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Bone density and bone area in Canadian Aboriginal women: the First Nations Bone Health Study

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Abstract

Introduction

Canadian Aboriginal women are at increased risk of fracture compared with the general population.

Hypothesis

There is disproportionately reduced bone density in Aboriginal women as compared to white females of similar age.

Methods

A random age-stratified (25–39, 40–59 and 60–75) sample of Aboriginal women (n=258) and white women (n=181) was recruited. All subjects had calcaneus and distal forearm bone density measurements, and urban participants (n=397 [90.4%]) also had measurements of the lumbar spine, hip and total body.

Results

Unadjusted measurements were similar in the two groups apart from the distal forearm which showed a significantly lower mean Z-score in the Aboriginal women (p=0.03). Aboriginal women were heavier than white women (81.0±18.0 kg vs. 76.0±18.0 kg, p=0.02). Weight was directly associated with BMD at all measurement sites (p<0.00001) and potentially confounded the assessment of ethnicity on bone mass measurements. Weight-adjusted ANCOVA models demonstrated significantly lower bone density in Aboriginal than white women for the calcaneus, distal forearm, and total body (all p<0.05), but not at the other sites. ANCOVA models (adjusted for age, height and weight) were used to explore differences in bone area and bone mineral content (BMC). There was a significant effect of ethnicity on bone area with Aboriginal women having larger adjusted mean values than white women (lumbar spine p=0.038, total hip p=0.0004, total body p=0.020). In contrast, there was no detectable effect of ethnicity on BMC (all p>0.2).

Conclusions

We identified significant site-specific differences in age-and weight-adjusted bone density for Aboriginal and white women. Larger bone area, rather than a reduction in BMC, appeared to be primarily responsible. Further work is needed to define how these differences in bone density and geometry affect indices of bone strength.

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Notes

  1. In Canada, the terms Aboriginal or native are used to refer to “Indians”, and includes First Nations, Metis and Inuit peoples. First Nations are Aboriginal peoples signatory to treaties and/or recognized by the federal government as a fiduciary responsibility. This paper reports on data derived exclusively from First Nations populations which represent the large majority of Aboriginal persons living in Canada.

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Acknowledgements

The authors would like to thank the rest of the First Nations Bone Health Study Research Group: Dr. C.R. Greenberg, Dr. L. Lix, Dr. A. Tenenhouse, Dr. J. Krahn, Dr. L. Roos, Dr. E.A. Salamon, and Ms. A. Walker Young. The authors are indebted to Health Information Management of Manitoba Health and to the First Nations and Inuit Health Branch and Indian and Northern Affairs Canada for permission to use the Status Verification System, and to the Health Information Research Committee of the Assembly for Manitoba Chiefs for actively supporting this work.

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Correspondence to W. D. Leslie.

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Supported by a grant from the Canadian Institutes for Health Research and the Manitoba Health Research Council.

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Leslie, W.D., Metge, C.J., Weiler, H.A. et al. Bone density and bone area in Canadian Aboriginal women: the First Nations Bone Health Study. Osteoporos Int 17, 1755–1762 (2006). https://doi.org/10.1007/s00198-006-0184-0

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