Having established the geographic and secular epidemiology of hip fracture, we are surveying the published literature to generate similar information for vertebral and distal forearm fracture. Using the international multicentre GLOW cohort, containing 60,000 postmenopausal women, we are investigating the role of comorbidities and risk perception on the incidence of osteoporotic fracture. Further assessment of the role of comorbidities in fracture risk is underway using CPRD, and registries in Denmark and Sweden, together with assessments of the comparative safety and effectiveness of antiosteoporosis medications in UK primary care settings. We have established a theme of investigation using the UK Biobank cohort, aiming at elucidating, in this prospective study of 500,000 UK adults, interactions between environmental and genetic determinants of fracture pathogenesis.

Age – and sex-specific fracture incidence rate at any site among adults, 1988-2012, CPRD.

These studies will characterise further the global impact of osteoporotic fracture and elucidate novel pathogenetic mechanisms and markers of fracture risk, which should inform approaches to risk assessment and the development of novel therapies aimed at improving bone mass.