Osteoporosis International
Volume 26, Issue 11, 2015, Pages 2617-2622

Is the Swedish FRAX model appropriate for Swedish immigrants? (Article)

Johansson H.* , Odén A. , Lorentzon M. , McCloskey E. , Kanis J.A. , Harvey N.C. , Karlsson M.K. , Mellström D.
  • a Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom, Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • b Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
  • c Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • d Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
  • e Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
  • f MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
  • g Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmo, Sweden
  • h Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Abstract

Summary: 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. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation.

Author Keywords

Osteoporosis immigrants Sweden Hip fracture FRAX Epidemiology

Index Keywords

immigrant Asian Europe Hip Fractures Swedish citizen follow up human epidemiology risk assessment middle aged immigration hip fracture clinical assessment tool statistics and numerical data priority journal Aged USSR African ethnology groups by age procedures Sweden North America migrant Humans male Emigrants and Immigrants female South America Aged, 80 and over very elderly Pacific islands fragility fracture fracture risk assessment tool Osteoporotic Fractures Incidence Article major clinical study adult migration cohort analysis Emigration and Immigration
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84944357368&doi=10.1007%2fs00198-015-3180-4&partnerID=40&md5=4a562d710134be16bc665e43416cdcab
DOI: 10.1007/s00198-015-3180-4
ISSN: 0937941X
Cited by: 13
Original Language: English