title: When, where and how osteoporosis-associated fractures occur: an analysis from the Global Longitudinal Study of Osteoporosis in Women (GLOW).
abstract: OBJECTIVE
  To examine when, where and how fractures occur in postmenopausal women.
  
  
  METHODS
  We analyzed data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), including women aged ≥55 years from the United States of America, Canada, Australia and seven European countries. Women completed questionnaires including fracture data at baseline and years 1, 2 and 3.
  
  
  RESULTS
  Among 60,393 postmenopausal women, 4122 incident fractures were reported (86% non-hip, non-vertebral [NHNV], 8% presumably clinical vertebral and 6% hip). Hip fractures were more likely to occur in spring, with little seasonal variation for NHNV or spine fractures. Hip fractures occurred equally inside or outside the home, whereas 65% of NHNV fractures occurred outside and 61% of vertebral fractures occurred inside the home. Falls preceded 68-86% of NHNV and 68-83% of hip fractures among women aged ≤64 to ≥85 years, increasing with age. About 45% of vertebral fractures were associated with falls in all age groups except those ≥85 years, when only 24% occurred after falling.
  
  
  CONCLUSIONS
  In this multi-national cohort, fractures occurred throughout the year, with only hip fracture having a seasonal variation, with a higher proportion in spring. Hip fractures occurred equally within and outside the home, spine fractures more often in the home, and NHNV fractures outside the home. Falls were a proximate cause of most hip and NHNV fractures. Postmenopausal women at risk for fracture need counseling about reducing potentially modifiable fracture risk factors, particularly falls both inside and outside the home and during all seasons of the year.
authors.affiliation: Department of Medicine, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, United States of America ; Department of Medicine, Division of Endocrinology, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Aline G
authors.initials: AG
authors.lastname: Costa
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Allison
authors.initials: A
authors.lastname: Wyman
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, United States of America.
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Siris
authors.affiliation: Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio, United States of America.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.affiliation: Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: Stuart
authors.initials: S
authors.lastname: Silverman
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.affiliation: Paris Descartes University, Cochin Hospital, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.affiliation: Rheumatology Section, Department of Medicine, University of Verona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.affiliation: Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfeilschifter
authors.affiliation: Helen Hayes Hospital and Columbia University, West Haverstraw, New York, United States of America.
authors.forename: Jeri W
authors.initials: JW
authors.lastname: Nieves
authors.affiliation: Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J Coen
authors.initials: JC
authors.lastname: Netelenbos
authors.affiliation: University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, Australia.
authors.forename: Lyn
authors.initials: L
authors.lastname: March
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Hooven
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gehlbach
authors.affiliation: Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain ; RETICEF, ISCIII Madrid; Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Díez-Pérez
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Juliet E
authors.initials: JE
authors.lastname: Compston
authors.affiliation: Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Chapurlat
authors.affiliation: Universiteit Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.affiliation: St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: Rheumatology Section, Department of Medicine, University of Verona, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012621:Seasons