Incidence and Risk Factors for Osteoporotic Non-vertebral Fracture in Low-income Community-dwelling Elderly: a Population-based Prospective Cohort Study in Brazil. The São Paulo Ageing and Health (SPAH) Study

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2020 Oct 10

PMID 33037462

Citations 5

Authors

D S Domiciano

L G Machado

C P Figueiredo

V F Caparbo

R M Oliveira

P R Menezes

R M R Pereira

Affiliations

Soon will be listed here.

Abstract

Introduction: No data on incidence of osteoporotic non-vertebral fracture have been reported in low-income countries where the population's aging has been faster. Even in developed countries, currently available prospective data on major fracture rates beyond hip are scarce. The aim of this study is to describe the incidence and risk factors for non-vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort.

Methods: Seven hundred seven older adults (449 women, 258 men) were evaluated at baseline and after a mean follow-up of 4.3 ± 0.8 years. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. New non-vertebral fracture (hip, proximal humerus, rib, forearm) was determined during the follow-up. Multivariate Poisson regression models were used to identify independent predictors of fracture.

Results: The age-standardized incidence of non-vertebral fracture was 1562.3/100,000 (1085.7-2248.1/100,000) person-years (pyr) in women and 632.8/100,000 (301.7-1327.3/100,000) in men. Concerning to hip fractures, the incidence was 421.2/100,000 (210.7-842.3/100,000) pyr in women and 89.9/100,000 (12.7-638.5/100,000) in men. In a multivariate analysis, age (RR 2.07, 95% CI 1.13-3.82, p = 0.019, each 10-year increase), prior non-vertebral fracture (RR 3.08, 95% CI 1.36-6.95, p = 0.007), and total hip BMD (RR 1.68, 95% CI 1.11-2.56, p = 0.015, each 1 SD decrease) were predictors of new non-vertebral fracture. In men, fitting a model of risk factors for fracture was prevented by the limited number of events in male sample.

Conclusion: This is the first population-based study to ascertain the incidence of major non-vertebral fractures in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, and hip BMD were predictors of the short-term incidence of fracture.

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References

Handa R, Kalla A, Maalouf G . Osteoporosis in developing countries. Best Pract Res Clin Rheumatol. 2008; 22(4):693-708. DOI: 10.1016/j.berh.2008.04.002. View

Amin S, Achenbach S, Atkinson E, Khosla S, Melton 3rd L . Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res. 2013; 29(3):581-9. PMC: 3929546. DOI: 10.1002/jbmr.2072. View

Ballane G, Cauley J, Luckey M, Fuleihan G . Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res. 2014; 29(8):1745-55. DOI: 10.1002/jbmr.2218. View

Rosengren B, Karlsson M, Petersson I, Englund M . The 21st-century landscape of adult fractures: cohort study of a complete adult regional population. J Bone Miner Res. 2014; 30(3):535-42. DOI: 10.1002/jbmr.2370. View

Roux C, Wyman A, Hooven F, Gehlbach S, Adachi J, Chapurlat R . Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). Osteoporos Int. 2012; 23(12):2863-71. PMC: 4881739. DOI: 10.1007/s00198-012-1935-8. View

Freemantle N, Cooper C, Roux C, Diez-Perez A, Guillemin F, Jonsson B . Baseline observations from the POSSIBLE EU® study: characteristics of postmenopausal women receiving bone loss medications. Arch Osteoporos. 2011; 5(1-2):61-72. PMC: 3010211. DOI: 10.1007/s11657-010-0035-7. View

Holloway K, Henry M, Brennan-Olsen S, Bucki-Smith G, Nicholson G, Korn S . Non-hip and non-vertebral fractures: the neglected fracture sites. Osteoporos Int. 2015; 27(3):905-913. DOI: 10.1007/s00198-015-3322-8. View

van Staa T, Dennison E, Leufkens H, Cooper C . Epidemiology of fractures in England and Wales. Bone. 2001; 29(6):517-22. DOI: 10.1016/s8756-3282(01)00614-7. View

Edwards M, Jameson K, Denison H, Harvey N, Aihie Sayer A, Dennison E . Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women. Bone. 2012; 52(2):541-7. PMC: 3654628. DOI: 10.1016/j.bone.2012.11.006. View

10.

Domiciano D, Machado L, Lopes J, Figueiredo C, Caparbo V, Takayama L . Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int. 2014; 25(12):2805-15. DOI: 10.1007/s00198-014-2821-3. View

11.

Nevitt M, Cummings S, Stone K, Palermo L, Black D, Bauer D . Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res. 2004; 20(1):131-40. DOI: 10.1359/JBMR.041003. View

12.

Cooper C, Atkinson E, OFallon W, Melton 3rd L . Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res. 1992; 7(2):221-7. DOI: 10.1002/jbmr.5650070214. View

13.

Ioannidis G, Flahive J, Pickard L, Papaioannou A, Chapurlat R, Saag K . Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW). Osteoporos Int. 2012; 24(1):59-67. PMC: 4878124. DOI: 10.1007/s00198-012-1968-z. View

14.

Cooper C, Cole Z, Holroyd C, Earl S, Harvey N, Dennison E . Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011; 22(5):1277-88. PMC: 3546313. DOI: 10.1007/s00198-011-1601-6. View

15.

da Rocha F, Ribeiro A . Low incidence of hip fractures in an equatorial area. Osteoporos Int. 2003; 14(6):496-9. DOI: 10.1007/s00198-003-1394-3. View

16.

Komatsu R, Ramos L, Szejnfeld V . Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging. 2004; 8(5):362-7. View

17.

Schwartz A, Kelsey J, Maggi S, Tuttleman M, Ho S, Jonsson P . International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int. 1999; 9(3):242-53. DOI: 10.1007/s001980050144. View

18.

Melton 3rd L, Thamer M, Ray N, Chan J, Chesnut 3rd C, Einhorn T . Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997; 12(1):16-23. DOI: 10.1359/jbmr.1997.12.1.16. View

19.

Seeley D, Browner W, Nevitt M, Genant H, Scott J, Cummings S . Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med. 1991; 115(11):837-42. DOI: 10.7326/0003-4819-115-11-837. View

20.

Silva D, Lazaretti-Castro M, de Freitas Zerbini C, Szejnfeld V, Eis S, Borba V . Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil. Arch Osteoporos. 2019; 14(1):47. DOI: 10.1007/s11657-019-0597-y. View