{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T22:56:53Z","timestamp":1769209013114,"version":"3.49.0"},"reference-count":19,"publisher":"BMJ","issue":"6753","license":[{"start":{"date-parts":[[1990,9,29]],"date-time":"1990-09-29T00:00:00Z","timestamp":654566400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1990,9,29]]},"abstract":"<jats:p>OBJECTIVE--To assess the relative importance of osteoporosis of the os calcis, cognisance, and mobility in the risk of subsequent fracture of the hip in elderly women. DESIGN--Prospective study of elderly women in residential care over two years. SETTING--21 Private or 38 local authority residential homes for the elderly and 4 geriatric hospitals in Doncaster and Hull. SUBJECTS--1414 Ambulant women aged over 69, in private or local authority residential care or geriatric care. Those who had had bilateral hip surgery were excluded. MAIN OUTCOME MEASURES--Broad band ultrasonic attenuation (BUA) index, Clifton assessment procedures for the elderly test (for cognisance), and mobility on a six point scale, and fracture of the hip in the subsequent two year period. RESULTS--73 Women fractured their hip during the two years. Their mean age was not significantly different from that of the women who did not have a fracture (85.3 (SD 5.6) v 83.9 (6.3); p = 0.07), but their mean BUA index (40.3 (19.3) v 50.9 (22.2) db\/MH2), and score for cognisance (median 19 (interquartile range 10.5-27.0) v 24 (17-30)) were significantly lower (both p less than 0.001). These variables had independent associations with fracture of the hip. Women with fractures had a significantly lower score for the psychomotor component of the cognisance test (4.5 (1-8) v 7 (2-10); p less than 0.0025 and were significantly more mobile (1(1-3) v 3 (1-6); p less than 0.02). Subdividing women according to high, medium, and low scores for BUA index and cognisance testing disclosed a high risk group (118 women) with low BUA index and cognisance score, whose incidence of fracture was 12.8%; in the group at lowest risk (136 women) with high BUA index and cognisance score, the incidence of fracture was only 1.5% (relative risk 8.4 (95% confidence interval -2.0 to 35.5]. Further analysis showed that those most at risk were, additionally, most mobile but that less mobile women with good cognisance had a low incidence of fractures, regardless of the BUA index, (1.2%, high index, v 0.9%, low index). CONCLUSIONS--Elderly women most at risk of sustaining hip fractures were those with low BUA index, low cognisance test score, and high mobility. Improving bone strength and cognisance in elderly women may reduce their incidence of hip fracture.<\/jats:p>","DOI":"10.1136\/bmj.301.6753.638","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"638-641","source":"Crossref","is-referenced-by-count":223,"title":["Prediction of hip fracture in elderly women: a prospective study."],"prefix":"10.1136","volume":"301","author":[{"given":"R W","family":"Porter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C G","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Grainger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S B","family":"Palmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1990,9,29]]},"reference":[{"key":"ref_1","article-title":"Fractured neck offemur. Prevention and management","author":"of Physicians, Royal College","year":"1989","unstructured":"Royal College of Physicians. Fractured neck offemur. Prevention and management. London: RCP, 1989."},{"key":"ref_2","first-page":"514","article-title":"Keeping up with orthopaedic epidemics","volume":"295","author":"Bulstrode, C.","year":"1987","unstructured":"Bulstrode C. Keeping up with orthopaedic epidemics. BrMedJr 1987;295:514.","journal-title":"BrMedJr"},{"key":"ref_3","first-page":"13","article-title":"and age in fracture of the proximal femur","volume":"295","author":"Cooper, C.; Barker, D.J.P.; Morris, J.; Osteoporosis, Briggs R.S.J.; falls","year":"1987","unstructured":"Cooper C, Barker DJP, Morris J, Briggs RSJ. Osteoporosis, falls, and age in fracture of the proximal femur. 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EngMed 1984;13:89-91.","journal-title":"EngMed"},{"key":"ref_7","article-title":"Colles fracture, BUA and thoracic kyphosis","author":"Porter, R.W.; Johnson, K.; McCutchan, J.D.S.","unstructured":"Porter RW, Johnson K, McCutchan JDS. Colles fracture, BUA and thoracic kyphosis. Bone (in press)."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1192\/bjp.133.5.457","article-title":"The two year predictive validity of the Clifton assessment schedule and the shortened Stockton geriatric rating scale","volume":"133","author":"Pattie, A.H.; Gilleard, C.J.","year":"1978","unstructured":"Pattie AH, Gilleard CJ. The two year predictive validity of the Clifton assessment schedule and the shortened Stockton geriatric rating scale. BrJ Psychiatry 1978;133:457-60.","journal-title":"BrJ Psychiatry"},{"key":"ref_9","article-title":"Ultrasonic studies of bone","author":"Palmer, S.B.; McD, Langton C.","year":"1987","unstructured":"Palmer SB, Langton C McD. Ultrasonic studies of bone. London: Institute of Physics, 1987. (Short meetings series No 6)."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/BF02571310","article-title":"Ultrasonic attenuation of the os calcis in women with osteoporosis and hip fractures","volume":"43","author":"Baran, D.T.; Kelly, A.M.; Karellas, A.","year":"1988","unstructured":"Baran DT, Kelly AM, Karellas A, et al. Ultrasonic attenuation of the os calcis in women with osteoporosis and hip fractures. Calcif Tiss Int 1988;43: 138-42.","journal-title":"Calcif Tiss Int"},{"key":"ref_11","first-page":"262","article-title":"Selection of the optimal skeletal side for fracture risk prediction","volume":"216","author":"Wasnich, R.D.; Ross, P.D.; Heilbrun, L.K.; Vogel, J.M.","year":"1987","unstructured":"Wasnich RD, Ross PD, Heilbrun LK, Vogel JM. Selection of the optimal skeletal side for fracture risk prediction. 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