Osteoporotic fractures among foreign-born individuals:​ a national Swedish study

Wändell, P.<sup>1</sup>; Li, X.<sup>2</sup>; Carlsson, A. C.<sup>1,3</sup>; Sundquist, J.<sup>2,4,5</sup>; Sundquist, K.<sup>2,4,5</sup>

Affiliations

¹Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83 Huddinge, Sweden

²Center for Primary Health Care Research, Lund University, Malmö, Sweden

³Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden

⁴Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

⁵Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan

Abstract and keywords

Summary: In this national study of osteoporotic fractures in foreign-born individuals, we found a lower risk of osteoporotic fractures in general among foreign-born individuals compared with Swedish-born, especially in immigrants from southern Europe. A higher risk was found among some groups, i.e. men and women from Bosnia and Iraq and men from Lebanon.

Introduction: The aim of this study was to analyse risk of osteoporotic fractures in foreign-born individuals compared with Swedish-born individuals.

Methods: This was a nationwide study of individuals 50 years of age and older (N = 2,775,736). Osteoporotic fractures were defined as at least one registered diagnosis of fractures in the hip, humerus, forearm or vertebrae, in the National Patient Register between January 1, 1998, and December 31, 2012. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 99% confidence intervals (CI)) of incident osteoporotic fractures in foreign-born compared with Swedish-born individuals. The Cox regression models were stratified by sex and adjusted for age, comorbidities and sociodemographic status.

Results: A total of 362,899 osteoporotic fractures were registered (96,847 among men and 266,052 among women), with hip fractures dominating (54.0% among men, 42.6% among women). Fully adjusted HRs (99% CI) were for all immigrant men 0.75 (99% CI, 0.73–0.78) and women 0.83 (99% CI, 0.81–0.84), with significantly lower HRs among most groups but with higher HRs in certain countries. For the specific fractures, higher HRs were found for lower forearm fractures for men from Asia and for vertebral fractures among women from Asia.

Conclusions: We observed a generally lower risk of osteoporotic fractures among first-generation immigrants, with few exceptions.

Keywords: Forearm fractures; Gender; Hip fractures; Humerus fractures; Immigrants; Neighbourhood; Osteoporotic fractures; Socioeconomic status; Vertebral fractures

Links

DOI: 10.1007/s00198-020-05597-5

PubMed: 32814995

WoS: 000561972200001

History

Received: 2020-04-23

Accepted: 2020-08-10

Online: 2020-08-19

Cited Works (5)

Year	Entry
2020	Wändell P, Li X, Carlsson AC, Sundquist J, Sundquist K. Distal forearm fractures in immigrant groups: a national Swedish study. Bone. September 2020;138:115508.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
2002	Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SAA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative Randomized Controlled Trial. JAMA. July 17, 2002;288(3):321-333.
2017	Ballane G, Cauley JA, Luckey MM, Fuleihan GE-H. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. May 2017;28(5):1531-1542.
2006	Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. December 2006;17(12):1726-1733.