title: Comparison of fracture rates between indigenous and non-indigenous populations: a systematic review protocol.
abstract: Over recent years, there has been concerted effort to 'close the gap' in the disproportionately reduced life expectancy and increased morbidity experienced by indigenous compared to non-indigenous persons. Specific to musculoskeletal health, some data suggest that indigenous peoples have a higher risk of sustaining a fracture compared to non-indigenous peoples. This creates an imperative to identify factors that could explain differences in fracture rates. This protocol presents our aim to conduct a systematic review, first, to determine whether differences in fracture rates exist for indigenous versus non-indigenous persons and, second, to identify any risk factors that might explain these differences.
  
  
  
  We will conduct a systematic search of PubMed, OVID, MEDLINE, CINAHL and EMBASE to identify articles that compare all-cause fracture rates at any skeletal site between indigenous and non-indigenous persons of any age. Eligibility of studies will be determined by 2 independent reviewers. Studies will be assessed for methodological quality using a previously published process. We will conduct a meta-analysis and use established statistical methods to identify and control for heterogeneity where appropriate. Should heterogeneity prevents numerical syntheses, we will undertake a best-evidence analysis to determine the level of evidence for differences in fracture between indigenous and non-indigenous persons.
  
  
  
  This systematic review will use published data; thus, ethical permissions are not required. In addition to peer-reviewed publication, findings will be presented at (inter)national conferences, disseminated electronically and in print, and will be made available to key country-specific decision-makers with authority for indigenous health.
authors: Deakin University, Geelong, Victoria, Australia Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia Australian Institute for Musculoskeletal Science, The University of Melbourne, St Albans, Victoria, Australia.
authors: Sharon L
authors: SL
authors: Brennan-Olsen
authors: Deakin University, Geelong, Victoria, Australia.
authors: Shae E
authors: SE
authors: Quirk
authors: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: William D
authors: WD
authors: Leslie
authors: Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, Queensland, Australia.
authors: Maree
authors: M
authors: Toombs
authors: Deakin University, Geelong, Victoria, Australia.
authors: Kara L
authors: KL
authors: Holloway
authors: Deakin University, Geelong, Victoria, Australia.
authors: Sarah M
authors: SM
authors: Hosking
authors: Deakin University, Geelong, Victoria, Australia.
authors: Julie A
authors: JA
authors: Pasco
authors: Deakin University, Geelong, Victoria, Australia.
authors: Brianna J
authors: BJ
authors: Doolan
authors: Deakin University, Geelong, Victoria, Australia.
authors: Richard S
authors: RS
authors: Page
authors: Deakin University, Geelong, Victoria, Australia.
authors: Lana J
authors: LJ
authors: Williams
mesh_terms: D055317:Evidence-Based Practice; D050723:Fractures, Bone / Q000208:ethnology*; D006801:Humans; D044382:Population Groups / Q000706:statistics & numerical data*; D012107:Research Design; D012307:Risk Factors; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
keywords: Indigenous; Musculoskeletal; fracture