There were around 1.6m hip fractures in the US and EU in 2010.

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In one of Novartis' biggest studies of the drug, it reduced hip fractures by 35% and the risk of death by 28%.

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In osteoporosis the RANK ligand protein is all too effective in producing the breakdown effect, resulting in debilitating hip fractures in postmenopausal women and others.

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Studies show that elderly people taking tricyclics are at increased risk of hip fractures from falling, which in turn is associated with an increased risk of dying.

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But to add to the risk-list associated with the habit, this week's British Medical Journal found that cigarette smoking accounts for one in eight hip fractures in women.

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There was no difference in the chance of hip fractures for those people looked at in the study regardless of how long they had been exposed to higher fluoride levels.

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This finding suggests that hip fractures might arise from a mismatch between the genetic drive for bone growth and the environmental influences which affect the mineralisation of bones during childhood.

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Osteoporosis, which is responsible for more than two million fractures year, affects nearly 10 million people in the US (8 million women, 2 million men) Hip fractures are often the most serious concern of those with osteoporosis.

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And there is no direct evidence that Fosamax prevents hip or wrist fractures in this broader group.

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