Elsevier

Bone Reports

Volume 6, June 2017, Pages 145-158
Bone Reports

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

https://doi.org/10.1016/j.bonr.2017.04.003Get rights and content
Under a Creative Commons license
open access

Highlights

  • Higher standardized hip fracture rates were seen for indigenous than non-indigenous persons from Canada and Australia.

  • Compared to non-indigenous persons, indigenous persons had higher standardized rates of craniofacial fractures.

  • There may be many varied reasons for differences in fracture rates and risk according to indigenous status.

  • Communities, governments and professionals need to act in order to prevent trauma-related fractures in indigenous persons.

  • Osteoporotic fractures are mostly preventable in all populations.

Abstract

Background

Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences.

Methods

On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries.

Results

Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture.

Conclusions

The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

Keywords

Fracture
Incidence
Indigenous peoples
Risk factors
Systematic review

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