Skip to main content
SpringerLink
Log in

Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos)

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Fracture determinants differ between Canadians of Chinese and White descent, the former constituting the second largest visible minority group in Canada. The results of this study support the importance of characterizing bone health predictors in Canadians of different ethnicity to improve population-specific fracture prevention and treatment strategies.

Purpose

We aimed to compare clinical risk factors, bone mineral density, prevalence of osteoporosis, and fractures between Chinese and White Canadians to identify ethnicity-specific risks.

Methods

We studied 236 Chinese and 8945 White Canadians aged 25+ years from the Canadian Multicentre Osteoporosis Study (CaMos). The prevalence of osteoporosis using ethnicity-specific peak bone mass (PBM), and of prior and incident low trauma fractures were assessed and compared between groups. Linear regressions, adjusting for age and anthropometric measures, were used to examine the association between baseline and 5-year changes in BMD and ethnicity.

Results

Chinese participants had shorter stature, lower BMI, and lower rate of falls than White participants. Adjusted models showed no significant differences in baseline BMD between ethnic groups except in younger men where total hip BMD was 0.059 g/cm2 (0.009; 0.108) lower in Chinese. Adjusted 5-year BMD change at lumbar spine was higher in older Chinese women and men compared with Whites. When using Chinese-specific PBM, the prevalence of osteoporosis in Chinese women was 2-fold lower than when using that of White women The prevalence of fractures was higher in White women compared with Chinese with differences up to 14.5% (95% CI 9.2; 19.7) and 10.5% (95% CI 4.5–16.4) in older White men. Incident fractures were rare in young Chinese compared with White participants and not different in the older groups.

Conclusion

Our results support the importance of characterizing bone strength predictors in Chinese Canadians and the development of ethnicity-specific fracture prediction and prevention strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tarride JE, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A, Bessette L, Brown JP, Goeree R (2012) The burden of illness of osteoporosis in Canada. Osteoporos Int 23:2591–2600

    PubMed  PubMed Central  Google Scholar 

  2. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Leslie WD (2012) Clinical review: ethnic differences in bone mass--clinical implications. J Clin Endocrinol Metab 97:4329–4340

    CAS  PubMed  Google Scholar 

  4. Thu WPP, Logan SJS, Cauley JA, Kramer MS, Yong EL (2019) Ethnic differences in bone mineral density among midlife women in a multi-ethnic Southeast Asian cohort. Arch Osteoporos 14:80

    PubMed  Google Scholar 

  5. Geng Y, Lo JC, Brickner L, Gordon NP (2017) Racial-ethnic differences in fall prevalence among older women: a cross-sectional survey study. BMC Geriatr 17:65

    PubMed  PubMed Central  Google Scholar 

  6. Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469:1891–1899

    PubMed  PubMed Central  Google Scholar 

  7. The ethnocultural diversity of the Canadian population. https://www.statcan.gc.ca/pub/91-551-x/2010001/hl-fs-eng.htm. https://www.statcan.gc.ca/pub/91-551-x/2010001/hl-fs-eng.htm

  8. Stevenson JKR, Cheung MC, Earle CC, Fischer HD, Camacho X, Saskin R, Shah BR, Austin PC, Singh S (2018) Chinese and South Asian ethnicity, immigration status, and clinical cancer outcomes in the Ontario Cancer System. Cancer 124:1473–1482

    PubMed  Google Scholar 

  9. Yu YH, Farmer A, Mager DR, Willows ND (2012) Dairy foods are an important source of calcium and vitamin D among Canadian-born and Asian-born Chinese in Edmonton, Alberta. Nutrition research (New York, NY) 32:177-184

  10. Kreiger N, Tenenhouse A, Joseph L, MacKenzie T, Poliquin S, Brown J, Prior JC, Rittmaster RS (1999) The Canadian Multicentre Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387

    Google Scholar 

  11. Ethnic Origin Reference Guide, Census of Population, 2016. https://www12.statcan.gc.ca/census-recensement/2016/ref/guides/008/98-500-x2016008-eng.cfm

