Reduced Incidence of Hip Fracture in the Old Order Amish

Elizabeth A. Streeten, Daniel J. McBride, Amy L. Lodge, Toni I. Pollin, David G. Stinchcomb, Richa Agarwala, Alejandro A. Schäffer, Jay R. Shapiro, Alan R. Shuldiner, Braxton D. Mitchell

Research output: Contribution to journalArticlepeer-review


The incidence of hip fracture was estimated in a community of Old Order Amish and compared with available data from non-Amish whites. Hip fracture rates were 40% lower in the Amish, and the Amish also experienced higher BMD. Introduction: Understanding the patterns of fracture risk across populations could reveal insights about bone health and lead to the earlier detection and prevention of osteoporosis. Toward this aim, we compared hip fracture incidence and bone mineral density (BMD) between an Old Order Amish (OOA) community, characterized by a rural and relatively active lifestyle, and non-Amish U.S. whites. Materials and Methods: All hospital admissions for hip fracture among OOA individuals in Lancaster County, PA, were identified between 1995 and 1998 from four area hospitals. Hip fracture incidence was calculated by cross-referencing an available Anabaptist genealogy database with communities located within these hospital service areas and compared with non-Amish whites obtained from National Hospital Discharge data. Additionally, BMD at the hip was compared between 287 Amish subjects and non-Amish whites from the National Health and Nutrition Examination Survey III survey. Results and Conclusions: OOA experienced 42% fewer hip fractures than would be expected had they experienced the same rate of hip fracture as observed in non-Amish whites (p < 0.01) and a higher mean BMD that was significant in women (p < 0.05) but not men. Further evaluation of lifestyle and/or genetic differences between Amish and non-Amish populations may shed insights into etiologic factors influencing hip fracture risk.

Original languageEnglish (US)
Pages (from-to)308-313
Number of pages6
JournalJournal of Bone and Mineral Research
Issue number2
StatePublished - Feb 2004


  • Amish
  • Bone mineral density
  • Geographic information systems
  • Hip fracture
  • Osteoporosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

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