Risk factors for non-vertebral fractures in community-dwelling elderly: a 10-year follow-up study in New Zealand

This 10-year study of 5000 + adults aged 50-84 found 20% experienced non-vertebral fractures. Higher risk was linked to female sex, older age, European ethnicity, lower education, living alone, alcohol use, prior falls/fractures, osteoporosis, arthritis, and antidepressants. Targeting modifiable factors (living arrangements, alcohol, antidepressants) could reduce fracture burden cost-effectively in older adults.

Although there has been extensive research on non-vertebral fractures, their risk factors remain incompletely understood. This study aimed to examine risk factors associated with non-vertebral fractures through a longitudinal examination of a community-dwelling cohort.

This was a follow-up of participants recruited from family practices into a randomized trial of vitamin D supplementation and interviewed between 2011 and 2012, with follow-up until 2022. The outcome was the first non-vertebral fracture during the follow-up period, as identified from hospital events and insurance claims for fractures. Candidate risk factors were selected using a domain-based approach, and Cox models were employed to estimate adjusted hazard ratios (HRs).

The analysis comprised 5108 participants aged 50-84 years. Of these, 83% were of European/other ethnicity. A substantial proportion reported living with non-family members or living alone (20.5%), engaging in daily drinking (21.6%), or using antidepressants (11.9%). Over a median 10-year follow-up, 1016 participants (20%) experienced non-vertebral fractures. In the multivariable model, several factors were related to higher risk of non-vertebral fracture, including females (HR = 1.53), aged 80-84 years (HR = 1.47), European/other ethnicity, primary school education (HR = 1.65), living with non-family members (HR = 1.47) or living alone (HR = 1.29), daily alcohol drinking (HR = 1.51), history of falls (HR = 1.59) or fractures (HR = 1.43), osteoporosis (HR = 1.95), and arthritis (HR = 1.20), and dispensing of antidepressants (HR = 1.52) and antiarrhythmic medications (HR = 1.51).

Non-vertebral fractures are prevalent among older adults, with several prevalent and potentially modifiable risk factors identified, such as living situation, drinking habits, and antidepressant dispensing. Further exploration of these factors' causality and the implementation of public health interventions targeting them, could yield significant benefits and cost-effectively reduce the burden of fractures.

This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000402943).