Do Blondes Have More Bone Fractures?

Two things that are not true about blondes: 1) They have more fun, and 2) they have more bone fractures.

Marilyn Monroe in "Gentlemen Prefer Blondes" movie trailer, posted by MachoCarioca in Wikimedia Commons.

Even if those were true, I suppose they might cancel each other out. But, in fact, the “common wisdom” that people with blond hair or light-colored skin have a higher risk for osteoporosis and bone fractures is a myth. Medical data show that blondes, brunettes and redheads seem to have the same risk for osteoporosis and fractures, Dennis M. Black, Ph.D. said at a conference on osteoporosis sponsored by the University of California, San Francisco.

Another myth: Fracture risk is higher in the northern latitudes of a country, so that people in Minnesota are more prone to fractures than, say, people in Florida. In fact, within the United States, the lowest hip fracture rates are in the northern areas of the country.

That last one was a bit of a trick question, because data have shown that Scandinavians have a higher fracture risk than do equatorial peoples. The incidence of osteoporotic fractures in Norway is 421/ 100,000 people, compared with 1/100,000 in Nigeria. But within any one country, there is no significant north/south difference in fracture rates, said Dr. Black, professor of epidemiology and biostatistics at the university.

So, what does increase a person’s risk of having one of the 1.5 million osteoporotic fractures that occur each year in the United States? Older age and sex, for starters. At age 50 years, a woman’s lifetime risk of fracture exceeds her combined risk of breast, ovarian and uterine cancer. For men who are 50, their lifetime risk of fracture exceeds the risk of prostate cancer. A third of women and a fifth of men will develop osteoporotic fractures in their lifetimes.

Dr. Black (Photo by Sherry Boschert)

Race also is a risk factor. Age-adjusted fracture rates are 968/ 100,000 white people in the United States but only 314/100,000 for U.S. blacks and 219/100,000 for U.S. Hispanics, for example.

A family history of hip fracture doubles your risk for hip fracture, but the same does not apply to spine fractures. More dramatically, having had any kind of nonvertebral fracture yourself increases your risk for any kind of nonvertebral fracture by 1.5- to 3-fold independent of bone mineral density.

Regardless of bone mineral density, smoking doubles your risk for hip fracture, and diabetes doubles your risk for hip or humerus fracture and nearly triples your risk for foot fracture.

Drinking more than two drinks per day boosts the risk of hip fracture by 30%-40% and even more so with higher alcohol consumption. Wine lovers, take note: There is some hint of evidence that hip fracture risk is worse with beer drinking, compared with wine, Dr. Black said.

Of course, bone mineral density is a main predictor of one’s risk for osteoporosis and fracture, but “there is a growing realization that bone mineral density doesn’t tell the whole story and that other risk factors play important and independent roles,” he said.

Clinicians and patients can use the free, online FRAX tool to estimate one’s 10-year risk for fracture by combining many risk factors with bone density. The FRAX is “not without controversy” because it does not include all pertinent risk factors, but it seems to be the best option available when used to guide discussions between physicians and patients about bone health.

Dr. Black has received funding for research, travel or teaching from Merck, Novartis, Roche, and Amgen.

–Sherry Boschert (@sherryboschert)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Internal Medicine, Uncategorized

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