[Show abstract][Hide abstract] ABSTRACT: The relationship between osteoarthritis (OA) and osteoporosis remains controversial. This study was designed to determine the association between hip and knee radiographic OA and change in total hip bone mineral density (BMD) over 2.6 years. A total of 867 population-based randomly selected subjects (mean age 62 years, range 51 to 80 years, and 49% female) were included. Hip and knee joint space narrowing (JSN, 0 to 3) and osteophytes (0 to 3) in both lower limbs was assessed using Altman's atlas. Total hip BMD was measured by dual-energy X-ray absorptiometry (DXA). We found that radiographic OA (score of JSN or osteophytes > 0) was common in this sample (hip 45%, knee 68%). In multivariable analyses, percentage change in total hip BMD per year was predicted by right and left hip axial JSN (beta = -0.25% and -0.29% per grade, respectively, both p < .05), right hip superior femoral osteophytes (grades 2 and 3 versus 0: beta = -1.60, p < .05), combined right and left knee tibiofemoral JSN (beta = -0.06 per grade from grades 0 to 12, p < .05), and osteophytes (beta = -0.06 per grade from grades 0 to 14, p < .05) independent of each other and joint pain. In conclusion, older subjects with radiographic hip and knee OA have higher total hip bone loss over 2.6 years regardless of symptoms, suggesting that consideration should be given to the monitoring of bone mass in these subjects.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 10/2009; 25(4):858-65. · 6.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the association between osteoporotic fractures and prior non-melanoma skin cancer (NMSC, a biomarker for cumulative sun exposure). The risk of prior NMSC in our fracture cohort was significantly reduced (standardised incidence ratio 0.69, 95% CI 0.61, 0.78). Adequate lifetime sun exposure may be necessary to protect against osteoporotic fractures in later life.
The relationship between cumulative sun exposure and osteoporotic fractures is uncertain. We aimed to study the association between non-melanoma skin cancer (NMSC), a marker of cumulative sun exposure, and osteoporotic fractures in an older cohort.
A retrospective cohort study in southern Tasmania in people aged at least 50 years with incident radiographic fracture (n = 2,283) was carried out. By record linkage to the Tasmanian Cancer Registry the cohort was followed backwards through time until the occurrence of NMSC or end-of follow-up. Relative risk was estimated by the standardised incidence ratio (SIR) using sex-, age- and calendar year-specific cancer incidence rates in southern Tasmania as reference.
The incidence of prior NMSC in the fracture cohort was 31% lower than for the general population (SIR 0.69, 95% CI 0.61, 0.78). This effect was significant for most fracture subtypes except pelvic and wrist fractures and observed for both NMSC subtypes, squamous cell carcinoma and basal cell carcinoma.
Older people with osteoporotic fractures may have had lifestyles linked to lower cumulative sunlight exposure. Achieving a balance between adequate lifetime sun exposure and protection against its adverse effects (such as fractures and skin cancer) may require assessment of individual risks.
Osteoporosis International 06/2007; 18(5):687-92. · 4.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the association between knee and hip radiographic osteoarthritis (ROA), a measure of knee pain, stiffness and functional ability and objectively measured physiological falls risk predictors.
Cross-sectional, population-based study of 850 randomly selected men and women aged 50-80 years (mean 62.5, SD 7.4). Falls risk (Z score) was determined objectively with the short form Physiological Profile Assessment (PPA). Two observers assessed knee and hip ROA using the Altman atlas. Pain, stiffness and functional ability were assessed using the Western Ontario McMasters Osteoarthritis index (WOMAC).
Overall, the study population was at a mild risk of falling. In multivariable analysis, the WOMAC function and pain score were significantly associated with reaction time, balance, proprioception, knee extension strength, and edge contrast sensitivity. Stiffness was associated with knee extension strength and edge contrast sensitivity. Males had a dose response association between the global WOMAC score and falls risk (r=0.17, P<0.001). Those who reported a global WOMAC score of 50 and above had a higher risk of falling compared to those with a score below 50 (Z score: 0.53 vs 0.14, P<0.001). Hip joint space narrowing (JSN) was significantly associated with knee extension strength (r=-0.10, P=0.003), however, no other significant associations were observed between ROA and falls risk predictors.
