In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking. In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool. The risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients. This analysis included a total of 1,691,024 participants (61.2

Objective: To assess the feasibility of providing dance groups to people with recent acquired brain injuries (ABIs) in a hospital rehabilitation outpatient setting. Design: A mixed methods exploratory trial that included qualitative interviews and a single blind randomized controlled trial comparing 10 weeks (3 per wk: 30 sessions) of dance group to circuit group. Setting: A day rehabilitation outpatient setting in a tertiary hospital in South Australia. Participants: A total of 49 participants (N=49) with ABI consented and were randomly divided. Interventions: Patients were randomly divided to a 10-week program of either dance group (n=25) or physiotherapy circuit group (n=24). The intervention was completed by 84% of dance participants and 87% of physiotherapy circuit group participants. Main Outcome Measures: Primary outcome measure was health-related quality of life measured with Short Form-36. Secondary outcomes included a battery of assessments of balance, function, mobility, mood, and cognition. Feasibility outcomes included information on enrolment rates, attendance, participant satisfaction, and adverse events. Results: Physical outcomes were comparable between the 2 groups (with no adverse outcomes), but gains in the mental health component of quality of life measures were observed in the dance group only, including energy/fatigue and emotional well-being. Qualitative results indicated that participants found both dance and circuit groups enjoyable and acceptable. Participants offered that dance had complemented other aspects of their rehabilitation. Conclusions: Dance groups in rehabilitation outpatient settings appear a safe, feasible therapeutic option post ABI, with significant gains in health-related quality of life, mood, and fatigue measures. Findings support feasibility to progress to a larger cluster randomized controlled trial to assess cost effectiveness and implementation issues in rehabilitation services generally.

The relationship between bone mineral density (BMD) at the femoral neck and fracture risk was determined in a meta-analysis of primary data of 307205 men and women from 53 cohort studies. Low BMD was an important predictor of fracture risk, particularly for hip fracture. This study aimed to quantify the relationship between DXA-measured femoral neck BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value on fracture risk, with a view to updating FRAX®. We studied 307,205 men and women from within 53 predominately population-based cohorts followed up for an average of 8.7 years and a total of 2,683,185 person-years. The association of BMD and fracture risk was examined using a Poisson model in each cohort separately by sex. Results were expressed as a gradient of risk (GR, hazard ratio/standard deviation decrease in BMD). The different studies were then merged using weighted coefficients. Most hip fractures arose in men and women with low bone mass or osteoporosis at baseline (73 = 0.12 for women and p = 0.89 for men). A significant decrease in GR for hip fracture was observed with increasing duration of follow-up, but the magnitude of the effect was modest compared with the effect of age. For other fracture outcomes, including non-hip major osteoporotic fracture, the gradient of risk was lower than for hip fracture. Femoral neck BMD is a risk factor for fracture of substantial importance, particularly for future hip fracture. The lower magnitude of association at older age is consistent with other non-skeletal factors contributing to hip fracture risk with advancing age. Its validation on an international basis supports its use in case finding strategies. Its use should, however, take account of the variations in predictive value of BMD with age, sex, length of follow-up, and BMD.

In the largest meta-analysis of international cohorts to date, a family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. Parental and sibling histories of fracture carry the same significance for future fracture, including the impact of family hip fracture on future hip fracture risk. PURPOSE:We have undertaken a meta-analysis of international prospective cohorts to quantify the relationship between a family history of fracture and future fracture incidence. METHODS:The analysis dataset comprised 350,542 men and women from 42 cohorts in 29 countries followed for 2.8 million person-years. We investigated the relationship between family history of hip fracture or any fracture and the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture alone using an extended Poisson model in each cohort. Models were adjusted for current age, sex, BMD, and follow-up time. RESULTS:As no difference in influence of family history of fracture was seen between genders, results are presented for men and women combined. A parental history of hip fracture was associated with a higher risk of incident fracture across all fracture outcome categories, with a stronger relationship with future hip fracture (hazard ratios (HR, 95% CI) for hip and MOF 1.37, 1.23-1.52 and 1.19, 1.12-1.27, respectively). Associations were slightly reduced but remained significant when additionally adjusted for BMD and did not vary by baseline offspring age, follow-up time, or parent affected. In a more limited analysis, parental history of any fracture or a sibling history of hip or any fracture showed similar associations to those observed with parental history of hip fracture. CONCLUSIONS:A family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. While parental hip fracture appears the strongest factor for future hip fracture, a family history of other fractures might be appropriate for inclusion in future iterations of the FRAX tool.

