Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study.

The Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study examines the risk factors for fractures and low bone density in middle-aged women. In the present study we investigated lifestyle and other risk factors for ankle fracture. The study population consisted of 11,798 women, aged 47-56 years at baseline. During the 5 year follow-up, these women sustained 194 validated malleolar fractures, giving an incidence of 3.4 fractures/1000 person-years. Four independent predictors for malleolar fracture were detected: smoking; multipharmacy; fracture history; and overweight status. The hazard ratio (HR) for positive fracture history was 1.63 (p = 0.005). In women with a body mass index (BMI) of 25-30 kg/m(2) vs. those with a BMI <25 kg/m(2), HR was 1.69 (p = 0.003). Those who used three or more prescribed drugs had an HR of 2.03 (p = 0.0003) vs. those who used no drugs. Smoking had a dose-response effect, with HRs of 1.73 (p = 0.016) in those smoking 1-19 cigarettes/day, and 2.94 (p = 0.001) in those smoking > or =20 cigarettes/day. Lifestyle factors and fracture history appear to be important predictors of ankle fracture.