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

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Abstract

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.

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Data availability

Study data were from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba. These data are not publicly available. In order to access Repository data, an individual must prepare a proposal, complete an accreditation process, obtain ethical and data access approval, and complete a researcher agreement with the provincial ministry of health.

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Acknowledgments

We acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC #: 2008/2009-16; MCHP Project #: 2009-008). The results and conclusions are those of authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers is intended or should be inferred.

Funding

This study was supported by funding from the Canadian Institute of Health Research (Grant # FRN 151726). LML is supported by a Tier 1 Canada Research Chair.

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Authors and Affiliations

  1. Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada

    A.F. Hamad, L. Yan, L.L. Roos & L.M. Lix

  2. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China

    S. Yang

  3. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    W.D. Leslie

  4. Department of Medicine, McGill University, Montreal, Quebec, Canada

    S.N. Morin

  5. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada

    R. Walld & L.L. Roos

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  1. A.F. Hamad
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Contributions

Authors substantially contributed to conception, design, and analysis (AFH, LML, WDL, RW, LY, SY, LRL); interpretation of data (all authors); drafting the article (AFH, LML, LY); critically revising the article for important intellectual content (all authors); and final approval of the version to be published (all authors).

Corresponding author

Correspondence to A.F. Hamad.

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Conflicts of interest

SNM has received research funding from Amgen Canada. AFH, SY, LY, WDL, RW, LLR, and LML declare that they have no conflict of interest.

Ethics approval

The study was approved by the Health Research Ethics Board of the University of Manitoba; data access approval was provided by the Manitoba Health Information Privacy Committee.

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The SAS codes used to generate the results can be made available to editors and reviewers upon request.

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Hamad, A., Yang, S., Yan, L. et al. The association of objectively ascertained sibling fracture history with major osteoporotic fractures: a population-based cohort study. Osteoporos Int 32, 681–688 (2021). https://doi.org/10.1007/s00198-020-05635-2

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