Category: Injury

Age-Related Weight Loss Raises Risk of Major Fracture in Older Men

Adjunct Professor Kristine Ensrud
Adjunct Professor Kristine Ensrud

Aging men commonly experience a gradual, mild loss in weight, which places them at greater risk for bone fractures. Such weight loss is also a risk factor for death and could be a sign of underlying disease. The competing risk of death makes it difficult to accurately estimate how much weight loss raises the chance of getting a major fracture. A new study by Adjunct Professor Kristine Ensrud sought to untangle the two factors by calculating the risk older men have in breaking the hip, spine, and pelvis with and without accounting for the competing risk of death.

The study was published in the Journal of Bone and Mineral Research.

“Disabling fractures like hip fractures and mortality share many common risk factors in older adults,” says Ensrud. “The sicker you are or if you smoke, the more likely you are to die or fall and get a hip fracture.”

The study found that as men age, weight loss increases their risk of fracture over time. On top of that, the researchers discovered that the probability of fractures and the association between weight loss and fractures can be overestimated if the competing risk of mortality is not accounted for.

Specifically, the study found that if mortality risk is not taken into account, the probability of a hip, spine, or pelvis fracture in aging men with gradual weight loss was approximately seven percent at five years and 17 percent at 10 years. When mortality risk was factored in, the fracture probability dropped to about six percent at five years and 10 percent at 10 years when calculated using a competing risk approach.

Ensrud said the overestimation gets worse over a longer period of time and had a greater impact on the 10-year probability than it did on the five-year probability of a fracture.

The results have big implications for how providers and patients think about their long-term health.

“When you see an older patient, you should communicate his or her 10-year probability for a specific serious health event like a hip fracture,” says Ensrud. “But doctors should also take into account the patient’s risk of mortality not related to the condition of interest, because your probability of a hip fracture is lower if you are at high risk of dying from something else.”

Researchers should also factor-in how individual patient mortality risk changes probabilities for specific adverse disease events in older adults.

“In research, when trying to estimate the lifetime risk of an adverse outcome, it’s important in older age groups to take into account the risk of death, because it’s more likely for them than younger populations,” says Ensrud.

The data for this study came from a larger studyEnsrud is conducting, called MrOS, which examines age-related conditions in a cohort of older, community-dwelling men.

Reducing Child Marriage and Partner Violence in Bangladesh

Theresa Osypuk
Associate Professor Theresa Osypuk

While child marriage before the age of 15 is a problem around the world, Bangladesh has the highest prevalence of very early child marriage, which often leads to intimate partner violence (IPV). A new study, based on research conducted in collaboration with Associate Professor Theresa Osypuk, looked at how the community prevalence of child marriage influences a woman’s risk of IPV in Bangladesh.

The study was published in the journal Demography.

“There are many places like Bangladesh in the world where women can’t fully express their basic human rights,” says Osypuk. “Men marry young girls because of strong social norms to do so, which reinforces local systems of male dominance. The identities of young girls aren’t fully formed, so it’s easier, in that case, for men to sustain dominance, often through violence.”

In Bangladesh, the incidence of IPV varies widely from village to village. To learn more about the relationship between child marriage and partner violence, the researchers interviewed more than 3,000 women from 77 rural villages about their experiences.

Specifically, the researchers tested if marrying after age 18 offered a protective effect against IPV. They also investigated if women in villages with a higher prevalence of very early child marriage (before age 15) suffered more violence. And finally, they explored if the protective effect of marrying at 18 or older was diminished in villages where child marriage was common.

The results showed that 45 percent of women reported recent intimate partner violence and 69 percent of women had married as children before age 18. Of those who married before 18, 20 percent were married before age 15. Women living in villages with a higher rate of child marriage experienced higher risk of intimate partner violence. And marrying over the age of 18 protected against IPV at the individual level.

The researchers also found a more complex association that showed marrying after age 18 protected women against violence in villages where early marriage was uncommon. However, the benefits of older marriage were negated in villages where early marriage was prevalent.

“This association suggests that the collective practice of very early child marriage is a feature of male dominance, and as a social norm, it interacts with the age at first marriage to increase risk of IPV among women,” says Osypuk.

Osypuk said the study has important implications for international organizations and policymakers who develop programs addressing health, wellbeing, and women’s rights.

“They can reduce the widespread practice of early child marriage and risk of intimate partner violence by investing in programs that enforce women’s rights and dismantle barriers to their development through education, anti-poverty, and norm-changing programs, particularly changing social norms among men,” says Osypuk.

Osypuk plans to continue research with this cohort of Bangladeshi women to examine other aspects of the community social environment and how it relates to intimate partner violence.

Don’t Shoot

How a public health approach — which focuses on keeping people safe and informing policy — can help solve one of our country’s biggest problems.

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Gun Violence and Mental Health: Too Much Has Slipped Through the Cracks

Recently, the Minnesota community was rocked by an absolute tragedy. I do not wish to add to the wounds of the family so I will not use any quotes or names. After battling anxiety and depression for what is believed to be months, a Lake Minnetonka man took the lives of his wife, son, two daughters, and then turned the gun on himself. The bereaved family buried their lost relatives a few weeks ago and what stuck out to me were the words spoken about the family. A loving family who worked hard to get where they were … The American Dream. It saddens me that we as a community have yet again been affected by gun violence.

In just the last few months, we have witnessed the radical nature that is gun violence. From a disgruntled employee who gunned down his former co-workers on live television to numerous unexplained murders that occur across our nation, we have a problem with guns. Of the 16,121 homicides that occurred in 2013, 11,208 (69.5 percent) were due to firearms. Also during this same year, 21,175 (51.5 percent) suicides were caused by firearms. The NIH published an article called “Suicide: A Major, Preventable Mental Health Problem” in which a common sign of suicide is searching online for or buying a gun. The link between gun violence and mental health can be exemplified in suicide, depression, and other mental disorders are major risk factors associated with suicide.

Are guns the issue? Are people the problem? Or is it an extremely difficult question that cannot be answered with one issue or one policy change? At this point, the rhetoric surrounding the gun control debate belittles the lives lost due to gun violence. Everyone can agree that guns in the wrong hands can cause horrible calamities. Progressive action is needed rather than arguments over whose rights are being infringed upon. Families of the Sandy Hook victims, mayors across the nation, mothers throughout the U.S., and survivors of gun violence began an organization called “Everytown for Gun Safety.” Through a variety of actions, they hope to make every town safer by preventing gun violence. A noble goal but a difficult one to achieve.

We, as Public Health professionals, have an interesting role to play in this debate. Do we choose a side and enter the debate? Or do we sit back and deal with issues we believe are more important? In my opinion, we cannot do either. We must bring to light the issue in a fair and calculated way, utilizing statistics and empirical evidence to prove a link between gun access and gun violence. Further, we must substantiate the need for better background checks so that individuals who may be suffering from mental disorders are not allowed to obtain a gun. –Post written by Jake Tanumihardjo

[This blog does not represent the opinion of the University of Minnesota’s School of Public or the members of the Active Response Coalition for Public Health, only the author.]


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