OpenLB
Open Library of Bioscience
Advanced Search
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Jul, 2021;32 (7): 1343-1350.

Osteoporotic fractures in second-generation immigrants and Swedish natives.

P Wändell, X Li, A C Carlsson, J Sundquist, K Sundquist
Author Information
  1. P Wändell: Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden. per.wandell@ki.se.
  2. X Li: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
  3. A C Carlsson: Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden.
  4. J Sundquist: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
  5. K Sundquist: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
PMID: 33469689 DOI: 10.1007/s00198-020-05776-4

Abstract

In this national study of osteoporotic fractures in second-generation immigrants in Sweden, we found a similar risk of osteoporotic fractures in general compared to Swedish natives, which suggests that environmental factors are important for the high risk of osteoporotic fractures in Nordic countries.
INTRODUCTION: Second generation immigrants may have a similar environment as individuals with two native-born parents. These individuals may be of interest to study concerning whether environmental or hereditary factors could be mostly associated to the risk of osteoporotic fractures. The aim of this study was to analyse the risk of osteoporotic fractures in second-generation immigrants compared to Swedish natives.
METHODS: This was a nationwide study of individuals aged 50 years of age and older (N = 1,377,035; 691,750 men and 685,285 women). 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 95% confidence intervals (CI)) of incident osteoporotic fractures in second generation immigrants compared to Swedish natives. The Cox regression models were adjusted for age, comorbidities and for sociodemographic status.
RESULTS: A total of 114,505 osteoporotic fractures were registered, 109,622 (8.4%) were among individuals with Swedish-born parents and 4883 (7.5%) among those with foreign-born parents, with distal forearm fractures dominating in general (44.9%). Fully adjusted HRs (95% CI) were for all immigrants 0.95 (95% CI, 0.91-0.99), for men 0.96 (95% CI, 0.89-1.04) and for women 0.95 (95% CI, 0.90-1.00).
CONCLUSIONS: We observed a similar risk of osteoporotic fractures among second-generation immigrants as in Swedish natives, which suggests that environmental factors are important for osteoporotic fractures.

Keywords

Forearm fractures Hip fractures Humerus fractures Immigrants Neighbourhood Osteoporotic fractures Sex Socioeconomic status Vertebral fractures