  12. Berger C, Goltzman D, Langsetmo L, Joseph L, Kreiger N, Tenenhouse A, Davison KS, Josse RG, Prior JC, Hanley DA (2010) Peak bone mass from longitudinal data: implications for the prevalence, pathophysiology, and diagnosis of osteoporosis. J Bone Miner Res 25:1948–1957

    PubMed  Google Scholar 

  13. Berger C, Leslie WD, Langsetmo L, Tsang J, Papaioannou A, Kovacs CS, Hanley DA, Goltzman D (2009) Exclusion of vertebral artifacts from spine DXA does not alter fracture prediction. J Bone Miner Metab 24

  14. Kanis JA, Adachi JD, Cooper C et al (2013) Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 24:2763–2764

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Prior JC, Langsetmo L, Lentle BC et al (2015) Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study-comparing site and age-specific risks in women and men. Bone 71:237–243

    PubMed  Google Scholar 

  16. Huang H, Han GY, Jing LP, Chen ZY, Chen YM, Xiao SM (2018) Tea consumption is associated with increased bone strength in middle-aged and elderly Chinese women. J Nutr Health Aging 22:216–221

    CAS  PubMed  Google Scholar 

  17. Zhang ZF, Yang JL, Jiang HC, Lai Z, Wu F, Liu ZX (2017) Updated association of tea consumption and bone mineral density: A meta-analysis. Medicine 96:e6437

    PubMed  PubMed Central  Google Scholar 

  18. Li X, Qiao Y, Yu C et al (2019) Tea consumption and bone health in Chinese adults: a population-based study. Osteoporos Int 30:333–341

    CAS  PubMed  Google Scholar 

  19. Poliquin S, Joseph L, Gray-Donald K (2009) Calcium and vitamin D intakes in an adult Canadian population. Can J Diet Pract Res 70:21–27

    PubMed  Google Scholar 

  20. Harvey NC, Oden A, Orwoll E et al (2018) Falls predict fractures independently of FRAX probability: a meta-analysis of the Osteoporotic Fractures in Men (MrOS) study. J Bone Miner Res 33:510–516

    PubMed  Google Scholar 

  21. Leslie WD, Berger C, Langsetmo L et al (2011) Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts. Osteoporos Int 22:1873–1883

    CAS  PubMed  Google Scholar 

  22. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    CAS  PubMed  Google Scholar 

  23. Zhang ZQ, Ho SC, Chen ZQ, Zhang CX, Chen YM (2014) Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int 25:497–507

    PubMed  Google Scholar 

  24. Walker MD, Babbar R, Opotowsky AR et al (2006) A referent bone mineral density database for Chinese American women. Osteoporos Int 17:878–887

    PubMed  Google Scholar 

  25. Finkelstein JS, Brockwell SE, Mehta V et al (2008) Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab 93:861–868

    CAS  PubMed  Google Scholar 

  26. Nam HS, Shin MH, Zmuda JM, Leung PC, Barrett-Connor E, Orwoll ES, Cauley JA (2010) Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 21:2115–2123

    PubMed  PubMed Central  Google Scholar 

  27. Zhang YY, Liu PY, Lu Y, Davies KM, Dvornyk V, Recker RR, Deng HW (2005) Race and sex differences and contribution of height: a study on bone size in healthy Caucasians and Chinese. Am J Hum Biol 17:568–575

    PubMed  Google Scholar 

  28. Dvornyk V, Liu PY, Long JR, Zhang YY, Lei SF, Recker RR, Deng HW (2005) Contribution of genotype and ethnicity to bone mineral density variation in Caucasians and Chinese: a test for five candidate genes for bone mass. Chin Med J 118:1235–1244

    CAS  PubMed  Google Scholar 

  29. Finkelstein JS, Lee ML, Sowers M, Ettinger B, Neer RM, Kelsey JL, Cauley JA, Huang MH, Greendale GA (2002) Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87:3057–3067

