Abstract
Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromsø, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromsø than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort.
Similar content being viewed by others
References
Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208.
Huopio J, Kroger H, Honkanen R, Saarikoski S, Alhava E. Risk factors for perimenopausal fractures: a prospective study. Osteoporos Int. 2000;11(3):219–27. doi:10.1007/s001980050284.
Barrett-Connor E. The economic and human costs of osteoporotic fracture. Am J Med. 1995;98(Suppl 2A):S3–8. doi:10.1016/S0002-9343(05)80037-3.
Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos Int. 2007;18(8):1109–17. doi:10.1007/s00198-007-0362-8.
Kanis JA, Black D, Cooper C, Dargent P, Dawson-Hughes B, Laet CD, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int. 2002;13(7):527–36. doi:10.1007/s001980200069.
van der Klift M, de Laet CD, Pols HA. Assessment of fracture risk: who should be treated for osteoporosis? Best Pract Res Clin Rheumatol. 2005;19(6):937–50. doi:10.1016/j.berh.2005.06.001.
World-Health-Organisation. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: WHO; 1994.
Johnston CC Jr, Hui S. Absolute versus relative fracture risk. J Bone Miner Res. 2005;20((4):704. doi:10.1359/JBMR.041215.
Siminoski L, Frame H, Josse K, et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 2007;10(2):120–3. doi:10.1016/j.jocd.2007.01.001.
Díez-Pérez A, González-Macías J, Marín F, Abizanda M, Alvarez R, Gimeno A, et al. Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound. Osteoporos Int. 2007;18(5):629–39. doi:10.1007/s00198-006-0297-5.
Graeme T, Andrew M, Charles P, Allan GN, Ian MD, Richard LP, et al. The importance of calculating absolute rather than relative fracture risk. Bone. 2007;41(6):937–41. doi:10.1016/j.bone.2007.07.015.
Lippuner K, Johansson H, Kanis J, Rizzoli R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int. 2008. doi:10.1007/s00198-008-0779-8
Hiligsmann M, Bruyère O, Ethgen O, Gathon H-J, Reginster J-Y. Lifetime absolute risk of hip and other osteoporotic fracture in Belgian women. Bone. 2008;43:991–4.
Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989;149:2445–8. doi:10.1001/archinte.149.11.2445.
Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int. 2000;11(8):669–74. doi:10.1007/s001980070064.
van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29(6):517–22. doi:10.1016/S8756-3282(01)00614-7.
Cooley H, Jones GA. Population-based study of fracture incidence in Southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same Country. Osteoporos Int. 2001;V12(2):124–30. doi:10.1007/s001980170144.
Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the US medicare population. J Clin Epidemiol. 1999;52(3):243–9. doi:10.1016/S0895-4356(98)00167-X.
Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res. 2007;22(6):781–8. doi:10.1359/jbmr.070315.
Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17(7):1237–44. doi:10.1359/jbmr.2002.17.7.1237.
Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005;16(Suppl 2):S3–7. doi:10.1007/s00198-004-1702-6.
Joakimsen RM, Fonnebo V, Sogaard AJ, Tollan A, Stormer J, Magnus JH. The Tromso study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int. 2001;12(12):1001–5. doi:10.1007/s001980170008.
Feuer EJ, Wun LM, Boring CC, Flanders WD, Timmel MJ, Tong T. The lifetime risk of developing breast cancer. J Natl Cancer Inst. 1993;85(11):892–7. doi:10.1093/jnci/85.11.892. See comment.
Schouten LJ, Straatman H, Kiemeney LA, Verbeek AL. Cancer incidence: life table risk versus cumulative risk. J Epidemiol Community Health. 1994;48(6):596–600. doi:10.1136/jech.48.6.596.
Statistics Norway. Population statistics. 2006.
Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, et al. Epidemiology of hip fractures in Oslo, Norway. Bone. 2001;29(5):413–8. doi:10.1016/S8756-3282(01)00603-2.
Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Hip fracture incidence in central norway: a followup study. Clin Orthop Relat Res. 2004;419:173–8. doi:10.1097/00003086-200402000-00028.
Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R. The changing picture of hip fractures: dramatic change in age distribution and no change in age-adjusted incidence within 10 years in Central Finland. Bone. 1999;24(3):257–9. doi:10.1016/S8756-3282(98)00182-3.
Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults—the influence of age and gender. J Bone Joint Surg. 1998;80B(2):243–8. doi:10.1302/0301-620X.80B2.7762.
Sanders KM, Seeman E, Ugoni AM, Pasco JA, Martin TJ, Skoric B, et al. Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int. 1999;10(3):240–7. doi:10.1007/s001980050222.
Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA. Lifetime risk of hip fractures is underestimated. Osteoporos Int. 1998;8(6):599–603. doi:10.1007/s001980050105.
Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadephia: Lippincott-Raven; 1998.
Nevitt MC, Cummings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc. 1994;41(11):1226–34.
Ahmed LA, Schirmer H, Fønnebø V, Joakimsen RM, Berntsen GK. Validation of the cummings’ risk score; how well does it identify women with high risk of hip fracture: the Tromsø Study. Eur J Epidemiol. 2006;21(11):815–22. doi:10.1007/s10654-006-9072-3.
Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000;27(5):585–90. doi:10.1016/S8756-3282(00)00381-1.
McClung. Do current management strategies and guidelines adequately address fracture risk? Bone. 2006;38(2):13–7. doi:10.1016/j.bone.2005.11.012.
Deal CL. Absolute fracture risk. Curr Rheumatol Rep. 2007;9(1):66–70. doi:10.1007/s11926-007-0024-z.
Mosca L. Absolute risk assessment in the clinical setting. Am J Med. 1999;107(2A):7S–9S. doi:10.1016/S0002-9343(99)00135-7.
Joakimsen RM. Risk factors for non-vertebral fractures in middle-aged population (thesis). Tromsø: University of Tromsø; 1999.
Acknowledgment
The study was financed by The Centre for Research in the Elderly in Tromsø, the Northern Norway Regional Health Authority.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ahmed, L.A., Schirmer, H., Bjørnerem, Å. et al. The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24, 441–448 (2009). https://doi.org/10.1007/s10654-009-9353-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-009-9353-8