Fracture incidence and secular trends between 1989 and 2013 in a population based cohort: The Rotterdam Study

• Published in: Bone (New York, N.Y.) N.Y.), 2018-09, Vol.114, p.116-124
• Main Authors: Trajanoska, Katerina, Schoufour, Josje D., de Jonge, Ester A.L., Kieboom, Brenda C.T., Mulder, Marlies, Stricker, Bruno H., Voortman, Trudy, Uitterlinden, Andre G., Oei, Edwin H.G., Ikram, M. Arfan, Zillikens, M. Carola, Rivadeneira, Fernando, Oei, Ling
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon - trends; Aged; Bone Density - physiology; Bone mineral density; Cohort Studies; Dual-energy X-ray absorptiometry; Female; Follow-Up Studies; Fracture; Fractures, Bone - diagnostic imaging; Fractures, Bone - epidemiology; Humans; Incidence; Male; Middle Aged; Netherlands - epidemiology; Osteoporosis; Population Surveillance - methods; Prospective Studies; Risk Factors; Trends
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2018.06.004

Fracture incidence needs to be evaluated over time to assess the impact of the enlarging population burden of fractures (due to increase in lifespan) and the efficacy of fracture prevention strategies. Therefore, we aimed to evaluate the association of femoral neck bone mineral density (FN-BMD) measured using dual-energy X-ray absorptiometry (DXA) at baseline with fracture risk over a long follow-up time period. Incident non-vertebral fractures were assessed in 14,613 individuals participating in the Rotterdam Study with up to 20 years of follow-up. During a mean follow-up of 10.7 ± 6.2 years, 2971 (20.3%) participants had at least one incident non-vertebral fracture. The risk for any non-vertebral fracture was 1.37 (95% Confidence Interval (CI): 1.25–1.49) and 1.42 (95%CI: 1.35–1.50) for men and women, respectively. The majority (79% in men and 75% in women) of all fractures occurred among participants a normal or osteopenic T-score. The incidence rates per 1000 person-years for the most common fractures were 5.3 [95%CI: 5.0–5.7] for hip, 4.9 [95%CI: 4.6–5.3] for wrist and 2.3 [95%CI: 2.0–2.5] for humerus. To examine the predictive ability of BMD through follow-up time we determined fracture hazard ratios (HR) per standard deviation decrease in femoral neck BMD across five year bins. No differences were observed, with a HR of 2.5 (95%CI: 2.0–3.1) after the first 5 years, and of 1.9 (95%CI: 1.1–3.3) after 20 years. To assess secular trends in fracture incidence at all skeletal sites we compared participants at an age of 70–80 years across two time periods: 1989–2001 (n = 2481, 60% women) and 2001–2013 (n = 2936, 58% women) and found no statistically significant difference (p