The recurrence of osteoporotic fractures among first- and second-generation immigrants in Sweden

This nationwide cohort study compared recurrent osteoporotic fracture risk in first- and second-generation immigrants to native Swedes. First- and second-generation immigrant men had lower risks; first- and second-generation immigrant women had similar risks to native Swedes. Variations were observed by region of origin, suggesting differences in fracture susceptibility among immigrant groups.

To analyse the risk of a recurrent osteoporotic fracture in immigrants using Swedish-born individuals with Swedish-born parents as referents.

A nationwide open cohort study including individuals ≥ 50 years of age at baseline (N = 296,118) with a previous fracture. Immigrants were classified as first- or second-generation immigrants, i.e. foreign-born or Swedish-born individuals with at least one foreign-born parent. Osteoporotic fractures were defined as at least one registered diagnosis of fractures in the hip, humerus, forearm, vertebrae, or pelvis in the National Patient Register between January 1, 2010, and December 31, 2018. Logistic regression analysis estimated odds ratios (ORs) with 95% confidence intervals (95% CI) for a second osteoporotic fracture in individuals with a first osteoporotic fracture. Logistic regression models were stratified by sex and adjusted for age, comorbidities, and sociodemographic status.

A total of 33,172 fractures (men n = 7,428, and women n = 25,744) were registered in the first-generation study, and 12,979 (men n = 3,607 and women n = 9,372) in the second-generation study. Fully adjusted ORs (95% CI) were for all foreign-born men 0.90 (0.82-0.98) and women 0.95 (0.91-1.00), and for men with foreign-born parents 0.85 (0.73-0.99), and women 1.00 (0.91-1.09). Groups with statistically significant lower odds included men from Asia, women from Eastern Europe, Baltic countries, Asia and Latin America, and men with parents from the Nordic countries.

Among first- and second-generation men, the risk of a second fracture was slightly lower than that of native Swedes, while among first- and second-generation women, the risk was similar to the reference group.