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Is the Swedish FRAX model appropriate for Swedish immigrants?

Is the Swedish FRAX model appropriate for Swedish immigrants?
Is the Swedish FRAX model appropriate for Swedish immigrants?
The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate.

Introduction

Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden.

Methods

We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals.

Results

Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446–454) for a Swedish-born woman and 239 (95 % CI 223–257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5–0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence.

Conclusions

The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living in Sweden.
epidemiology, FRAX, hip fracture, immigrants, osteoporosis, sweden
0937-941X
1-6
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Karlsson, M.K.
28115dd6-7278-4e26-a577-80a9d2c5a3bb
Mellstrom, D.
43d24c2f-97e4-423a-acec-6a13b3d477d9
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Lorentzon, M.
11692e10-5916-4bb5-86c5-3ff9ccd77af6
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Karlsson, M.K.
28115dd6-7278-4e26-a577-80a9d2c5a3bb
Mellstrom, D.
43d24c2f-97e4-423a-acec-6a13b3d477d9

Johansson, H., Oden, A., Lorentzon, M., Kanis, J.A., Harvey, N.C., Karlsson, M.K. and Mellstrom, D. (2015) Is the Swedish FRAX model appropriate for Swedish immigrants? Osteoporosis International, 1-6. (doi:10.1007/s00198-015-3180-4). (PMID:26018091)

Record type: Article

Abstract

The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate.

Introduction

Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden.

Methods

We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals.

Results

Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446–454) for a Swedish-born woman and 239 (95 % CI 223–257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5–0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence.

Conclusions

The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living in Sweden.

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More information

Submitted date: 18 March 2015
Accepted/In Press date: 14 May 2015
Published date: 28 May 2015
Keywords: epidemiology, FRAX, hip fracture, immigrants, osteoporosis, sweden
Organisations: MRC Life-Course Epidemiology Unit

Identifiers

Local EPrints ID: 378124
URI: http://eprints.soton.ac.uk/id/eprint/378124
ISSN: 0937-941X
PURE UUID: 222bc686-b7f9-4cea-b541-716818925058
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 26 Jun 2015 16:08
Last modified: 15 Mar 2024 03:19

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Contributors

Author: H. Johansson
Author: A. Oden
Author: M. Lorentzon
Author: J.A. Kanis
Author: N.C. Harvey ORCID iD
Author: M.K. Karlsson
Author: D. Mellstrom

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