    CAS  PubMed  Google Scholar 

  30. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194

    PubMed  Google Scholar 

  31. Bolotin HH (2007) DXA in vivo BMD methodology: an erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling. Bone 41:138–154

    CAS  PubMed  Google Scholar 

  32. Sheu Y, Cauley JA, Wheeler VW, Patrick AL, Bunker CH, Ensrud KE, Orwoll ES, Zmuda JM (2011) Age-related decline in bone density among ethnically diverse older men. Osteoporos Int 22:599–605

    CAS  PubMed  Google Scholar 

  33. Jain RK, Vokes T (2017) Dual-energy X-ray absorptiometry. J Clin Densitom 20:291–303

    PubMed  Google Scholar 

  34. Lo JC, Kim S, Chandra M, Ettinger B (2016) Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA. Osteoporos Int 27:3477–3484

    CAS  PubMed  Google Scholar 

  35. Leslie WD, Morin SN, Lix LM, McCloskey EV, Johansson H, Harvey NC, Kanis JA (2020) Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

  36. National Osteoporosis Foundation (2014) Clinician's Guide to the prevention and treatment of osoteoporosis. In: National Osteoporosis Foundation. National Osteoporosis Foundation, Washington, DC

    Google Scholar 

  37. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1997) Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 146:502–509

    CAS  PubMed  Google Scholar 

  38. Khandelwal S, Chandra M, Lo JC (2012) Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal U.S South Asian Women Bone 51:1025-1028

  39. Dhanwal DK, Cooper C, Dennison EM (2010) Geographic variation in osteoporotic hip fracture incidence: the growing importance of asian influences in coming decades. J Osteoporos 2010:757102

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244

    PubMed  Google Scholar 

  41. Bow CH, Cheung E, Cheung CL et al (2012) Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 23:879–885

    CAS  PubMed  Google Scholar 

  42. Cong E, Walker MD (2014) The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture. Bone Res 2:14009

    PubMed  PubMed Central  Google Scholar 

  43. Faulkner KG, Cummings SR, Nevitt MC, Pressman A, Jergas M, Genant HK (1995) Hip axis length and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 10:506–508

    CAS  PubMed  Google Scholar 

  44. Leslie W, Pahlavan P, Tsang J, Lix L (2009) Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort. Osteoporos Int 20:1767–1774

    CAS  PubMed  Google Scholar 

  45. Cummings SR, Cauley JA, Palermo L, Ross PD, Wasnich RD, Black D, Faulkner KG (1994) Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group. Osteoporos Int 4:226–229

    CAS  PubMed  Google Scholar 

  46. Wang XF, Duan Y, Beck TJ, Seeman E (2005) Varying contributions of growth and ageing to racial and sex differences in femoral neck structure and strength in old age. Bone 36:978–986

    PubMed  Google Scholar 

  47. Boutroy S, Walker MD, Liu XS, McMahon DJ, Liu G, Guo XE, Bilezikian JP (2014) Lower cortical porosity and higher tissue mineral density in Chinese American versus white women. J Bone Miner Res 29:551–561

    PubMed  Google Scholar 

  48. Liu XS, Walker MD, McMahon DJ, Udesky J, Liu G, Bilezikian JP, Guo XE (2011) Better skeletal microstructure confers greater mechanical advantages in Chinese-American women versus white women. J Bone Miner Res 26:1783–1792

    PubMed  Google Scholar 

  49. Leslie WD, Morin SN, Lix LM, Martineau P, Bryanton M, McCloskey EV, Johansson H, Harvey NC, Kanis JA (2019) Fracture prediction from self-reported falls in routine clinical practice: a registry-based cohort study. Osteoporos Int 30:2195–2203

    CAS  PubMed  Google Scholar 

  50. Karlsson MK, Ribom EL, Nilsson JA et al (2014) International and ethnic variability of falls in older men. Scand J Public Health 42:194–200

    PubMed  Google Scholar 

  51. Adachi JD, Berger C, Barron R et al (2019) Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 14:53

    PubMed  Google Scholar 

  52. Wu XP, Hou YL, Zhang H, Shan PF, Zhao Q, Cao XZ, Dai RC, Luo XH, Liao EY (2008) Establishment of BMD reference databases for the diagnosis and evaluation of osteoporosis in central southern Chinese men. J Bone Miner Metab 26:586–594

    PubMed  Google Scholar 

  53. Cheng XG, Yang DZ, Zhou Q et al (2007) Age-related bone mineral density, bone loss rate, prevalence of osteoporosis, and reference database of women at multiple centers in China. J Clin Densitom 10:276–284

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank CaMos participants.

