title: Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study - comparing site and age-specific risks in women and men.
abstract: BACKGROUND
  Population-based incident fracture data aid fracture prevention and therapy decisions. Our purpose was to describe 10-year site-specific cumulative fracture incidence by sex, age at baseline, and degree of trauma with/without consideration of competing mortality in the Canadian Multicentre Osteoporosis Study adult cohort.
  
  
  METHODS
  Incident fractures and mortality were identified by annual postal questionnaires to the participant or proxy respondent. Date, site and circumstance of fracture were gathered from structured interviews and medical records. Fracture analyses were stratified by sex and age at baseline and used both Kaplan-Meier and competing mortality methods.
  
  
  RESULTS
  The baseline (1995-97) cohort included 6314 women and 2789 men (aged 25-84 years; mean±SD 62±12 and 59±14, respectively), with 4322 (68%) women and 1732 (62%) men followed to year-10. At least one incident fracture occurred for 930 women (14%) and 247 men (9%). Competing mortality exceeded fracture risk for men aged 65+years at baseline. Age was a strong predictor of incident fractures especially fragility fractures, with higher age gradients for women vs. men. Major osteoporotic fracture (MOF) (hip, clinical spine, forearm, humerus) accounted for 41-74% of fracture risk by sex/age strata; in women all MOF sites showed age-related increases but in men only hip was clearly age-related. The most common fractures were the forearm for women and the ribs for men. Hip fracture incidence was the highest for the 75-84 year baseline age-group with no significant difference between women 7.0% (95% CI 5.3, 8.9) and men 7.0% (95% CI 4.4, 10.3).
  
  
  CONCLUSIONS
  There are sex differences in the predominant sites and age-gradients of fracture. In older men, competing mortality exceeds cumulative fracture risk.
authors.affiliation: University of British Columbia, Vancouver, Canada. Electronic address: jerilynn.prior@ubc.ca.
authors.forename: Jerilynn C
authors.initials: JC
authors.lastname: Prior
authors.affiliation: CaMos National Coordinating Centre, McGill University, Montreal, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Langsetmo
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lentle
authors.affiliation: CaMos National Coordinating Centre, McGill University, Montreal, Canada.
authors.forename: Claudie
authors.initials: C
authors.lastname: Berger
authors.affiliation: McGill University, Montreal, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.affiliation: Memorial University, St John's, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: Dalhousie University, Halifax, Canada.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Kaiser
authors.affiliation: McMaster University, Hamilton, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: McMaster University, Hamilton, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.affiliation: Queen's University, Kingston, Canada.
authors.forename: Tassos
authors.initials: T
authors.lastname: Anastassiades
authors.affiliation: Queen's University, Kingston, Canada.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Towheed
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: Laval University, Quebec City, Canada.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
authors.affiliation: University of Manitoba, Winnipeg, Canada.
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kreiger
mesh_terms: D000328:Adult; D000367:Age Factors; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology; D002170:Canada / Q000453:epidemiology; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012307:Risk Factors; D014944:World Health Organization
keywords: 10-year fracture incidence; Clinical vertebral fracture; Fracture prediction; Hip fracture; Population-based; Sex