Self-reported functional ability and pain, and to a lesser extent, stiffness (but not knee and hip ROA), have a modest but independent association with physiological predictors of falls risk.
Osteoarthritis and Cartilage 06/2006; 14(6):533-9. · 4.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the association between chondral defects, bone marrow lesions, knee and hip radiographic osteoarthritis (OA), and knee pain.
Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index. T1- and T2-weighted fat saturation magnetic resonance imaging was performed on the right knee to assess chondral defects and subchondral bone marrow lesions. Radiography was performed on the right knee and hip and scored for radiographic OA. Body mass index (BMI) and knee extension strength were measured.
A total of 500 randomly selected men and women participated. The prevalence of knee pain was 48%. In multivariable analysis, prevalent knee pain was significantly associated with medial tibial chondral defects (odds ratio [OR] 2.32, 95% confidence interval [95% CI] 1.02-5.28 for grade 3 versus grade 2 or less; OR 4.93, 95% CI 1.07-22.7 for grade 4 versus grade 2 or less), bone marrow lesions (OR 1.44, 95% CI 1.04-2.00 per compartment), and hip joint space narrowing (OR 1.36, 95% CI 1.07-1.73 per unit), as well as greater BMI and lower knee extension strength. It was not significantly associated with radiographic knee OA. These variables were also associated with more severe knee pain. In addition, there was a dose response association between knee pain and number of sites having grade 3 or 4 chondral defects (OR 1.39, 95% CI 1.12-1.73 per site), with all subjects having knee pain if all compartments of the knee had these defects.
Knee pain in older adults is independently associated with both full and non-full-thickness medial tibial chondral defects, bone marrow lesions, greater BMI, and lower knee extension strength, but is not associated with radiographic knee OA. The association between radiographic hip OA and knee pain indicates that referred pain from the hip needs to be considered in unexplained knee pain.
[Show abstract][Hide abstract] ABSTRACT: Knee cartilage defects may play an important role in early osteoarthritis, but little is known about their natural history.
Knee cartilage defect score (range, 0-4), cartilage volume, and bone surface area were determined using T1-weighted fat-saturated magnetic resonance imaging in 325 subjects (mean age, 45 years) at baseline and 2 years later.
Thirty-three percent of the subjects had a worsening (>or=1-point increase) and 37% of the subjects had an improvement (>or=1-point decrease) in cartilage defect score in any knee compartment during 2.3 years. A worsening in cartilage defect score was significantly associated with female sex (odds ratio [OR], 3.09 and 3.64 in the medial and lateral tibiofemoral compartments) and baseline factors, including age (OR, 1.05 per year in the medial tibiofemoral compartment), body mass index (OR, 1.08 in the lateral tibiofemoral compartment), tibiofemoral osteophytes (OR, 6.22 and 6.04 per grade), tibial bone area (OR, 1.24 and 2.07 per square centimeter), and cartilage volume (OR, 2.91 and 1.71 per milliliter in the medial tibiofemoral and patellar compartments). An improvement in cartilage defect score had similar but reversed associations with these factors (except for sex), including a decrease in body mass index (OR, 1.23 in the medial tibiofemoral compartment).
Knee cartilage defects are variable, and changes are associated with female sex, age, and body mass index. Increases are associated with baseline cartilage volume, bone size, and osteophytes, suggesting a role for these in the pathogenesis of cartilage defects. Interventions such as weight loss may improve knee cartilage defects.
Archives of Internal Medicine 03/2006; 166(6):651-8. · 13.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the differences in knee cartilage defects between offspring of subjects with at least one parent with a total knee replacement for severe primary knee osteoarthritis (OA) and controls; and to estimate the heritability of knee cartilage defects in sib-pairs.
Population based, case-control study of 186 matched pairs (mean age 45 yrs, range 26-61) and sib-pair study of 128 subjects from 51 families (115 sib-pairs) within the case-control study. Knee cartilage defect scores (0-4) and prevalence (a cartilage defect score > or = 2) were assessed at the patellar, tibial, and femoral sites by processing images acquired using T1 weighted fat-saturated magnetic resonance imaging. Heritability was estimated using the SOLAR genetic analysis program.
