Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX.

A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted ß-coefficients. RESULTS: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan.

We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).

Long-Term Aspirin Use and Self-Reported Walking Speed in Older Men: The Physicians' Health Study.

BACKGROUND: Mobility limitation is a component of frailty that shares a bidirectional relationship with cardiovascular disease (CVD). Data are limited on the role of established CVD prevention therapies, such as aspirin, for prevention of frailty and mobility limitation. OBJECTIVES: Examine the association between long-term aspirin use and walking speed. DESIGN, SETTING, PARTICIPANTS: Prospective cohort of 14,315 men who participated in the Physicians' Health Study I, a completed randomized controlled trial of aspirin (1982-1988), with extended post-trial follow-up. MEASUREMENTS: Annual questionnaires collected data on aspirin use, lifestyle and other factors. Average annual aspirin use was categorized for each participant: ≤60 days/year and >60 days/year. Mobility was defined according to self-reported walking pace, categorized as: don't walk regularly (reference), easy/casual <2mph, normal ≥2-2.9mph, or brisk/very brisk ≥3mph. Propensity scoring balanced covariates between aspirin categories. Multinomial logistic regression models estimated odds of being in each self-reported walking category. RESULTS: Mean age was 70±8 years; mean aspirin use 11 years. There were 2,056 (14.3%) participants who reported aspirin use ≤60 days/year. Aspirin use >60 days/year was associated with drinking alcohol, smoking, hypertension, heart disease and stroke, while ≤60 days/year was associated with anticoagulation use and bleeding history. In all, 13% reported not walking regularly, 12% walked <2 mph, 44% walked ≥2-2.9 mph, and 31% walked ≥3 mph. After propensity score adjustment, regular aspirin use was associated with a faster walking speed. Odds ratios (95% confidence intervals) were 1.16 (0.97 to 1.39), 1.24 (1.08 to 1.43), and 1.40 (1.21 to 1.63) for <2 mph, ≥2-2.9 mph and ≥3 mph, respectively, compared to not walking regularly (p-trend<0.001). CONCLUSIONS: In this cohort of older men, long-term aspirin use is associated with a greater probability of faster walking speed later in life.

Correction to: The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study.

The original version of this article, published 23 February 2011, unfortunately contained a mistake. The following correction has therefore been made in the original.

Changes in bone mineral density (BMD): a longitudinal study of osteoporosis patients in the real-world setting.

In clinical practice, the frequency of patients achieving improved T-scores and the expected change in bone mineral density (BMD) according to osteoporosis drugs is unknown. We found that osteoporosis medications infrequently achieve improved femoral neck T-scores over 1.2 years. BMD increases were more often seen with IV bisphosphonates and denosumab. PURPOSE: To determine the frequency of osteoporosis patients achieving improvement in T-scores and quantify the change in bone mineral density (BMD) over time according to osteoporosis medication use. METHODS: The study included all patients receiving clinical care at United Osteoporosis Centers, Gainesville, GA, 1995-2015, who had at least two measures of femoral neck BMD (N = 1232). We evaluated successive pairs of BMD tests to describe the distribution of transitions between T-score categories. Generalized estimating equations were used to estimate %BMD change between successive pairs of BMD tests according to osteoporosis medication, adjusted for age, sex, height, weight, baseline BMD, previous fracture, and follow-up time. RESULTS: Mean (±SD) age was 68 (±10) years, and 90% of patients were women. Mean baseline T-score was - 2.04 (± 0.85). In total, 1232 patients had 4918 pairs of successive BMD tests, with a mean 1.2 years (± 0.9) between assessments. Frequency of transition to an improved T-score category was 41% when prior T-score ≤ - 3.5, and 15% when prior T-score - 1.99 to - 1.50. Most individuals (69%) remained in the same T-score category. BMD increased 0.54% (95% CI 0.23-0.85%) with IV bisphosphonates and 1.23% (95% CI 0.56-1.90%) with denosumab, whereas no significant change was seen with oral bisphosphonates, teriparatide, or raloxifene. CONCLUSIONS: Osteoporosis patients are unlikely to improve femoral neck T-scores over 1.2 years. Additional studies are needed to determine the optimal time to repeat BMD testing while receiving osteoporosis treatment and to determine whether fracture risk is reduced in patients who achieve target T-scores.

