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Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging

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Abstract

Summary

Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates.

Purpose

We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces.

Methods

We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50–85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012–2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates.

Results

The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity.

Conclusion

Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.

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Data availability

Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca ) for researchers who meet the criteria for access to de-identified CLSA data.

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Acknowledgements

The authors wish to thank the participants of the Canadian Longitudinal Study on Aging. SNM is a scholar of the Fonds de Recherche du Québec en santé. AM Cheung holds a Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health. A. Papaioannou holds a Tier 1 Canada Research Chair in Geriatric Medicine and Health Aging. This research was also made possible through the support of Réseau de recherche en santé buccodentaire et osseuse du Québec for a scholarship to N Hassanabadi. The opinions expressed in this manuscript are the author’s own and do not reflect the views of the Canadian Longitudinal Study on Aging.

Funding

We obtained funding from the Canadian Institutes of Health Research to analyze the data provided by the CLSA (Catalyst Grant: Analysis of Canadian Longitudinal Study in Aging Data 2018-09-05). This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference LSA 94473 and the Canada Foundation for Innovation, as well as the following provinces, Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia. This research has been conducted using the CLSA dataset Tracking Baseline v3.4 and Comprehensive Baseline v4.0 under Application ID 180909. The CLSA is led by Drs. Parminder Raina, Christina Wolfson, and Susan Kirkland.

Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data.

Author information

Authors and Affiliations

  1. Department of Medicine, McGill University, Montreal, Canada

    N. Hassanabadi, E. Rahme, D. Goltzman & S. N. Morin

  2. Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada

    N. Hassanabadi, C. Berger, E. Rahme, D. Goltzman & S. N. Morin

  3. Department of Medicine, McMaster University, Hamilton, Canada

    A. Papaioannou

  4. Department of Medicine, University of Toronto, Toronto, Canada

    A. M. Cheung

  5. Department of Medicine, University of Manitoba, Winnipeg, Canada

    W. D. Leslie

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  1. N. Hassanabadi
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  2. C. Berger
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  6. W. D. Leslie
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  8. S. N. Morin
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Contributions

SNM conceived the study and secured funding for this study. NH and CB conducted the data analysis and drafted the initial manuscript supervised by SNM. AP, AMC, ER, WDL, and DG helped with results interpretation and gave critical feedback on the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to S. N. Morin.

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Conflicts of interest

N Hassanabadi, SN Morin, C Berger, E Rahme, WD Leslie, and D Goltzman declare they have no conflict of interests. A Papaioannou has received grants and honoraria from Amgen. AM Cheung has received honoraria from Amgen and Paladin.

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Hassanabadi, N., Berger, C., Papaioannou, A. et al. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 35, 599–611 (2024). https://doi.org/10.1007/s00198-023-06975-5

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