The prevalence of knee cartilage defects was surprisingly high (50% scored > or = 2 in any site). Compared to controls, offspring had higher knee cartilage defect scores and prevalence in tibiofemoral (4.39 vs 4.01, p = 0.003; 41% vs 28%, p = 0.009), patellar (1.32 vs 1.10, p = 0.031; 35% vs 26%, p = 0.075), and whole (5.71 vs 5.10, p = 0.002; 57% vs 42%, p = 0.007) compartments. These all became nonsignificant after adjustment for knee pain and radiographic OA. In the sib-pair component, knee cartilage defects had heritability for scores and prevalence, respectively, of 38% (p = 0.072) and 47% (p = 0.082) for tibiofemoral, 52% (p = 0.009) and 78% (p = 0.025) for patellar, and 43% (p = 0.038) and 68% (p = 0.072) for the whole compartments. These estimates became weaker at tibiofemoral and whole compartments after adjustment for bone size, knee pain, and radiographic OA.
Knee cartilage defects are common, have a genetic component that is linked to the genetic contribution to knee pain and bone size, and may have a role in the genetic pathogenesis of knee OA.
The Journal of Rheumatology 10/2005; 32(10):1937-42. · 3.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare associations between anthropometric and lifestyle factors and femoral head cartilage volume/thickness and radiographic features of osteoarthritis (OA) and to provide evidence of construct validity for magnetic resonance imaging (MRI) assessment of femoral cartilage volume and thickness.
We studied a cross-sectional sample of 151 randomly selected subjects (79 men, 72 women; mean age 63 years) from the Tasmanian Older Adult Cohort Study. A sagittal T1-weighted fat-suppression MRI scan of the right hip was performed to determine femoral head cartilage volume, cartilage thickness, and size. An anteroposterior radiograph of the pelvis with weight bearing was performed and scored for radiographic evidence of OA in the right hip. Other factors measured were height, weight, leg strength, serum vitamin D levels, and bone mineral density.
Hip cartilage volume was significantly associated with female sex, body mass index, and femoral head size, whereas hip cartilage thickness was significantly associated only with the size of the femoral head. Only female sex was significantly associated with the total radiographic OA score and the joint space narrowing (JSN) score, but not the osteophyte score. Radiographic JSN of the hip, especially axial JSN (but not osteophytes), was significantly correlated with hip cartilage volume and thickness.
Femoral head cartilage volume and thickness have modest but significant construct validity when correlated with radiographic findings. Furthermore, the generally stronger associations with volume compared with radiographic OA suggest that MRI may be superior at identifying risk factors for hip OA.
[Show abstract][Hide abstract] ABSTRACT: To describe the associations between age, knee cartilage morphology, and bone size in adults.
A cross sectional convenience sample of 372 male and female subjects (mean age 45 years, range 26-61) was studied. Knee measures included a cartilage defect five site score (0-4 respectively) and prevalence (defect score of > or =2 at any site), cartilage volume and thickness, and bone surface area and/or volume. These were determined at the patellar, medial, and lateral tibial and femoral sites using T(1)weighted fat saturation MRI. Height, weight, and radiographic osteoarthritis (ROA) were measured by standard protocols.
In multivariate analysis, age was significantly associated with knee cartilage defect scores (beta = +0.016 to +0.073/year, all p<0.01) and prevalence (OR = 1.05-1.10/year, all p<0.05) in all compartments. Additionally, age was negatively associated with knee cartilage thickness at all sites (beta = -0.013 to -0.035 mm/year, all p<0.05), and with patellar (beta = -11.5 microl/year, p<0.01) but not tibial cartilage volume. Lastly, age was significantly positively associated with medial and lateral tibial surface bone area (beta = +3.0 to +4.7 mm(2)/year, all p<0.05) and patellar bone volume (beta = +34.4 microl/year, p<0.05). Associations between age and tibiofemoral cartilage defect score, cartilage thickness, and bone size decreased in magnitude after adjustment for ROA, suggesting these changes are directly relevant to OA.