[In search of the true dosage: statistics applied to the analysis of the cocaine]. / À la recherche du juste dosage : statistique appliquée à l'analyse de la cocaïne.

A method of separation by gas chromatography with a flame ionization detector was developed for quantifying cocaine in powders seized by the police. The method was validated by studying parameters of calibration, trueness, precision based on trueness error (or systematic bias) and random error. Total error, which is the combination of these errors, is used to confirm the method adequacy with the objectives fixed by the analyst. Accuracy profile is an efficient decision tool to do it. Results obtained with weighted regression model allow concluding that the method fits quantitation of heroin and cocaine in powders on 2 to 100% concentration (w/w) domain with 10% limits of acceptation and a risk of 5%.

Functional foot symmetry and its relation to lower extremity physical performance in older adults: the Framingham Foot Study.

BACKGROUND: While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures. METHODS: Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function. RESULTS: Individuals with faster gait speed displayed greater foot function asymmetry; individuals with -3.0% to -9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced. CONCLUSIONS: While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.

The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study.

SUMMARY: We examined the relation between a biomechanical measure, factor-of-risk, and hip fracture risk in 1,100 men and women from the Framingham Study and found that it predicted hip fracture (men, ORs of 1.8; women, 1.2-1.4). INTRODUCTION: Alternative methods of predicting hip fracture are needed since 50% of adults who fracture do not have osteoporosis by bone mineral density (BMD) measurements. One method, factor-of-risk (Φ), computes the ratio of force on the hip in a fall to femoral strength. We examined the relation between Φ and hip fracture in 1,100 subjects from the Framingham Study with measured hip BMD, along with weight, height, and age, collected in 1988-1989. METHODS: We estimated both peak and attenuated force applied to the hip in a sideways fall from standing height, where attenuated force incorporated cushioning effects of trochanteric soft tissue. Femoral strength was estimated from femoral neck BMD, using cadaveric femoral strength data. Sex-specific, age-adjusted survival models were used to calculate hazard ratios (HR) and 95% confidence intervals for the relation between Φ (peak), Φ (attenuated), and their components with hip fracture. RESULTS: In 425 men and 675 women (mean age, 76 years), 136 hip fractures occurred over median follow-up of 11.3 years. Factor-of-risk, Φ, was associated with increased age-adjusted risk for hip fracture. One standard deviation increase in Φ (peak) and Φ (attenuated) was associated with HR of 1.88 and 1.78 in men and 1.23 and 1.41 in women, respectively. Examining components of Φ, in women, we found fall force and soft tissue thickness were predictive of hip fracture independent of femoral strength (was estimated from BMD). CONCLUSIONS: Thus, both Φ (peak) and Φ (attenuated) predict hip fracture in men and women. These findings suggest additional studies of Φ predicting hip fracture using direct measurements of trochanteric soft tissue.

One year variability of peak heights, heterozygous balance and inter-locus balance for the DNA positive control of AmpFℓSTR© Identifiler© STR kit.

Multivariate analyses of 205 positive control experiments in an AmpFℓSTR© Identifiler© STR kit were used to analyze the factors affecting peak heights at 16 loci. Peak heights were found to be highly correlated between loci and there was evidence for a difference in sensitivity of the two genetic analyzers in the blue channel. Heterozygous balance response at 10 loci was found to behave as a random variable following a beta-distribution with typical median values of 90%, without locus or genetic analyzer effect. Inter-locus balance at 16 loci was influenced by the blue channel effect and a temporal switch of unexplained origin. The implications of these results for the choice of minimum threshold values in quality control are discussed.

Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study.

