BMJ 1999;319:1334-1337 ( 20 November )

Papers

Genetic factors and osteoporotic fractures in elderly people: prospective 25 year follow up of a nationwide cohort of elderly Finnish twins

Pekka Kannus, chief physician, a Mika Palvanen, research fellow, a Jaakko Kaprio, professor, b Jari Parkkari, research fellow, a Markku Koskenvuo, professor. c

a Accident and Trauma Research Center and the Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, PO Box 30, FIN-33501 Tampere, Finland, b Department of Public Health, University of Helsinki, PO Box 41, FIN-00014, Helsinki, Finland, c Department of Public Health, University of Turku, FIN 20520, Turku, Finland

Correspondence to: P Kannus UKK Institute, Kaupinpuistonkatu 1, FIN-33500 Tampere, Finland klpeka{at}uta.fi

Objective: To determine whether genetic factors partly explain variation in risk of osteoporotic fracture, the true end point of the osteoporosis problem.
Design: Prospective 25 year follow up of a nationwide cohort of elderly Finnish twins.
Setting: The Finnish twin cohort and the national hospital discharge register, covering the entire 5 million population of Finland.
Subjects: All same sex twin pairs born before 1946. The cohort contained 2308 monozygotic and 5241 dizygotic twin pairs (15 098 people) at the beginning of follow up.
Main: outcome measure The number and concordance of osteoporotic fractures in the twin pairs, 1972-96.
Results: 786 cohort members sustained an osteoporotic fracture. In women, the pairwise concordance rate for fracture (that is, the relative number of twin pairs in whom the fracture affected both twins in a pair) was 9.5% (95% confidence interval 5.3% to 15.5%) in monozygotic pairs and 7.9% (5.2% to 11.4%) in dizygotic pairs. In men, the figures were 9.9% (4.4% to 18.5%) and 2.3% (0.6% to 5.7%).
Conclusions: Susceptibility to osteoporotic fractures in elderly Finns is not strongly influenced by genetic factors, especially in elderly women. The traditional strategy for prevention of osteoporotic fractures---that is, increasing peak bone mass and preventing age related bone loss---should be changed to include new elements such as prevention of falls and protection of the critical anatomical sites of the body when a fall occurs.


Key messages

  • Genetic factors have a substantial role in explaining age specific variation in bone mass and density, but no previous study has directly evaluated whether they have a role in the variation of risk of osteoporotic fracture, the true end point of the entire osteoporosis problem

  • Genetic factors are not strongly related to likelihood of osteoporotic fracture, particularly in elderly women

  • For this reason, the traditional prevention strategy of osteoporotic fractures---increasing peak bone mass and preventing age related bone loss---could include new additional elements, such as prevention of falls in elderly people and protection of the critical anatomical sites of the body when a fall occurs




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Relevant Articles

Genetic factors and osteoporotic fractures in elderly people
Alex J MacGregor, Harold Snieder, Tim D Spector, Andrea Nemetz, Amado Salvador Pena, Pekka Kannus, Jaakko Kaprio, Markku Koskenvuo, Mika Palvanen, and Jari Parkkari
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Rapid Responses:

Read all Rapid Responses

Twin data support a genetic contribution to fracture risk
Alex J MacGregor
bmj.com, 13 Dec 1999 [Full text]
On the genetic contribution of osteoporosis and osteoporotic fractures
Amado Salvador Pena
bmj.com, 23 Dec 1999 [Full text]
Authors' reply
Pekka Kannus
bmj.com, 3 Mar 2000 [Full text]
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