The most consistent knee structural changes with increasing age are increase in cartilage defect severity and prevalence, cartilage thinning, and increase in bone size with inconsistent change in cartilage volume. Longitudinal studies are needed to determine which of these changes are primary and confirm their relevance to knee OA.
Annals of the Rheumatic Diseases 05/2005; 64(4):549-55. · 9.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To generate hypotheses regarding the associations between knee cartilage defects and knee radiographic osteoarthritis (ROA), cartilage volume, bone size and type II collagen breakdown in adults.
A cross-sectional convenience sample of 372 male and female subjects (mean age 45 years, range 26-61) was studied. Knee cartilage defect score (0-4) and prevalence (a defect score of > or =2), cartilage volume, and bone surface area were determined using T1-weighted fat saturation MRI. Urinary levels of C-terminal crosslinking telopeptide of type II collagen (U-CTX-II) were measured by enzyme-linked immunosorbent assay. Height, weight and ROA were measured by standard protocols.
In multivariate analysis, the severity and prevalence of knee cartilage defects were significantly and independently associated with tibiofemoral osteophytes (regression coefficient (beta): +0.86 to +1.31/unit, odds ratio (OR): 2.97-3.68/unit, all P<0.05 with the exception of OR in lateral tibiofemoral compartment) and tibial bone area (beta: +0.11 to +0.25/cm2; OR: 1.33-1.58/cm2, all P<0.01). Knee cartilage defects were inconsistently associated with joint space narrowing after adjustment for osteophytes but consistently with knee cartilage volume (beta: -0.27 to -0.70/ml; OR: 0.16-0.56/ml, all P<0.01 except for OR at lateral tibial cartilage site P=0.06). Lastly, knee cartilage defect severity was significantly associated with U-CTX-II (Partial r=+0.18, P<0.001 for total cartilage defect score).
Osteophytes and increasing knee bone size may be causally related to knee cartilage defects. Furthermore, knee cartilage defects may result in increased cartilage breakdown leading to decreased cartilage volume and joint space narrowing suggesting an important role for knee cartilage defects in early knee OA.
Osteoarthritis and Cartilage 04/2005; 13(3):198-205. · 4.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the associations among BMI, knee cartilage morphology, and bone size in adults.
A cross-sectional convenience sample of 372 male and female subjects (mean age, 45 years; range, 26 to 61 years) was studied. Knee articular cartilage defect score (0 to 4) and prevalence (defect score of >/=2), volume, and thickness, as well as bone surface area and/or volume, were determined at the patellar, tibial, and femoral sites using T1-weighted fat-saturation magnetic resonance imaging. Height, weight, BMI, and radiographic osteoarthritis were measured by standard protocols.
In multivariate analysis in the whole group, BMI was significantly associated with knee cartilage defect scores (beta: +0.016/kg/m(2) to +0.083/kg/m(2), all p < 0.05) and prevalence (odds ratio: 1.05 to 1.12/kg/m(2), all p < 0.05 except for the lateral tibiofemoral compartment). In addition, BMI was negatively associated with patellar cartilage thickness only (beta = -0.021 mm/kg/m(2); p = 0.039) and was positively associated with tibial bone area (medial: beta = +7.1 mm(2)/kg/m(2), p = 0.001; lateral: beta = +3.2 mm(2)/kg/m(2), p = 0.037). Those who were obese also had higher knee cartilage defect severity and prevalence and larger medial tibial bone area but no significant change in cartilage volume or thickness compared with those of normal weight.
This study suggests that knee cartilage defects and tibial bone enlargement are the main structural changes associated with increasing BMI particularly in women. Preventing these changes may prevent knee osteoarthritis in overweight and obese subjects.
Obesity research 02/2005; 13(2):350-61. · 4.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women.
Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden's nodes (HN) based on hand photography.
The prevalence of hand OA was high in this sample at 65-70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18-0.79).
These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a "priming" effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA.
[Show abstract][Hide abstract] ABSTRACT: Previous studies have suggested a strong genetic component to osteoarthritis (OA), especially that of the hand, and three linkage studies have suggested the existence of susceptibility loci in disparate regions of chromosome 2q.
To examine for linkage to 2q in a Tasmanian population of women and men with familial hand OA.