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733 [DOI: 10.1007/s00198-006-0172-4]
  2. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136 [DOI: 10.1007/s11657-013-0136-1]
  3. Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10:338–351 [DOI: 10.1038/nrendo.2014.51]
  4. Wang XF, Seeman E (2012) Epidemiology and structural basis of racial differences in fragility fractures in Chinese and Caucasians. Osteoporos Int 23:411–422 [DOI: 10.1007/s00198-011-1739-2]
  5. Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA (2008) Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporos Int 19:781–786 [DOI: 10.1007/s00198-007-0499-5]
  6. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, Epidemiology IOFWGo, Quality of L (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256 [DOI: 10.1007/s00198-012-1964-3]
  7. Ross PD, Huang C (2000) Hip fracture incidence among Caucasians in Hawaii is similar to Japanese A population-based study. Aging (Milano) 12:356–359
  8. Statistics Sweden (2016) Foreign-born persons in Sweden by country of birth, age and sex. Year 2000 - 2015. Statistics Sweden,
  9. Wandell PE (2013) Population groups in dietary transition. Food Nutr Res 57:21668 [DOI: 10.3402/fnr.v57i0.21668]
  10. Wandell PE, Carlsson A, Steiner KH (2010) Prevalence of diabetes among immigrants in the Nordic countries. Curr Diabetes Rev 6:126–133 [DOI: 10.2174/157339910790909404]
  11. Albin B, Hjelm K, Elmstahl S (2010) Lower prevalence of hip fractures in foreign-born individuals than in Swedish-born individuals during the period 1987-1999. BMC Musculoskelet Disord 11:203 [DOI: 10.1186/1471-2474-11-203]
  12. Johansson H, Oden A, Lorentzon M, McCloskey E, Kanis JA, Harvey NC, Karlsson MK, Mellstrom D (2015) Is the Swedish FRAX model appropriate for Swedish immigrants? Osteoporos Int 26:2617–2622 [DOI: 10.1007/s00198-015-3180-4]
  13. Wandell P, Li X, Carlsson AC, Sundquist J, Sundquist K (2020) Distal forearm fractures in immigrant groups: a national Swedish study. Bone 138:115508 [DOI: 10.1016/j.bone.2020.115508]
  14. Wandell P, Li X, Carlsson AC, Sundquist J, Sundquist K (2020) Osteoporotic fractures among foreign-born individuals: a national Swedish study. Osteoporos Int. https://doi.org/10.1007/s00198-020-05597-5
  15. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674 [DOI: 10.1007/s001980070064]
  16. Sandhu SK, Hampson G (2011) The pathogenesis, diagnosis, investigation and management of osteoporosis. J Clin Pathol 64:1042–1050 [DOI: 10.1136/jcp.2010.077842]
  17. McCloskey EV, Harvey NC, Johansson H, Kanis JA (2016) FRAX updates 2016. Curr Opin Rheumatol 28:433–441 [DOI: 10.1097/BOR.0000000000000304]
  18. Stoen RO, Nordsletten L, Meyer HE, Frihagen JF, Falch JA, Lofthus CM (2012) Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. Osteoporos Int 23:2527–2534 [DOI: 10.1007/s00198-011-1888-3]
  19. Gutierrez OM, Farwell WR, Kermah D, Taylor EN (2011) Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int 22:1745–1753 [DOI: 10.1007/s00198-010-1383-2]
  20. Redmond J, Jarjou LM, Zhou B, Prentice A, Schoenmakers I (2014) Ethnic differences in calcium, phosphate and bone metabolism. Proc Nutr Soc 73:340–351 [DOI: 10.1017/S0029665114000068]
  21. Tiruneh A, Siman-Tov M, Radomislensky I, Itg PK (2017) Characteristics and circumstances of injuries vary with ethnicity of different population groups living in the same country. Ethn Health 22:49–64 [DOI: 10.1080/13557858.2016.1196647]
  22. Lips P (2007) Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol 103:620–625 [DOI: 10.1016/j.jsbmb.2006.12.076]
  23. Lips P (2010) Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol 121:297–300 [DOI: 10.1016/j.jsbmb.2010.02.021]
  24. Carlsson AC, Johansson SE, Theobald H, Wandell PE (2013) Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up. Blood Press Monit 18:72–77 [DOI: 10.1097/MBP.0b013e32835ea233]
  25. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450 [DOI: 10.1186/1471-2458-11-450]

Grants

  1. 2014-02517/Vetenskapsrådet
  2. 2016-01176/Vetenskapsrådet

MeSH Term

Emigrants and Immigrants
Female
Humans
Incidence
Male
Osteoporotic Fractures
Population Groups
Risk Factors
Sweden
Journal Article
Article has an altmetric score of 4

Word Cloud

Created with Highcharts 10.0.0fracturesosteoporoticimmigrantsrisk0Swedishnatives95%CIstudysecond-generationindividualssimilarcomparedenvironmentalfactorsparentsOsteoporoticamonggeneralsuggestsimportantgenerationmayage1menwomenregisteredforearmCoxregressionadjustedstatus95nationalSwedenfoundhighNordiccountriesINTRODUCTION:Secondenvironmenttwonative-borninterestconcerningwhetherhereditarymostlyassociatedaimanalyseMETHODS:nationwideaged50yearsolderN=377035691750685285definedleastonediagnosishiphumerusvertebraeNationalPatientRegisterJanuary1998December312012analysisusedestimaterelativehazardratiosHRconfidenceintervalsincidentsecondmodelscomorbiditiessociodemographicRESULTS:total11450510962284%Swedish-born488375%foreign-borndistaldominating449%FullyHRs91-0999689-10490-100CONCLUSIONS:observedForearmHipHumerusImmigrantsNeighbourhoodSexSocioeconomicVertebral

Similar Articles

Cited By