Background/Objectives: Evidence regarding the associations between coffee and tea consumption and bone mineral density (BMD) in postmenopausal women remains inconclusive. Prior studies have not examined these relationships using repeated measures of both beverage intake and BMD over an extended follow-up. This study aimed to evaluate the longitudinal associations of coffee and tea consumption with BMD in older women. Methods: Data were drawn from the Study of Osteoporotic Fractures (SOF), a prospective cohort of 9704 women aged ≥65 years. Coffee and tea intake were repeatedly assessed via self-administered questionnaires at visits 2, 4, 5, and 6, spanning approximately 10 years. Femoral neck and total hip BMD were repeatedly measured by dual-energy X-ray absorptiometry. Linear mixed-effects models with random intercepts were used to estimate associations, adjusting for demographic, physical activity, comorbidities, and medication use. Nonlinear relationships were assessed using natural splines, and subgroup analyses were conducted using exposure-by-covariate interaction terms. Results: During the 10-year follow-up, tea consumption was positively associated with total hip BMD (least squares mean: 0.718 vs. 0.715 g/cm2; mean difference: 0.003; 95% CI: 0.000–0.005; p = 0.026). No significant overall association was observed on coffee consumption with femoral neck or total hip BMD. However, spline analyses suggested that consuming more than five cups of coffee per day may be associated with lower BMD. Interaction analyses indicated significant interactions between coffee and alcohol intake (p = 0.0147) and between tea consumption and BMI (p = 0.0175). Conclusions: Tea consumption was associated with higher total hip BMD in postmenopausal women, whereas excessive coffee intake (>5 cups/day) may adversely affect BMD. Coffee consumption was negatively associated with femoral neck BMD in women with higher alcohol intake, while tea consumption appeared particularly beneficial for those with obesity.

Hip fractures in elderly women pose significant healthcare challenges. Promoting walking for exercise as a cost-effective intervention may help reduce the risk of fractures in this population. This study aimed to examine the relationship between walking and hip fracture risk among women aged 65 years and older. A 20-year prospective study (1986–2006) included 9704 women from the Study of Osteoporotic Fractures (SOF) in the USA. Participants were followed biennially, and walking exposure was assessed by the number of city blocks walked for exercise, routine activity, and total blocks walked daily. Cox regression models with time-varying covariates assessed associations, with competing risks addressed using Fine and Gray models. Penalized splines were used to explore dose–response relationships. In total, 1419 hip fractures were identified through the study period. The mean and median follow-up times for hip fractures or censoring were 15.0 and 15.8 years in the walking for exercise group, vs. 13.2 and 13.7 years in the not walking for exercise group. The hip fracture incidence rate was 10.0 cases per 1000 person-years (py) in the walking for exercise group compared to 10.9 per 1000 py in the not walking for exercise group. All-cause mortality was 37.1 per 1000 py in the walking for exercise group compared to 46.4 per 1000 py in the not walking for exercise group. Adjusted models showed that walking for exercise significantly reduced hip fracture risk (HR, 0.864; 95

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3

Using data from a meta-analysis including 606,715 women, we found that the predictive value of a fall the past year for future hip fractures in women significantly decreases with age, resulting in a diminishing population attributable risk with increasing age.PurposeIn a recent meta-analysis of 40 cohorts, we demonstrated that a fall history in the past year was associated with an increased risk of hip fracture. An interaction between fall history and age was observed in women, with lower hazard ratios (HR) for older women. This study aimed to determine the population-attributable risk (PAR) for hip fracture due to increased fall risk in women of different ages.MethodsFall history associated attributable risk (AR, %) for hip fracture was calculated [100(1-1/relative risk (HR))] for women per age stratum, using previously calculated HRs. PAR (%) of hip fractures in the female population (>= 50 years) that could be prevented if the fall history-mediated risk increase could be eliminated was calculated as 100Pexp(HR-1)/[1 + Pexp(HR-1)] where Pexp was the exposed proportion of the population (i.e. the proportion with past falls).ResultsA total of 606,715 women included from 40 cohorts, with fall risk documented in the past year (fall history yes/no or 2 or more falls) and prospective information about hip fracture and death, were analysed. The proportion of fallers increased progressively with age from 24.6% at age 50-54 years to 45.5% at age 90-94 years. In contrast, the AR due to falls decreased, from 54.8% at age 50-54 years to 8.3% at age 90-94 years, and the PAR diminished with age, from 23.9% in women 50-54 years old to 3.9% in women 90-94 years old.ConclusionsAs falls become more common with age, their predictive value for future hip fractures in women significantly decreases. This suggests that the effectiveness of fall prevention strategies in reducing hip fractures is lower in older women, who are at higher risk for serious falls and hip fractures.

