European Journal of Epidemiology

, Volume 22, Issue 9, pp 631–639 | Cite as

Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry

  • Kristin SiggeirsdottirEmail author
  • Thor Aspelund
  • Gunnar Sigurdsson
  • Brynjolfur Mogensen
  • Milan Chang
  • Birna Jonsdottir
  • Gudny Eiriksdottir
  • Lenore J. Launer
  • Tamara B. Harris
  • Brynjolfur Y. Jonsson
  • Vilmundur Gudnason
Locomotor Disease


Introduction and objective Misreporting fractures in questionnaires is known. However, the effect of misreporting on the association of fractures with subsequent health outcomes has not been examined. Methods Data from a fracture registry (FR) developed from an extensive review of radiographic and medical records were related to self-report of fracture for 2,255 participants from the AGES Reykjavik Study. This data was used to determine false negative and false positive rates of self-reported fractures, correlates of misreporting, and the potential effect of the misreporting on estimates of health outcomes following fractures. Results In women, the false positive rate decreased with age as the false negative rate increased with no clear trend with age in men. Kappa values for agreement between FR and self-report were generally higher in women than men with the best agreement for forearm fracture (men 0.64 and women 0.82) and the least for rib (men 0.28 and women 0.25). Impaired cognition was a major factor associated with discordant answers between FR and self-report, OR 1.7 (95% CI: 1.3–2.1) (P < 0.0001). We estimated the effect of misreporting on health after fracture by comparison of the association of the self-report of fracture and fracture from the FR, adjusting for those factors associated with discordance. The weighted attenuation factor measured by mobility and muscle strength was 11% (95% CI: 0–24%) when adjusted for age and sex but reduced to 6% (95% CI: −10–22%) when adjusted for cognitive impairment. Conclusion Studies of hip fractures should include an independent ascertainment of fracture but for other fractures this study supports the use of self-report.


Questionnaire Self-report Fracture Function Registry AGES-Reykjavik study 



This study was funded by NIH contract N01-AG-12100 and in part by the NIA Intramural Research Program., the Icelandic Parliament and the Icelandic Heart Association. Conflict of interest: none declared.

Supplementary material

10654_2007_9163_MOESM1_ESM.pdf (89 kb)
Comparison of the fracture registry and self-report, association of hip, vertebra, forearm and all fracture to the activity of daily living and health related quality of life. Adjusted for age and sex. Superimposed is a weighted least squares regression line and a 45 degree reference line. The scales shows the odds ratio of poor performance. (PDF 88 kb)


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Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Kristin Siggeirsdottir
    • 1
    Email author
  • Thor Aspelund
    • 1
  • Gunnar Sigurdsson
    • 2
  • Brynjolfur Mogensen
    • 2
  • Milan Chang
    • 2
  • Birna Jonsdottir
    • 1
  • Gudny Eiriksdottir
    • 1
  • Lenore J. Launer
    • 3
  • Tamara B. Harris
    • 3
  • Brynjolfur Y. Jonsson
    • 4
  • Vilmundur Gudnason
    • 1
    • 5
  1. 1.Icelandic Heart AssociationKopavogurIceland
  2. 2.Landspitalinn University HospitalReykjavikIceland
  3. 3.National Institute on AgingBethesdaUSA
  4. 4.University HospitalMalmoSweden
  5. 5.University of IcelandReykjavikIceland

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