{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:40:02Z","timestamp":1787697602138,"version":"build-2784847793"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2002,5,1]],"date-time":"2002-05-01T00:00:00Z","timestamp":1020211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Fracture of the proximal humerus is one of the most frequent fractures attributable to osteoporosis; yet, it has seldom been studied. Two types of factors (related to bone fragility and falls) were evaluated to identify risk factors for proximal humerus fractures as well as to examine possible interactions between them. Subjects were 6901 white women aged \u226575 years and all participated in the EPIDOS study of risk factors for osteoporotic fractures (France, 1992-1998). The baseline examination included measurements of femoral neck bone mineral density (BMD) and calcaneal ultrasound parameters (speed of sound [SOS] and broadband ultrasound attenuation [BUA]), a functional clinical examination, and completing a questionnaire on health status and lifestyle. During a mean of 3.6 (0.8) years of follow-up, 165 women had a humeral fracture. Using multivariate Cox regression models, we identified three predictors related to bone fragility\u2014low BMD (relative risk [RR] = 1.4; 95% CI, 1.1-1.7), low SOS (RR = 1.3; 95% CI, 1.0-1.6), and maternal history of hip fracture (RR = 1.8; 95% CI, 1.0-3.0)\u2014and four fall-related predictors\u2014a previous fall (RR = 3.0; 95% CI, 1.5-6.1), a low level of physical activity (RR = 2.2; 95% CI, 1.1-4.4), impaired balance (RR = 1.8; 95% CI, 1.1-2.9), and pain in lower limb extremity (RR = 1.4; 95% CI, 1.0-2.1). The effect of these fall-related predictors varied according to the BMD level; they were significantly associated with proximal humerus fractures in women with osteoporosis (BMD T score &amp;lt; \u22122.5) but not in nonosteoporotic women. The incidence of proximal humerus fracture in women with osteoporosis and a low fall risk score (5.1 per 1000 woman-years) was only slightly higher than in nonosteoporotic women (4.6 per 1000 woman-years) and similar to the incidence in women without osteoporosis but a high fall risk score (5.3 per 1000 woman-years). On the other hand, the incidence in women who had both types of risk factors was more than two times higher (12.1 per 1000 woman-years) than in women with only one of the two risk factors. These results suggest that women who have both types of risk factors should receive the highest priority for prevention.<\/jats:p>","DOI":"10.1359\/jbmr.2002.17.5.817","type":"journal-article","created":{"date-parts":[[2006,4,26]],"date-time":"2006-04-26T21:12:20Z","timestamp":1146085940000},"page":"817-825","source":"Crossref","is-referenced-by-count":194,"title":["Risk Factors for Fractures of the Proximal Humerus: Results From the EPIDOS Prospective Study"],"prefix":"10.1093","volume":"17","author":[{"given":"Sun H.","family":"Lee","sequence":"first","affiliation":[{"name":"INSERM, Unit\u00e9 149, 16 av. Paul Vaillant-Couturier, Villejuif Cedex, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Dargent-Molina","sequence":"additional","affiliation":[{"name":"INSERM, Unit\u00e9 149, 16 av. Paul Vaillant-Couturier, Villejuif Cedex, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e9rard","family":"Br\u00e9art","sequence":"additional","affiliation":[{"name":"INSERM, Unit\u00e9 149, 16 av. Paul Vaillant-Couturier, Villejuif Cedex, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2009,12,2]]},"reference":[{"key":"2024013019090381200_bib1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.7326\/0003-4819-115-11-837","article-title":"Which fractures are associated with low appendicular bone mass in elderly women?","volume":"115","author":"Seeley","year":"1991","journal-title":"Ann Intern Med"},{"key":"2024013019090381200_bib2","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/BF01623273","article-title":"Changing incidence and residual lifetime risk of common osteoporosis-related fractures","volume":"3","author":"Lauritzen","year":"1993","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib3","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/0020-1383(80)90129-1","article-title":"Fractures of the neck of humerus: A review of late results","volume":"12","author":"Clifford","year":"1980","journal-title":"Injury"},{"key":"2024013019090381200_bib4","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1097\/00005373-198508000-00013","article-title":"Fractures of the proximal humerus in adults","volume":"25","author":"Mills","year":"1985","journal-title":"J Trauma"},{"key":"2024013019090381200_bib5","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1007\/PL00004149","article-title":"Incidence and direct medical costs of hospitalisations due to osteoporotic fractures in Switzerland","volume":"7","author":"Lippuner","year":"1997","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib6","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0002-9343(85)90343-2","article-title":"Are patients with hip fractures more osteoporotic? Review of evidence","volume":"78","author":"Cummings","year":"1985","journal-title":"Am