OBJECTIVE: To examine potential risk factors for hallux valgus in community-dwelling elders. METHOD: Data from 600 MOBILIZE Boston Study participants (386 women and 214 men) were analyzed. Hallux valgus was defined as >15 degrees angular deviation of the hallux with respect to the first metatarsal bone toward the lesser toes. Associations of hallux valgus with age, body mass index (BMI), race, education, pes planus, foot pain, and in women, history of high heel shoe use, were assessed using sex-specific Poisson regression with robust variance estimation for risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Hallux valgus was present in 58% of women and 25% of men. Higher BMI was inversely associated with presence of hallux valgus in women (P trend=0.001), with the strongest inverse association observed in those with BMI of 30.0 or more compared to those with normal BMI (RR=0.7, 95% CI: 0.5, 0.9). Women, who usually wore high-heeled shoes during ages 20-64 years compared to those who did not, had increased likelihood of hallux valgus (RR=1.2, 95% CI: 1.0, 1.5). Among men, those with BMI between 25.0 and 29.9 had increased likelihood of hallux valgus compared to those with normal BMI (RR=1.9, 95% CI: 1.0, 3.5). Men with pes planus were more likely to have hallux valgus (RR=2.1, 95% CI: 1.3, 3.3) compared to men without pes planus. CONCLUSION: In women, hallux valgus was associated with lower BMI and high heel use during ages 20-64, while in men, associations were observed with higher BMI and pes planus. Our results suggest that the etiologic mechanisms for hallux valgus may differ between men and women.

Genetic markers in the playground of multivariate analysis.

Multivariate analyses such as principal component analysis were among the first statistical methods employed to extract information from genetic markers. From their early applications to current innovations, these approaches have proven to be efficient for the analysis of the genetic variability in various contexts such as human genetics, conservation and adaptation studies. However, because multivariate analysis is a wide and diversified area of statistics, choosing a method appropriate to both the data and to the question being asked can be difficult. Moreover, some particularities of genetic markers need to be taken into account when using multivariate methods. As a consequence, multivariate analyses are often used as black boxes, which results in frequent mistakes in the literature. In this review, we provide a critical analysis of the application of multivariate methods to genetic markers, using a general framework that unifies all these methods for the sake of clarity. First, we focus on some common mistakes in these applications and ways to avoid these pitfalls. We then detail the most critical particularities of allele frequencies that demand adaptations of multivariate methods, and we propose solutions to the subsequent problems. Finally, we tackle several questions of interest in which multivariate analysis has a great role to play, such as the study of the typological coherence of different genetic markers, or the investigation of spatial genetic patterns.

Revealing cryptic spatial patterns in genetic variability by a new multivariate method.

Increasing attention is being devoted to taking landscape information into account in genetic studies. Among landscape variables, space is often considered as one of the most important. To reveal spatial patterns, a statistical method should be spatially explicit, that is, it should directly take spatial information into account as a component of the adjusted model or of the optimized criterion. In this paper we propose a new spatially explicit multivariate method, spatial principal component analysis (sPCA), to investigate the spatial pattern of genetic variability using allelic frequency data of individuals or populations. This analysis does not require data to meet Hardy-Weinberg expectations or linkage equilibrium to exist between loci. The sPCA yields scores summarizing both the genetic variability and the spatial structure among individuals (or populations). Global structures (patches, clines and intermediates) are disentangled from local ones (strong genetic differences between neighbors) and from random noise. Two statistical tests are proposed to detect the existence of both types of patterns. As an illustration, the results of principal component analysis (PCA) and sPCA are compared using simulated datasets and real georeferenced microsatellite data of Scandinavian brown bear individuals (Ursus arctos). sPCA performed better than PCA to reveal spatial genetic patterns. The proposed methodology is implemented in the adegenet package of the free software R.

Eigenanalysis of selection ratios from animal radio-tracking data.

The development of methods to analyze habitat selection when resources are defined by several categories (e.g., vegetation types) is a topical issue in radio-tracking studies. The White and Garrott statistic, an extension of the widely used test of Neu et al., can be used to determine whether habitat selection is significant. As well, Manly's selection ratio, a particularly useful measure of resource selectivity by resource users, allows detection of the most strongly selected habitat types. However, when both the number of animals and types of habitat are large, the biologist often has to deal with an excessively large number of measures. In this paper we present a new method, the eigenanalysis of selection ratios, that generalizes these two common methods within the framework of eigenanalyses. This method undertakes an additive linear partitioning of the White and Garrott statistic, so that the difference between habitat use and availability is maximized on the first factorial axes. The eigenanalysis of selection ratios is therefore optimal in habitat selection studies. Although we primarily consider the case where the habitat availability is the same for all animals (design II), we also extend this analysis to the case where the habitat availability varies from one animal to another (design III). An application of this method is provided using radio-tracking data collected on 17 squirrels in five habitat types. The results indicate variability in habitat selection, with two groups of animals displaying two patterns of preference. This difference between the two groups is explained by the patch structure of the study area. Because this method is mainly exploratory, and therefore does not rely on any distributional assumption, we recommend its use in studies of habitat selection.

