Effects of regional drinking water composition on risk of hip fracture. A spatio-temporal analysis of nationwide hospital admissions from 2000 to 2010 in Portugal

Wednesday, 20 August 2014
Exhibit hall (Dena'ina Center)
Carla M Oliveira, MS , Instituto de Engenharia Biomédica da Universidade do Porto - INEB, Porto, Portugal
Hugo Teixeira, MS , Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
Theodoros Economou, PhD , College of Engineering, Mathematics & Physical Sciences, University of Exeter, Exeter, England
Trevor Bailey, PhD , College of Engineering, Mathematics & Physical Sciences, University of Exeter, Exeter, England
Maria Fátima Pina, PhD , Instituto de Engenharia Biomédica da Universidade do Porto - INEB, Porto, Portugal
INTRODUCTION: There is a strong geographical variation in the incidence rates of hip fractures (HF) in Portugal. Differences in the water composition may be a possible explanation since minerals deposition in bones contribute to their fragility and consequently to fractures. Our aim is to investigate the effects of drinking water composition in the risk of HF in Portugal (2000-2010).

METHODS:  From the National Hospital Discharge Register we selected admissions of patients aged ≥50 years, with diagnosis of HF (codes 820.x, ICD9.CM) caused by traumas of low energy. Cases of bone cancer and readmissions for after-care were excluded. Characteristics of drinking water (CDW), such as aluminum, conductivity, iron, pH, manganese, arsenic, cadmium, calcium, hardness, chromium, fluoride, and selenium were obtained from the Entidade Reguladora dos Serviços de Água e Resíduos at municipality level. A Poisson generalized additive model (GAM) was used to estimate the relative risk (RR) and confidence interval (95%CI) of HF associated with changes in CDW, adjusting for spatial variation, temporal trends, socioeconomic status, rural condition and sex-age-group structure.

RESULTS:  There were 96,905 HF (77.3% women). On average, women were older than men (81.1±8.5 vs 78.1±10.1 years; p<0.001) at admission. There was a decrease in HF risk of 0.30% (95%CI 0.26-0.34), 0.25%(95%CI 0.19-0.30) and 0.83% (95%CI 0.81-0.86) per increase of 1 mg/l in calcium and magnesium and of 1 ug/l in iron, respectively, and an increased risk of 26.55% (95%CI 21.17-32.17), 0.17% (95%CI 0.14-0.20), 1.53% (95%CI 1.27-1.80) and 2.64% (95%CI 2.35-2.94) per increase of 1 mg/l in fluoride and of 1 ug/l in aluminum, chromium and selenium, respectively.

CONCLUSIONS: Calcium, magnesium and iron in drinking water seem to help in preventing HF, while fluoride, aluminum, chromium and selenium seem to be a risk with regard to HF. Our study may have implications in the recommendation guidelines for drinking water.

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