The association of objectively ascertained sibling fracture history with major osteoporotic fractures: a population-based cohort study

• Published in: Osteoporosis international Vol. 32; no. 4; pp. 681 - 688
• Main Authors: Hamad, A.F., Yang, S., Yan, L., Leslie, W.D., Morin, S.N., Walld, R., Roos, L.L., Lix, L.M.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.04.2021; Springer Nature B.V
• Subjects: Adult; Bone Density; Canada; Cohort analysis; Cohort Studies; Diagnosis; Endocrinology; Female; Forearm; Fractures; Hip; Hip Fractures - epidemiology; Hip Fractures - etiology; Humans; Humerus; Male; Manitoba - epidemiology; Medicine; Medicine & Public Health; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Population studies; Population-based studies; Retrospective Studies; Rheumatology; Risk Assessment; Risk Factors; Siblings; Canada; Manitoba; Administrative data; Osteoporosis; Fracture risk; Family history
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-020-05635-2

Summary We investigated the association of objectively ascertained sibling fracture history with major osteoporotic fracture (hip, forearm, humerus, or clinical spine) risk in a population-based cohort using administrative databases. Sibling fracture history is associated with increased major osteoporotic fracture risk, which has implications for fracture risk prediction. Introduction We aimed to determine whether objectively ascertained sibling fracture history is associated with major osteoporotic fracture (MOF; hip, forearm, humerus, or clinical spine) risk. Methods This retrospective cohort study used administrative databases from the province of Manitoba, Canada, which has a universal healthcare system. The cohort included men and women 40+ years between 1997 and 2015 with linkage to at least one sibling. The exposure was sibling MOF diagnosis occurring after age 40 years and prior to the outcome. The outcome was incident MOF identified in hospital and physician records using established case definitions. A multivariable Cox proportional hazards regression model was used to estimate the risk of MOF after adjustment for known fracture risk factors. Results The cohort included 217,527 individuals; 91.9% were linked to full siblings (siblings having the same father and mother) and 49.0% were females. By the end of the study period, 6255 (2.9%) of the siblings had a MOF. During a median follow-up of 11 years (IQR 5–15), 5235 (2.4%) incident MOF were identified in the study cohort, including 234 hip fractures. Sibling MOF history was associated with an increased risk of MOF (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.44–1.92). The risk was elevated in both men (HR 1.57, 95% CI 1.24–1.98) and women (HR 1.74, 95% CI 1.45–2.08). The highest risk was associated with a sibling diagnosis of forearm fracture (HR 1.81, 95% CI 1.53–2.15). Conclusion Sibling fracture history is associated with increased MOF risk and should be considered as a candidate risk factor for improving fracture risk prediction.