From dissimilarities among species to dissimilarities among communities: a double principal coordinate analysis.

This paper presents a new ordination method to compare several communities containing species that differ according to their taxonomic, morphological or biological features. The objective is first to find dissimilarities among communities from the knowledge about differences among their species, and second to describe these dissimilarities with regard to the feature diversity within communities. In 1986, Rao initiated a general framework for analysing the extent of the diversity. He defined a diversity coefficient called quadratic entropy and a dissimilarity coefficient and proposed a decomposition of this diversity coefficient in a way similar to ANOVA. Furthermore, Gower and Legendre (1986) built a weighted principal coordinate analysis. Using the previous context, we propose a new method called the double principal coordinate analysis (DPCoA) to analyse the relation between two kinds of data. The first contains differences among species (dissimilarity matrix); the second the species distribution among communities (abundance or presence/absence matrix). A multidimensional space assembling the species points and the community points is built. The species points define the original differences between species and the community points define the deduced differences between communities. Furthermore, this multidimensional space is linked with the diversity decomposition into between-community and within-community diversities. One looks for axes that provide a graphical ordination of the communities and project the species onto them. An illustration is proposed comparing bird communities which live in different areas under mediterranean bioclimates. Compared to some existing methods, the double principal coordinate analysis can provide a typology of communities taking account of an abundance matrix and can include dissimilarities among species. Finally, we show that such an approach generalizes some of these methods and allows us to develop new analyses.

Differences in lactate exchange and removal abilities in athletes specialised in different track running events (100 to 1500 m).

The purpose of this study was to investigate whether track running specialisation could be associated with differences in the ability to exchange and remove lactate. Thirty-four male high-level runners were divided into two groups according to their specialty (100 - 400 m/800 - 1500 m). All performed a 1-min 25.2 km x h -1 event, followed by a 90-min passive recovery to obtain individual blood lactate recovery curves which were fitted to a bi-exponential time function: [La](t) = [La](0) + A 1 (1-e -gamma1t) + A 2 (1-e -gamma2t). The velocity constant gamma 1 which denotes the ability to exchange lactate between the previously worked muscles and blood was higher (p < 0.001) in middle-distance runners than in sprint runners. The velocity constant gamma 2 which reflects the overall ability to remove lactate did not differ significantly between the two groups. gamma 1 was positively correlated with the best performance over 800 m achieved by 16 athletes during the outdoor track season following the protocol (r = 0.55, p < 0.05). In conclusion, the lactate exchange ability seems to play a role on the athlete's capacity to sustain exercise close to 2-min-duration and specifically to run 800 m.

Time to exhaustion at VO(2)max is related to the lactate exchange and removal abilities.

The aim of the present study was to investigate the relationships between lactate exchange and removal abilities and the capacity to prolong exercise, as assessed by the time to exhaustion (Tlim) at a work rate corresponding to VO(2)max (Pa max ). The individual blood lactate recovery curves obtained for 13 untrained subjects after 5 min 90 % Pa max exercise were fitted to the biexponential time function: La(t) = La(0) + A(1) (1-e (-gamma(1) x t) + A(2) (1-e (-gamma(2) x t), where t is time into the recovery, La(0) is the arterialized lactate concentration measured at the end of the exercise, gamma(1) and gamma(2) are velocity constants denoting the lactate exchange and removal abilities, respectively. Tlim was positively related to gamma(1) and gamma(2) (r = 0.60, p < 0.05 and r = 0.56, p < 0.05, respectively) but was negatively related to La(0) (r = 0.75, p < 0.01). gamma()1 was positively related to the capillary density (r = 0.69, p < 0.01) and to the number of capillaries per type I fiber area (r = 0.62, p < 0.05). It was concluded that 1) high lactate exchange and removal abilities would allow continuing a high-intensity exercise for a longer duration, and 2) a high capillary density may explain the associated high lactate exchange ability.

Leg strength and stiffness as ability factors in 100 m sprint running.

