Measured height loss predicts fractures in middle-aged and older men and women: The EPIC-Norfolk prospective population study

In this large population-based prospective study among middle-aged and older men and women, we found that height loss of >2 cm over a period of 4 yr is a significant predictor of future fractures. Serial measurement of height is, therefore, recommended among the elderly people. Introduction: Height change can be easily measured and may contribute to fracture risk prediction. We assessed measured height loss and fracture incidence in a prospective population study. Materials and Methods: Height was measured in participants in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) between 1993 and 1997 and repeated between 1997 and 2000. Incident fractures to 2006 were ascertained by hospital record linkage. Results: In 14,921 men and women 42-82 yr of age, during a mean follow-up period of 7.1 yr, there were 390 fractures, including 122 hip fractures. Prior annual height loss in those who had an incident fracture (1.8 +/- 0.3 [SD] mm) was significantly greater than other participants (0.9 +/- 0.2 mm; p < 0.001). Participants with annual height loss >0.5 cm had an age- and sex-adjusted hazard ratio of any fracture of 1.76 (95% CI, 1.16-2.67) and of hip fracture of 2.08 (95% CI, 1.07-4.05) compared with those with no height loss. Each 1 cm/yr height loss was associated with a hazard ratio of 1.86 (95% CI, 1.28-2.72) for all fractures and 2.24 (95% CI, 1.23-4.09) for hip fracture after adjustment for age, sex, past history of fracture, smoking, body mass index, alcohol intake, and heel ultrasound measures. Annual height loss of 1 cm was comparable to having a past history of fracture and equivalent to being similar to 14 yr older in chronological age in terms of the magnitude of relationship with fracture risk. Conclusions: Middle-aged and older men and women with annual height loss >0.5 cut are at increased risk of hip and any fracture. Serial height measurements can contribute to fracture risk prediction.