Protein is an important component of bone, but the role of dietary protein intake in osteoporosis remains controversial. The Utah picture-sort food frequency questionnaire was found to produce a useful estimation of usual dietary intake in the elderly. This method of dietary assessment was used in a population-based case-control study to examine the relationship between protein intake and risk of osteoporotic hip fracture in elderly Utah residents. Analyses of risk of hip fracture across increasing quartiles of protein intake were stratified by age-group. Higher protein intake was associated with a reduced risk of hip fracture in men and women aged 50-69 years but did not appear to increase or decrease risk of hip fracture in those aged 70-89 years. The relationship appeared to be modified by age. Modification of protein intake late in life may be a useful means to prevent hip fractures in the elderly.

Prior studies have unequivocally established a consistent association between osteoporotic hip fracture risk and type 2 diabetes mellitus. One reason this association still remains unclear is primarily due to the limited amount of research conducted in this area. The Utah Study of Nutrition and Bone Health (USNBH) is a case-control study conducted in Utah during the period of 1997-2001 to determine risk factors for osteoporotic hip fracture. All study participants (n = 2590) were determined from Utah residents 50-90 years of age. Cases were determined from 18 Utah hospitals during 1997-2001. Age and gender-matched controls were randomly selected from the Utah Drivers License pool if less than 65 years of age and the Medicare databases if greater than 65 years of age. Logistic regression models were used to determine the association between type 2 diabetes and hip fracture risk. Logistic regression modeling controlled for gender, body mass index, smoking status, alcohol use, physical activity, education level, and estrogen use in women. The risk of hip fracture was associated with type 2 diabetes. The significant correlation was primarily found in females in which the risk of hip fracture increased accompanying diagnosis of type 2 diabetes. Estrogen usage in females decreased (p < 0.0001) hip fracture risk in both former or current users. Physical activity significantly decreased the risk of hip fracture for females (p < 0.0001) and for males (p = 0.001). Smoking and alcohol use may increase the risk of hip fracture, especially in women. This study substantiates the hypothesis that type 2 diabetes mellitus increases the risk of hip fracture.

Change in body weight is an important determinant of risk of osteoporotic hip fracture in aging adults. Weight loss has been associated with an increased risk of hip fracture and weight gain has been associated with a decreased risk of hip fracture . . Weight gain cannot be recommended as appropriate prevention against hip fracture, however, because it is associated with such adverse health outcomes as cardiovascular disease and diabetes, and weight loss is commonly recommended in the treatment of these types of diseases. Clarification of how weight loss is related to risk of hip fracture is needed to resolve this issue. An extensive review of published literature was completed to assess the relationships between hip fracture and body weight, weight change, and involuntary and voluntary weight loss. Change in body weight and weight lll loss that was either intentional or unintentional were then assessed for their effects on risk of hip fracture in a population-based case-control study of risk factors for osteoporotic hip fracture in aging Utah residents. Analyses of risk of hip fracture by quintile of weight change since age 18 and according to weight loss intention were performed through logistic regression modeling. Weight loss after age 18 was associated with an increased risk of hip fracture in men and women, and above average weight gain after age 18 was protective against hip fracture in women. Involuntary weight loss of more than 20 pounds was associated with an increased risk of hip fracture in men and women aged 50 to 69 years, but was not related to risk of hip fracture in participants aged 70 to 89. Voluntary weight loss of more than 20 pounds did not significantly increase risk of hip fracture in either age group. It was concluded that involuntary weight loss may be an important predictor of risk of hip fracture in aging adults and that voluntary weight loss may be safely recommended to aging adults without increasing their risk of hip fracture