INTRODUCTION:Hip fractures represent a major global health burden, associated with substantial morbidity, mortality, and economic costs, particularly among older adults. With population aging accelerating worldwide, understanding of the epidemiology, cost drivers, and cost-effectiveness of prevention and management strategies is essential for informed resource allocation. AREAS COVERED:This review summarizes the global burden and costs of hip fractures, with emphasis on high-risk groups. We searched the literature in MEDLINE (via Ovid), ScienceDirect, Scopus, PubMed, and Google Scholar. Data from the 2023 Global Burden of Disease study indicate 24.3 million new hip fracture cases globally. Burden and costs vary widely across regions, influenced by demographic trends, healthcare access, and system capacity. The review evaluates the cost-effectiveness of pharmacologic and non-pharmacologic interventions, along with broader health system approaches aimed at reducing incidence, improving treatment pathways, and preventing secondary fractures. EXPERT OPINION:Reducing the growing burden of hip fractures requires a multifaceted approach. While cost-effective interventions exist, their real-world implementation remains uneven. Future priorities include closing care gaps through systematic models, enhancing medication adherence, and tailoring strategies for low-resource settings. Emerging opportunities, such as digital health tools may improve risk stratification and personalize prevention, supporting more sustainable and equitable hip fracture care globally.

Detecting interactions is a critical aspect of medical research. When interactions are present, it is essential to calculate confidence intervals for both the main effect and the interaction effect. This requires determining the covariance between the two effects. In a two-stage individual patient data (IPD) meta-analysis, the coefficients, as well as their variances and covariances, can be calculated for each study. These coefficients can then be combined into an overall estimate using either a fixed-effect or random-effects meta-analysis model. The overall variance of the combined coefficient is typically derived using the inverse-variance method. The most commonly used method for calculating the overall covariance between the main effect and the interaction effect in meta-analysis is multivariate meta-analysis. In this paper, we propose an alternative, straightforward, and transparent method for calculating this covariance when interactions are considered in a meta-analysis. To facilitate implementation, we have developed an R package, ‘covmeta’.

The aim of this international meta-analysis was to quantify the predictive value of BMI for incident fracture and relationship of this risk with age, sex, follow-up time, and BMD. A total of 1 667 922 men and women from 32 countries (63 cohorts), followed for a total of 16.0 million person-years were studied. 293 325 had FN BMD measured (2.2 million person-years follow-up). An extended Poisson model in each cohort was used to investigate relationships between WHO-defined BMI categories (Underweight: <18.5 kg/m2; Normal: 18.5-24.9 kg/m2; Overweight: 25.0-29.9 kg/m2; Obese I: 30.0-34.9 kg/m2; Obese II: ≥35.0 kg/m2) and risk of incident osteoporotic, major osteoporotic and hip fracture (HF). Inverse-variance weighted β-coefficients were used to merge the cohort-specific results. For the subset with BMD available, in models adjusted for age and follow-up time, the hazard ratio (95% CI) for HF comparing underweight with normal weight was 2.35 (2.10-2.60) in women and for men was 2.45 (1.90-3.17). Hip fracture risk was lower in overweight and obese categories compared to normal weight [obese II vs normal: women 0.66 (0.55-0.80); men 0.91 (0.66-1.26)]. Further adjustment for FN BMD T-score attenuated the increased risk associated with underweight [underweight vs normal: women 1.69 (1.47-1.96); men 1.46 (1.00-2.13)]. In these models, the protective effects of overweight and obesity were attenuated, and in both sexes, the direction of association reversed to higher fracture risk in Obese II category [Obese II vs Normal: women 1.24 (0.97-1.58); men 1.70 (1.06-2.75)]. Results were similar for other fracture outcomes. Underweight is a risk factor for fracture in both men and women regardless of adjustment for BMD. However, while overweight/obesity appeared protective in base models, they became risk factors after additional adjustment for FN BMD, particularly in the Obese II category. This effect in the highest BMI categories was of greater magnitude in men than women. These results will inform the second iteration of FRAX®.

Researchers in this study assesses risk behaviors for sexually transmitted infections (STIs) among sexual minority women (SMW) in Beijing, China. A total of 1,631 SMW participated in the study. Compared with women who have sex with women exclusively, women who have sex with both women and men reported more sex partners, more likely sharing sex toys, experiencing STI infections. Digital-genital sex, using sex toys, G-spot stimulation is associated with STI symptoms. SMW in Beijing engaged in high-risk sexual behaviors that may cause substantial risk for STIs. SMW and healthcare providers should be informed and STI testing should be promoted among SMW.

The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). The resource comprised 906,359 women and men (66.9