Suchergebnisse

BACKGROUND: Recently, First Nations people were shown to be at high fracture risk compared with the general population. However, factors contributing to this risk have not been examined. This analysis focusses on geographic area of residence, income level, and diabetes mellitus as possible explanatory variables since they have been implicated in the fracture rates observed in other populations. METHODS: A retrospective, population-based matched cohort study of fracture rates was performed using the Manitoba administrative health data (1987-1999). The First Nations cohort included all Registered First Nations adults (20 years or older) as indicated in either federal and/or provincial files (n=32,692). Controls (up to three for each First Nations subject) were matched by year of birth, sex and geographic area of residence. After exclusion of unmatched subjects, analysis was based upon 31,557 First Nations subjects and 79,720 controls. RESULTS: Overall and site-specific fracture rates were significantly higher in the First Nations cohort. Income quintile, geographic area of residence, and diabetes were fracture determinants but the excess fracture risk of First Nations ethnicity persisted even after adjustment for these factors. CONCLUSION: First Nations people are at high risk for fracture but the causal factors contributing to this are unclear. Further research is needed to evaluate the importance of other potential explanatory variables.

IntroductionMajor osteoporotic fractures (MOF) are associated with significant morbidity and healthcare system burden.
Objectives and ApproachWe aimed to determine whether sibling fracture history is associated with MOF risk amongst individuals from a population-based cohort using objectively-ascertained measures of fracture history. This retrospective cohort study used administrative databases from the province of Manitoba, Canada, which has a universal healthcare system. The cohort included individuals aged 40 years and older between 1997 and 2015 with linkage to at least one sibling. The exposure was MOF diagnosis occurring at age 40 years or older in a randomly selected sibling. The outcome was incident clinically-diagnosed MOF (hip, wrist, humerus or spine) identified in hospital and physician records using established case definitions. A multivariable Cox proportional hazards regression was used to test the association of sibling fracture history with the risk of MOF in individuals after adjustment for known fracture risk factors.
ResultsThe cohort included 217,519 individuals; 92% were linked to full siblings (i.e., same mother/father) and 49% were females. During a median follow-up of 11 years (IQR 5 -15), 7274 (3.3%) incident MOF cases were identified. Sibling MOF history was associated with increased risk of MOF (HR 1.71, 95% CI 1.48–1.97). The risk was elevated in both men (HR 1.63, 95% CI 1.29-2.06) and women (HR 1.78, 95% CI 1.48-2.13) but was higher among sisters (HR 2.08, 95% CI 1.65-2.61) compared to brothers (HR 1.67, 95% CI 1.20-2.32). In a secondary analysis of sibling fracture site, the highest risk was observed with diagnosis of wrist followed by spine fractures (HR 1.86, 95% CI 1.57-2.21 and HR 1.46, 95% CI 1.08-1.98, respectively).
ConclusionSibling fracture history is associated with increased MOF risk in individuals and should be considered as a candidate risk factor for improving fracture risk prediction.

•Higher standardized hip fracture rates were seen for indigenous than non-indigenous persons from Canada and Australia.•Compared to non-indigenous persons, indigenous persons had higher standardized rates of craniofacial fractures.•There may be many varied reasons for differences in fracture rates and risk according to indigenous status.•Communities, governments and professionals need to act in order to prevent trauma-related fractures in indigenous persons.•Osteoporotic fractures are mostly preventable in all populations.