TY - JOUR
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.
N1 - Funding Information:
Sharon L Brennan-Olsen and Lana J Williams are each supported by a National Health and Medical Research Council (NHMRC) of Australia Career Development Fellowship (1107510, and 1064272, respectively). Kara L Holloway is supported by an Alfred Deakin Postdoctoral Research Fellowship, Deakin University.
Publisher Copyright:
© 2017 The Author(s)
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
UR - http://www.scopus.com/inward/record.url?scp=85019439655&partnerID=8YFLogxK
U2 - 10.1016/j.bonr.2017.04.003
DO - 10.1016/j.bonr.2017.04.003
M3 - Review article
AN - SCOPUS:85019439655
SN - 2352-1872
VL - 6
SP - 145
EP - 158
JO - Bone Reports
JF - Bone Reports
ER -