The Canadian Multicentre Osteoporosis Study (CaMos) was funded by the Canadian Institutes of Health Research (CIHR); Amgen Canada Inc; Actavis Pharma Inc (previously Warner Chilcott Canada Co); Dairy Farmers of Canada; Eli Lilly Canada Inc: Eli Lilly and Company; GE Lunar; Hologic Inc; Merck Frosst Canada Ltd; Novartis Pharmaceuticals Canada Inc; P&G Pharmaceuticals Canada Inc; Pfizer Canada Inc; Roche (F. Hoffmann-La Roche Ltd); Sanofi-Aventis Canada Inc (previously Aventis Pharma Inc); Servier Canada Inc; and The Arthritis Society.

The CaMos Research Group

David Goltzman (co-principal investigator, McGill University), Nancy Kreiger (co-principal investigator, University of Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto).

McGill University, Montreal, Quebec: Elham Rahme (biostatistician), J. Brent Richards (investigator), Suzanne N. Morin (investigator); Claudie Berger (study statistician)

Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher S. Kovacs (co-director).

Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie M. Kaiser (co-directors).

Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette (co-director), GRMO.

Queen’s University, Kingston, Ontario: Tassos P. Anastassiades (director), Tanveer Towheed (co-director), Wilma M. Hopman (investigator).

University of Toronto, Toronto, Ontario: Angela M. Cheung (director), Robert G. Josse (co-director), Andy Kin On Wong (co-director).

McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director).

University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director), K. Shawn Davison (co-director).

University of Calgary, Calgary, Alberta: David A. Hanley (director), Steven K. Boyd (co-director).

University of British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Shirin Kalyan (co-director), Brian Lentle (investigator/radiologist), Millan S. Patel (investigator).

University of Alberta, Edmonton, Alberta: Stuart D. Jackson (medical physicist).

University of Manitoba, Winnipeg, Manitoba: William D. Leslie (investigator/nuclear medicine physician).

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.

Author information

Authors and Affiliations

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

    S. N. Morin & D. Goltzman

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

    S. N. Morin

  3. Research Institute of the McGill University Health Centre, Montreal, Canada

    C. Berger

  4. McGill University, Montreal, Canada

    W. Liu

  5. Department of Medicine/Endocrinology, University of British Columbia, Vancouver, Canada

    J. C. Prior

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

    A. M. Cheung

  7. Department of Medicine, McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, Canada

    D. A. Hanley

  8. McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, Canada

    S. K. Boyd

  9. Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    A. K. O. Wong

  10. Department of Medicine, McMaster University, Ontario, Canada

    A. Papaioannou

  11. Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada

    E. Rahme

Authors
  1. S. N. Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. C. Prior
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. M. Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. A. Hanley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. K. Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. K. O. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Papaioannou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Rahme
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D. Goltzman
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the CaMos Research Group

Corresponding author

Correspondence to S. N. Morin.

Ethics declarations

Conflict of interest

SN Morin and AM Cheung have received Research Grants from Amgen Canada, outside of this work. D Goltzman and A Papaioannou have received honoraria from Amgen Canada, outside of this work. C Berger, W Liu, JC Prior, E Rahme, DA Hanley, SK Boyd, and AKO Wong have no conflict of interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 70 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morin, S.N., Berger, C., Liu, W. et al. Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 15, 147 (2020). https://doi.org/10.1007/s11657-020-00822-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-020-00822-4

Keywords

Search

Navigation