Risk factors predicting the 'time to first fracture' and its association with imminent fractures: a substudy of the FRISBEE cohort.

Only previous glucocorticoid use and rheumatoid arthritis were predictors of an early fracture (< 2 years after inclusion). A shorter 'time to first fracture' was not an independent clinical risk factor for imminent fractures. PURPOSE: Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter 'time to first fracture' and its impact on imminent fractures are unknown. METHODS: We studied the concept of 'time to first fracture' in the FRISBEE ("Fracture RIsk Brussels Epidemiological Enquiry") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined 'time to first fracture' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment. RESULTS: Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. 'Time to first fracture' was not an independent risk factor for imminent fractures. CONCLUSION: Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The 'time to first validated fracture' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the 'time to first fracture'.

Dietary disparities among adolescents according to individual and school socioeconomic status: a multilevel analysis.

This study aimed to estimate disparities in dietary habits according to the individual and contextual socioeconomic status (SES), while taking into account school nutrition-related characteristics. Data came from the 2018 cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey. Multilevel multiple logistic regressions were performed. Over two-thirds of the observed variance was explained by individual and school characteristics, with SES being the main contributors. For example, 76.9% of the variance in daily sugar-sweetened beverage (SSB) intake was explained by individual and school characteristics. Adolescents of a secondary or lower parental education level were more likely to consume SSB daily than those of a post-secondary level (aOR = 1.46 (1.29-1.66)). Compared to those in a high SES school, the odds to consume SSB daily was higher for adolescents in low SES schools (aOR = 2.37(1.90-2.96)). These findings support the need for schools to pursue a consistent nutrition policy, with an increased support in low socioeconomic populations.