state that this study should add to several aspects of our knowledge of fracture epidemiology, and thereby increase our ability to suggest preventive measures.
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