Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

Sharon L. Brennan-Olsen, Sara Vogrin, William D. Leslie, Rita Kinsella, Maree Toombs, Gustavo Duque, Sarah M. Hosking, Kara L. Holloway, Brianna J. Doolan, Lana J. Williams, Richard S. Page, Julie A. Pasco, Shae E. Quirk

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. Methods On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. Results Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. Conclusions The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

Original languageEnglish
Pages (from-to)145-158
Number of pages14
JournalBone Reports
Volume6
DOIs
Publication statusPublished - 1 Jun 2017

Keywords

  • Fracture
  • Incidence
  • Indigenous peoples
  • Risk factors
  • Systematic review

Cite this

Brennan-Olsen, S. L., Vogrin, S., Leslie, W. D., Kinsella, R., Toombs, M., Duque, G., ... Quirk, S. E. (2017). Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology. Bone Reports, 6, 145-158. https://doi.org/10.1016/j.bonr.2017.04.003
Brennan-Olsen, Sharon L. ; Vogrin, Sara ; Leslie, William D. ; Kinsella, Rita ; Toombs, Maree ; Duque, Gustavo ; Hosking, Sarah M. ; Holloway, Kara L. ; Doolan, Brianna J. ; Williams, Lana J. ; Page, Richard S. ; Pasco, Julie A. ; Quirk, Shae E. / Fractures in indigenous compared to non-indigenous populations : A systematic review of rates and aetiology. In: Bone Reports. 2017 ; Vol. 6. pp. 145-158.
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abstract = "Background Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. Methods On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. Results Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. Conclusions The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.",
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Brennan-Olsen, SL, Vogrin, S, Leslie, WD, Kinsella, R, Toombs, M, Duque, G, Hosking, SM, Holloway, KL, Doolan, BJ, Williams, LJ, Page, RS, Pasco, JA & Quirk, SE 2017, 'Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology' Bone Reports, vol. 6, pp. 145-158. https://doi.org/10.1016/j.bonr.2017.04.003

Fractures in indigenous compared to non-indigenous populations : A systematic review of rates and aetiology. / Brennan-Olsen, Sharon L.; Vogrin, Sara; Leslie, William D.; Kinsella, Rita; Toombs, Maree; Duque, Gustavo; Hosking, Sarah M.; Holloway, Kara L.; Doolan, Brianna J.; Williams, Lana J.; Page, Richard S.; Pasco, Julie A.; Quirk, Shae E.

In: Bone Reports, Vol. 6, 01.06.2017, p. 145-158.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Fractures in indigenous compared to non-indigenous populations

T2 - A systematic review of rates and aetiology

AU - Brennan-Olsen, Sharon L.

AU - Vogrin, Sara

AU - Leslie, William D.

AU - Kinsella, Rita

AU - Toombs, Maree

AU - Duque, Gustavo

AU - Hosking, Sarah M.

AU - Holloway, Kara L.

AU - Doolan, Brianna J.

AU - Williams, Lana J.

AU - Page, Richard S.

AU - Pasco, Julie A.

AU - Quirk, Shae E.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. Methods On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. Results Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. Conclusions The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

AB - Background Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. Methods On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. Results Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. Conclusions The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

KW - Fracture

KW - Incidence

KW - Indigenous peoples

KW - Risk factors

KW - Systematic review

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U2 - 10.1016/j.bonr.2017.04.003

DO - 10.1016/j.bonr.2017.04.003

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JO - Bone Reports

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