Hand OA (distal interphalangeal, carpometacarpal, and Heberden's nodes) was assessed by a combination of hand photographs and radiographs. A non-parametric linkage (NPL) analysis was performed on chromosome 2q of 69 members in 22 families with severe distal interphalangeal joint OA using Genehunter. A quantitative trait linkage analysis of a larger group of 456 members in 68 families was also performed using SOLAR.
The maximum non-parametric linkage score was 1.05 (p=0.15) at marker IL1R1, close to the centromere. All components of hand OA scores had significant heritability in this dataset (28%-35%, all p<0.001). Despite this, the quantitative trait analysis (after adjustment for age and, where appropriate, sex) yielded maximum LOD scores of 0.90 for Heberden's nodes (both sexes combined), and 1.19 for carpometacarpal OA score (women only).
These results do not provide confirmation of linkage on chromosome 2q in the larger white population with hand OA. They suggest that there are regional variations in the genetic cause of hand OA and that other loci not on 2q may be important in this disease.
Annals of the Rheumatic Diseases 12/2002; 61(12):1081-4. · 9.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the association between sex, smoking, physical activity, occupation, and previous digit fracture and hand osteoarthritis (OA).
Cross sectional study of 522 subjects from 101 Tasmanian families (348 women, 174 men). Hand OA was assessed by 2 observers using the OARSI atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal joints as well as a score for Heberden's nodes based on hand photography. A structured questionnaire collected information regarding physical activity, sport participation, occupation, and smoking history.
Women had a higher prevalence of hand OA and the increase with age was significantly higher for women at all sites (all p < 0.05). Ever smoking was associated with less frequent (OR 0.59, 95% CI 0.38, 0.92) and less severe Heberden's nodes (beta -0.60, 95% CI -1.03, -0.17), but not radiological disease. Recall of occupation, physical activity, and sport participation between the ages of 20 and 40 years had no association with the prevalence or severity of hand OA, while self-reported digital fracture was significantly associated with more common (OR 2.42, 95% CI 1.22, 4.83) and severe DIP joint disease (beta +3.92, 95% CI +1.50, +6.36). No factors were associated with carpometacarpal disease.
In this sample, women had a higher prevalence of hand OA at all sites as well as greater severity and a steeper age gradient (implying higher incidence rates). Smoking may decrease the risk of Heberden's nodes while having no effect on radiological hand OA, suggesting a differential effect possibly at the time of disease onset. With the exception of digital fracture, these data do not support a causal role for occupation or activity in earlier life with regard to hand OA.
The Journal of Rheumatology 08/2002; 29(8):1719-24. · 3.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To document symptomatic fracture incidence in those aged under 50 years of age.
Fractures were ascertained from X-ray reports containing the word 'fracture' from all radiology providers for the geographically defined population of southern Tasmania (n = 165 175) for the period 1 July 1997 to 30 June 1999.
In the 2-year study frame there were 2943 fractures in 164 730 person years in males and 1348 fractures in 165 620 person years in females. This represents a fracture incidence of 1787 per 100 000 person years in males and 819 per 100 000 person years in females. Peak fracture incidence was 10-14 years in females and 15-19 years in males although different fracture types had varying peak incidence suggesting different fracture-specific causes. The most common fractures were those of the hand (24%), forearm (17%), wrist (10%) and foot (9%). All fractures (including vertebral) were more common in males with relative risks ranging from 1.34 to 4.50. The estimated probability of at least one fracture between birth and 50 years of age was 59% for males and 34% for females.
There are threefold as many fractures in this age group compared to those due to osteoporosis in the elderly in any given year. More research priority needs to be given to understanding the causes of these fractures so that preventive strategies can be formulated.
