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Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

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Most of the published epidemiology on osteoporosis is derived from White populations; still many countries have increasing ethno-culturally diverse populations, leading to gaps in the development of population-specific effective fracture prevention strategies. We describe differences in prevalent fracture and bone mineral density patterns in Canadians of different racial/ethnic backgrounds.


We described prevalent fracture and bone mineral density (BMD) patterns in Canadians by their racial/ethnic backgrounds.


For this cross-sectional analysis, we used the Canadian Longitudinal Study on Aging baseline data (2011–2015) of 22,091 randomly selected participants of Black, East Asian, South or Southeast Asian (SSEA) and White race/ethnic backgrounds, aged 45–85 years with available information on the presence or absence of self-reported prevalent low trauma fractures and femoral neck BMD (FNBMD) measurement. Logistic and linear regression models examined associations of race/ethnic background with fracture and FNBMD, respectively. Covariates included sex, age, height, body mass index (BMI), grip strength and physical performance score.


We identified 11,166 women and 10,925 men. Self-reported race/ethnic backgrounds were: 139 Black, 205 East Asian, 269 SSEA and 21,478 White. White participants were older (mean 62.5 years) than the other groups (60.5 years) and had a higher BMI (28.0 kg/m2) than both Asian groups, but lower than the Black group. The population-weighted prevalence of falls was 10.0%, and that of low trauma fracture was 12.0% ranging from 3.3% (Black) to 12.3% (White), with Black and SSEA Canadians having lower adjusted odds ratios (aOR) of low trauma fractures than White Canadians (Black, aOR = 0.3 [95% confidence interval: 0.1–0.7]; SSEA, aOR = 0.5 [0.3–0.8]). The mean (SD) FNBMD varied between groups: Black, 0.907 g/cm2 (0.154); East Asian, 0.748 g/cm2 (0.119); SSEA, 0.769 g/cm2 (0.134); and White, 0.773 g/cm2 (0.128). Adjusted linear regressions suggested that Black and both Asian groups had higher FNBMD compared to White.


Our results support the importance of characterizing bone health predictors in Canadians of different race/ethnic backgrounds to tailor the development of population-specific fracture prevention strategies.

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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.

The opinions expressed in this manuscript are the author's own and do not reflect the views of the Canadian Longitudinal Study on Aging.


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. 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 ( for researchers who meet the criteria for access to de-identified CLSA data.

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

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Correspondence to Suzanne N. Morin.

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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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Morin, S.N., Berger, C., Papaioannou, A. et al. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int 33, 2637–2648 (2022).

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