Fracture Incidence and the Relevance of Dietary and Lifestyle Factors Differ in the United Kingdom and Hong Kong: An International Comparison of Longitudinal Cohort Study Data

Richard P G Hayhoe,Ailsa A Welch,Amy Jennings,Kay-Tee Khaw,Jason Leung,Jane Skinner,Jean Woo,Ruth Chan

doi:10.1007/s00223-021-00870-z

Abstract

Geographic variation in fracture risk may be due to divergent profiles of dietary, lifestyle, and other risk factors between populations. We investigated differences in fracture rates between two older-population cohorts: the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk cohort (n = 7732) in the United Kingdom (UK), and the Mr and Ms Os cohort (n = 3956) in Hong Kong (HK). Data were collected by questionnaires, laboratory assessments, and hospital records. Incidence of hip, spine, and wrist fractures in the two cohorts was calculated and multivariable regression was used to explore variables important to fracture risk. Total hip, spine, and wrist fracture incidence was higher in the UK vs HK for women (13.70 vs 8.76 per 1000 person-years; p < 0.001), but not men (5.95 vs 5.37 per 1000 person-years; p = 0.337), and the proportions of different fractures also varied between cohorts (p < 0.001). Hip fracture was the most common UK fracture (accounting for 56.8% fractures in men and 52.6% in women), while wrist fracture was most common in HK (42.9% in men and 57.9% in women). The major contributor to total fracture risk in multivariable regression models of both cohorts and sexes, was age; with BMI also an important contributor to fracture risk HK men and UK women. The distribution of factors relevant to fracture risk, and the rates of different fractures, varied significantly between UK and HK cohorts. However, the importance of each factor in contributing to fracture risk was similar between the cohorts. The differences in fracture rates suggest targeted approaches may be required when developing interventions and public health recommendations to reduce the burden of osteoporosis in these two countries.

Highlights

Worldwide there are estimated to be nearly 9 million osteoporotic fractures annually, creating an enormous health care burden and representing a leading cause of disability [1]
Significant differences between the United Kingdom (UK) and Hong Kong (HK) cohorts were seen for all variables tested for both men and women, except for fruit consumption in women (p = 0.062, n = 6031)
A limited number of the variables chosen a priori to be included in our analyses proved to be significantly associated with fracture risk in either the UK or HK cohorts

Summary

Introduction

Worldwide there are estimated to be nearly 9 million osteoporotic fractures annually, creating an enormous health care burden and representing a leading cause of disability [1]. The public health importance of the issue is made starkly apparent by the International Osteoporosis Foundation estimate that 1 in 3 women and 1 in 5 men over the age of 50 years will experience osteoporotic fractures [2]. Differences in skeletal size and structure, bone microarchitecture, peak bone mineral density, and rate of bone loss during ageing, may all contribute to variation in fracture rates in different regions of the world [4]. This is noticeable in comparisons between African Americans or New Zealand Maoris who have higher BMD and lower hip fracture rates than age-matched Caucasians [5]

Results

Discussion

Conclusion