BACKGROUND: The purpose of this study was to determine the importance of leg strength and stiffness relative to i) 100 m sprint performance, ii) mean speed on the three phases of the 100 m race (30-60-100 m) and iii) the speed differences between these phases. METHODS: Nineteen regional to national level male sprinters competed in a 100 m race. Video analysis was used to determine mean velocity parameters. Two subgroups were created since some of the runners decreased their velocity during the third phase (G1), whereas others maintained or accelerated it (G2). Leg strength (concentric half-squats - counter movement jump) and stiffness (hopping) were determined. Simple (r) and multiple regressions (R) were used. RESULTS: The mean performance over 100 m was 11.43 sec (10.72-12.87 sec). The concentric half-squats were related to 100 m (r=0.74, p<0.001) and to the mean speed of each phase (R=0.75, p<0.01). The counter movement jump was related to 100 m (r=0.57, p<0.05) and was the predictor of the first phase (r=0.66, p<0.01). The hopping test was the predictor of the two last phases (R=0.66, p<0.05). Athletes who had the greatest leg stiffness (G1) produced the highest acceleration between the first and the second phases, and presented a deceleration between the second and the third ones. CONCLUSIONS: The concentric half-squats test was the best predictor in the 100 m sprint. Leg stiffness plays a major role in the second phase.

Influence of changes in nasal ventilation on estimated workload during submaximal field running.

BACKGROUND: Breathe Right (BR) external nasal dilator have become increasingly popular over the past few years, however, the physiological basis for using BR remains unclear. We have examined whether alteration in nasal ventilation would influence the metabolic cost of submaximal running. METHODS: Metabolic cost was estimated in 10 male endurance triathletes by measuring heart rate (HR) and exercise perception by measuring the rate of perceived exertion (RPE) during submaximal field running. The protocol consisted of 5 min of running at 80% of their maximal aerobic velocity (MAV(f), previously determined under field conditions) for three randomised experimental conditions, separated by a 10 min rest. The conditions were normal nasal ventilation (N), no nasal ventilation (using a nose clip) (NC) and with a BR. RESULTS: Running with the BR or with NC did not significantly influence HR (N: 173+/-7, BR: 173+/-8, NC: 172+/-7 beat x min(-1); F=0.01, p=0.99) or RPE (N: 12.1+/-1.7, BR: 11.8+/-1.9, NC: 13.2+/-0.8; F=1.88, p=0.18). We conclude that alteration in nasal ventilation produced by using BR or NC do not influence HR or RPE in a group of triathletes running 5 min at 80% of MAV(f). CONCLUSIONS: The present study tended to demonstrate that both nasal ventilation would not influence the total metabolic cost, and that the BR device is not advantageous during high intensity exercise.

Hydrodynamics optimization in butterfly swimming: position, drag coefficient and performance.

A kinematic study allowed to define the three most propulsive positions during a butterfly swimming cycle, which were: the end of the external sweep, the end of the internal sweep and the end of thrust. These instantaneous positions were different for the ex-world champion Pankratov when compared to another swimmer. Using manikins and a drag-measuring device, we showed that the end of the internal sweep induced the highest drag values and that Pankratov may reduce energy expenditure by taking up a particular position during the end of the swimming cycle. These results point out the relations between swimming movements, passive drag and swimmers' performance.

Frequency-dependent maintenance of left handedness in humans.

The percentage (10-13%) of left handedness in human has apparently not changed since the Neolithic. Left handedness is heritable and appears to be repeatedly associated with some reduced fitness components; the persistence of left handedness implies that left handers have a fitness advantage in some situations. We propose that left handers have a frequency-dependent advantage in fights and for that reason a fitness advantage. To test this hypothesis, left handedness frequencies in the general population and in sporting individuals (both students and the sporting elite) have been compared, as sporting performance is likely to be a good indicator of fighting abilities. The higher proportion of left-handed individuals in interactive sports (reflecting some fighting elements), reaching 50% in some sports categories, but not in noninteractive sports, is consistent with the fighting hypothesis. The greater frequency of left handedness in males than in females is also consistent with this hypothesis, as male-male fights are universally more frequent than other combinations. The frequency-dependent advantage in fights of left handers might explain the stability of left handedness.