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

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.

The definition of spine bone mineral density (BMD)-classified osteoporosis and the much inflated prevalence of spine osteoporosis in older Chinese women when using the conventional cutpoint T-score of −2.5

“…The FF prevalence of older Chinese women is slightly less than half that of Caucasians ( 9 , 15 ). This is the case for hip FF, radiographic vertebral FF ( Figure 3 ) ( 16 ), clinical vertebral FF ( Figure 4 ) ( 17 , 18 ), and many other FF sites ( 9 , 15 ). Since the prevalences of vertebral FF and hip FF of older Chinese women are both slightly less than half of those of Caucasians, the clinical vertebral FF to hip FF ratio is also likely to be around 1 at the age of 70 for Chinese women (i.e., the same as for Caucasians), and this is demonstrated in Figure 4 .…”

“…The FF prevalence of older Chinese women is slightly less than half that of Caucasians (9,15). This is the case for hip FF, radiographic vertebral FF (Figure 3) (16), clinical vertebral FF (Figure 4) (17,18), and many other FF sites (9,15). Since the prevalences of vertebral FF and hip FF of older Chinese women are both slightly less than half of those of Caucasians, the clinical vertebral FF to hip FF ratio is also likely to be around 1 at the age of 70 for Chinese women (i.e., the same as for Caucasians), and this is demonstrated in Hologic device and its BMD reference; [10]: Hologic device and its BMD reference (specified for Caucasians); [11]: Lunar DPX or Norland devices and instrument BMD references; [12]: GE Lunar device with local BMD reference; [13]: Hologic device with local BMD reference; [14]: Hologic device with local BMD reference.…”

For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis

“…A fall involving a hip fracture is also associated with a larger ‘contact surface’ than a fall involving the distal forearm, and also the hip region has more soft tissues and muscles functioning as a cushion. Hayhoe et al ( 26 ) studied the proportions of hip, wrist, and clinical vertebral fractures for a UK population (n=3,678, mean age: 70.4±3.3 years) and a Hong Kong population (n=1,979, mean age: 72.4±5.0 years). In the UK cohort, hip fractures accounted for the largest proportion of fractures (56.8% in men and 52.6% in women); and wrist fractures made up the smallest proportion, particularly in men (9.1% in men and 20.7% in women).…”

A Mini Review on Osteoporosis: From Biology to Pharmacological Management of Bone Loss

“…Despite a lower BMD, total hip, spine, and wrist fracture incidence of Hong Kong Chinese was lower compared to Caucasian women in the UK. The difference was attenuated in men [ 103 ]. Thus, BMD alone may not explain the variation in fracture risk.…”