Nationwide data on municipal drinking water and hip fracture: Could calcium and magnesium be protective? A NOREPOS study

- We investigated Norwegian municipal drinking water concentrations of calcium and magnesium in relation to over 19,000 incident hip fractures nationwide.
- Magnesium was found to have an inverse association with hip fracture risk in both men and women.
- No consistent association between calcium and hip fracture risk was observed.
- A higher degree of urbanization was associated with an increase in hip fracture risk, regardless of calcium and magnesium.

Norway has a high incidence of hip fractures, and the incidence varies by degree of urbanization. This variation may reflect a difference in underlying environmental factors, perhaps variations in the concentration of calcium and magnesium in municipal drinking water. A trace metal survey (1986-1991) in 556 waterworks (supplying 64% of the Norwegian population) was linked geographically to hip fractures from hospitals throughout the country (1994-2000). In all, 5472 men and 13,604 women aged 50-85 years suffered a hip fracture. Poisson regression models were fitted, adjusting for age, urbanization degree, region of residence, type of water source, and pH. The concentrations of calcium and magnesium in drinking water were generally low. An inverse association was found between concentration of magnesium and risk of hip fracture in both genders (IRR men highest vs. lowest tertile = 0.80, 95% CI: 0.74, 0.87; IRR women highest vs. lowest tertile = 0.90, 95% CI: 0.85, 0.95), but no consistent association between calcium and hip fracture risk was observed. The highest tertile of urbanization degree (city), compared to the lowest (rural), was related to a 23 and 24% increase in hip fracture risk in men and women, respectively. The association between magnesium and hip fracture did not explain the variation in hip fracture risk between city and rural areas. Magnesium in drinking water may have a protective role against hip fractures; however this association should be further investigated.