J Med"},{"key":"2024013019090381200_bib7","doi-asserted-by":"crossref","first-page":"516","DOI":"10.7326\/0003-4819-112-7-516","article-title":"Screening for osteoporosis","volume":"112","author":"Melton","year":"1990","journal-title":"Ann Intern Med"},{"key":"2024013019090381200_bib8","first-page":"321","article-title":"Heterogeneity of age-related fractures: Implications for epidemiology","volume":"2","author":"Melton","year":"1987","journal-title":"Bone Miner"},{"key":"2024013019090381200_bib9","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(96)01440-7","article-title":"Fall-related factors and risk of hip fracture: The EPIDOS prospective study","volume":"348","author":"Dargent-Molina","year":"1996","journal-title":"Lancet"},{"key":"2024013019090381200_bib10","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1056\/NEJM199503233321202","article-title":"Risk factors for hip fracture in white women","volume":"332","author":"Cummings","year":"1995","journal-title":"N Engl J Med"},{"key":"2024013019090381200_bib11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1093\/oxfordjournals.aje.a116314","article-title":"Risk factors for fractures of the distal forearm and proximal humerus","volume":"135","author":"Kelsey","year":"1992","journal-title":"Am J Epidemiol"},{"key":"2024013019090381200_bib12","doi-asserted-by":"crossref","first-page":"M107","DOI":"10.1093\/geronj\/44.4.M107","article-title":"A hypothesis: The causes of hip fractures","volume":"44","author":"Cummings","year":"1989","journal-title":"J Gerontol Med Sci"},{"key":"2024013019090381200_bib13","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1001\/jama.1994.03510260060029","article-title":"Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly","volume":"271","author":"Greenspan","year":"1994","journal-title":"JAMA"},{"key":"2024013019090381200_bib14","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1007\/s001980070040","article-title":"The injury mechanism of osteoporotic upper extremity fractures among older adults: A controlled study of 287 consecutive patients and their 108 controls","volume":"11","author":"Palvanen","year":"2000","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib15","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1111\/j.1532-5415.1993.tb07307.x","article-title":"Type of fall and risk of hip and wrist fractures: The study of osteoporotic fractures","volume":"41","author":"Nevitt","year":"1993","journal-title":"JAGS"},{"key":"2024013019090381200_bib16","first-page":"99","article-title":"Evaluation of the calcium content of diet by frequential self-questionnaire (French)","volume":"58","author":"Fardellone","year":"1991","journal-title":"Rev Rhum Mal Osteoartic"},{"key":"2024013019090381200_bib17","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: Self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"2024013019090381200_bib18","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/j.1532-5415.1975.tb00927.x","article-title":"A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients","volume":"23","author":"Pfeiffer","year":"1975","journal-title":"J Am Geriatr Soc"},{"key":"2024013019090381200_bib19","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S0140-6736(95)11456-4","article-title":"Ultrasonographic heel measurements to predict hip fracture in elderly women: The EPIDOS prospective study","volume":"348","author":"Hans","year":"1996","journal-title":"Lancet"},{"key":"2024013019090381200_bib20","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1136\/bmj.301.6753.638","article-title":"Prediction of hip fracture in elderly women: A prospective study","volume":"301","author":"Porter","year":"1990","journal-title":"BMJ"},{"key":"2024013019090381200_bib21","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1001\/archinte.1997.00440270067006","article-title":"Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women","volume":"157","author":"Bauer","year":"1997","journal-title":"Arch Intern Med"},{"key":"2024013019090381200_bib22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.5650080102","article-title":"Heritable and life-style determinants of bone mineral density","volume":"8","author":"Krall","year":"1993","journal-title":"J Bone Miner Res"},{"key":"2024013019090381200_bib23","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1002\/jbmr.5650101102","article-title":"Bone density determinants in elderly women: A twin study","volume":"10","author":"Flicker","year":"1995","journal-title":"J Bone Miner Res"},{"key":"2024013019090381200_bib24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/oxfordjournals.aje.a009362","article-title":"Bone mass, lean mass, and fat mass: Same genes or same environments?","volume":"147","author":"Nguyen","year":"1998","journal-title":"Am J Epidemiol"},{"key":"2024013019090381200_bib25","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1359\/jbmr.1999.14.1.102","article-title":"Familial resemblance of bone mineral density (BMD) and calcaneal ultrasound attenuation: The BMD in mothers and daughters study","volume":"14","author":"Danielson","year":"1999","journal-title":"J Bone