Risk Factors for First Incident Fragility Fracture in Middle-Aged and Older Women: the Canadian Longitudinal Study on Aging

Abstract Fragility fracture is a major cause of chronic disease morbidity leading to reduced life quality and quantity in middle-aged and older women. Many risk factors have been identified but the relative contribution of each of them when being considered simultaneously remains unclear. We conducted a secondary analysis using data from a large Canadian prospective cohort study to investigate, among all the known risk factors, which are statistically independently associated with a first incident fragility fracture in middle-aged and older women after mutual adjustment. A total of 10,930 female participants with a mean age of 61.70 ± SD 10.00 years old were included in the analytical sample. 1048 fracture events were self reported during the six-year follow-up. Multivariate logistic regression considering only variables feasible to obtain during a single primary care visit revealed that eight factors were associated with increased fracture risk and were robust across all analyses including adjustment for bone mineral density T-score total hip and after multiple imputation for missing data. These factors are currently taking antidepressants [OR 1.29 (1.18, 1.42), p=.0060], impaired balance [OR 1.34 (1.21, 1.49), p=.0041], epilepsy [OR 2.18 (1.66, 2.87), p=.0043], lower hand grip strength [OR 0.97 (0.96, 0.98) per kg, p<.0001], greater height [OR 1.03 (1.02, 1.03) per cm, p<.0001], osteoarthritis [OR 1.19 (1.10, 1.29), p=.0234], parental hip fracture after age 50 [OR 1.30 (1.18, 1.43), p=.0068] and a personal history of fall in the past 12 months [OR 1.78 (1.61, 1.96), p<.0001]. These findings suggest that middle-aged and older women with such factors may be at higher risk of sustaining fracture in near future and could benefit from clinical attention and targeted preventive strategies.