Journal of Paediatrics and Child Health 07/2002; 38(3):278-83. · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are limited data describing urban-rural differences in fracture incidence and the overall effect remains controversial. The aim of this study was to compare symptomatic fracture incidence occurring in geographically defined rural (n = 34619) and urban (n = 194974) populations of Southern Tasmania from July 1, 1997 to June 30, 1999. Fractures were ascertained by reviewing reports from all the radiology providers within the area. In the 2-year study time frame there were 3644 fractures in males and 2657 fractures in females. Fracture incidence was significantly higher in urban compared with rural populations in both sexes (male: RR 1.60, 95% CI 1.47-1.75; female: RR 1.77, 95% CI 1.58-1.98). This higher urban fracture incidence was present across all age groups and all fracture types with the exception of knee and pelvis fractures in males (although not all were statistically significant). In addition, urban men >50 years old had a higher fracture incidence than rural women >50 years old (RR 1.25, 95% CI 1.05-1.50), suggesting that in later life the factors responsible for the urban-rural difference are able to offset completely the effect of gender. While some of the reduced fracture incidence in the rural population may be explained by urban drift and underreporting of minor fractures such as foot fractures, the overall pattern of higher fracture risk was very consistent, suggesting a real difference in whole-of-life symptomatic fracture incidence. Further research at an individual level is required to determine what factors account for these large urban-rural differences, as they imply a substantial potential for fracture prevention.
Osteoporosis International 01/2002; 13(4):317-22. · 4.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the associations between hand osteoarthritis (OA), pain and disability in males and females and to further validate the Australian/Canadian OA hand index (AUSCAN LK3.0).
Cross-sectional study of 522 subjects from 101 Tasmanian families (males N=174, females N=348). Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal and first carpometacarpal joints as well as a score for Heberden's nodes based on hand photography. Hand pain and function were assessed by the AUSCAN LK3.0 and grip strength by dynamometry in both hands on two occasions.
The prevalence of hand OA was high in this sample at 44-71% (depending on site). Pain and dysfunction increased with age while grip strength decreased (all P< 0.001). All three measures were markedly worse in women, even after taking the severity of arthritis into account. Hand OA explained 5.7-10% of the variation in function, grip strength and pain scores, even after adjustment for age and sex. Further adjustment suggested that the osteoarthritic associations with function and grip strength were largely mediated by pain. Severity of disease was more strongly associated with these scores than presence or absence. Lastly, the AUSCAN LK3.0 showed a comparable association to grip strength with structural damage providing further evidence of index validity.
Hand OA at these two sites makes substantial contributions to hand function, strength and pain. The associations with function and strength measures appear mediated by pain. Gender differences in all three measures persist after adjustment for variation in age and OA severity indicating that factors apart from radiographic disease are responsible.
Osteoarthritis and Cartilage 10/2001; 9(7):606-11. · 4.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Symptomatic fractures are a significant problem in terms of both morbidity and financial cost. Marked variation in both total and site-specific fracture incidence has been documented internationally but there is limited within-country data. This prospective population-based study documented the incidence of all symptomatic fractures occurring from July 1, 1997 to June 30, 1999 in adults > or =50 years of age resident in Southern Tasmania (total population > or = 50 years: 64688). Fractures were ascertained by reviewing reports from all the radiology providers within the area. There were 701 fractures in men and 1309 fractures in women. The corresponding fracture incidence in men and women was 1248 and 1916 per 100000 person-years, respectively. Residual lifetime fracture risk in a person aged 50 years was 27% for men and 44% for women with fractures other than hip fractures constituting the majority of symptomatic fracture events. These fracture risk estimates remained remarkably constant with increasing age. In comparison to Geelong, there were significantly lower hip fracture rates (males: RR 0.59, 95% CI 0.45-0.76; females: RR 0.61, 95% CI 0.53-0.71) but significantly higher distal forearm fractures (males: RR 1.87, 95% CI 1.10-3.78; females: RR 1.31, 95% CI 1.11-1.55) and total fractures in men (RR 1.31, 95% CI 1.17-1.46) but not women (RR 1.05, 95% CI 0.98-1.13). In contrast, Southern Tasmania had lower age-standardized rates of all fractures compared with Dubbo (RR 0.28-0.79). In conclusion, this study provides compelling evidence that fracture incidence varies between different geographic sites within the same country, which has important implications for health planning. In addition, the combination of high residual fracture risk and short life expectancy in elderly subjects suggests fracture prevention will be most cost-effective in later life.
Osteoporosis International 02/2001; 12(2):124-30. · 4.17 Impact Factor