Miner Res"},{"key":"2024013019090381200_bib26","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s001980050061","article-title":"How hip and whole-body bone mineral density predict hip fracture in elderly women: The EPIDOS prospective study","volume":"8","author":"Schott","year":"1998","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib27","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s001980070048","article-title":"In elderly women weight is the best predictor of a very low bone mineral density: Evidence from the EPIDOS Study","volume":"11","author":"Dargent-Molina","year":"2000","journal-title":"Osteoporos Int"},{"issue":"Suppl 4","key":"2024013019090381200_bib28","first-page":"1","article-title":"The prevention of falls in later life","volume":"34","author":"Kellogg international work group on the prevention of falls in the elderly","year":"1987","journal-title":"Dan Med Bull"},{"key":"2024013019090381200_bib29","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1056\/NEJM198904203201606","article-title":"Prevention of falls among the elderly","volume":"320","author":"Tinetti","year":"1989","journal-title":"N Engl J Med"},{"key":"2024013019090381200_bib30","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/j.1532-5415.1995.tb07017.x","article-title":"Falls in community-dwelling older persons","volume":"43","author":"King","year":"1995","journal-title":"JAGS"},{"key":"2024013019090381200_bib31","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1056\/NEJM198812293192604","article-title":"Risk factors for falls among elderly persons living in the community","volume":"319","author":"Tinetti","year":"1988","journal-title":"N Engl J Med"},{"key":"2024013019090381200_bib32","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1001\/jama.1989.03420180087036","article-title":"Risk factors for recurrent nonsyncopal falls: A prospective study","volume":"261","author":"Nevitt","year":"1989","journal-title":"JAMA"},{"key":"2024013019090381200_bib33","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1001\/jama.1995.03520410035023","article-title":"The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials","volume":"273","author":"Province","year":"1995","journal-title":"JAMA"},{"key":"2024013019090381200_bib34","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/BF02652555","article-title":"Physical activity and predisposition for hip fractures: A review","volume":"7","author":"Joakimsen","year":"1997","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib35","doi-asserted-by":"crossref","first-page":"81","DOI":"10.7326\/0003-4819-129-2-199807150-00002","article-title":"Physical activity and osteoporotic fracture risk in older women","volume":"129","author":"Gregg","year":"1998","journal-title":"Ann Intern Med"},{"key":"2024013019090381200_bib36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S1047-2797(96)00110-X","article-title":"Physical activity, functional limitations, and risk of fall-related fractures in community-dwelling elderly","volume":"7","author":"Stevens","year":"1997","journal-title":"Ann Epidemiol"},{"key":"2024013019090381200_bib37","first-page":"69","volume-title":"Falls, Balance and Gait Disorders in the Elderly","author":"Nevitt","year":"1992"},{"key":"2024013019090381200_bib38","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/BF01623273","article-title":"Changing incidence and residual lifetime risk of common osteoporosis-related fractures","volume":"3","author":"Lauritzen","year":"1993","journal-title":"Osteoporos Int"},{"key":"2024013019090381200_bib39","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/00001648-199401000-00008","article-title":"Racial differences in fracture risk","volume":"5","author":"Baron","year":"1994","journal-title":"Epidemiology"},{"key":"2024013019090381200_bib40","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1302\/0301-620X.80B2.0800243","article-title":"Epidemiology of fractures in 15000 adults. The influence of age and gender","volume":"80","author":"Singer","year":"1998","journal-title":"J Bone Joint Surg Br"},{"issue":"Suppl 103","key":"2024013019090381200_bib41","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3109\/03009749609103738","article-title":"The incidence of osteoporotic fractures at the university hospital of Tartu, Estonia","volume":"25","author":"Haviko","year":"1996","journal-title":"Scand J Rheumatol"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1359%2Fjbmr.2002.17.5.817","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/17\/5\/817\/56470291\/5650170509.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/17\/5\/817\/56470291\/5650170509.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T15:05:00Z","timestamp":1710342300000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/17\/5\/817-825\/7592409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,5,1]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2009,12,2]]},"published-print":{"date-parts":[[2002,5,1]]}},"URL":"https:\/\/doi.org\/10.1359\/jbmr.2002.17.5.817","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2002,5,1]]},"published":{"date-parts":[[2002,5,1]]}}}