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Leukocyte telomere length (LTL) was measured in baseline samples using a validated polymerase chain reaction (PCR) method. We used, in men and women separately, Cox proportional hazards models to calculate the hazard ratio (HR) for incident fracture (any, osteoporotic) or arthroplasty (hip or knee) over 1,186,410 person-years of follow-up. Covariates included age, white cell count, ethnicity, smoking, alcohol, physical activity, and menopause (women). In further analyses we adjusted for either estimated bone mineral density (eBMD) from heel quantitative ultrasound, handgrip strength, gait speed, total fat mass (bioimpedance), or blood biomarkers, all measured at baseline (2006\u20132010). We studied 59,500 women and 51,895 men, mean \u00b1 standard deviation (SD) age 56.4\u2009\u00b1\u20098.0 and 57.0\u2009\u00b1\u20098.3\u2009years, respectively. During follow-up there were 5619 fractures; 5285 hip and 4261 knee arthroplasties. In confounder-adjusted models, longer LTL was associated with reduced risk of incident knee arthroplasty in both men (HR\/SD 0.93; 95% confidence interval [CI], 0.88\u20130.97) and women (0.92; 95% CI, 0.88\u20130.96), and hip arthroplasty in men (0.91; 95% CI, 0.87\u20130.95), but not women (0.98; 95% CI, 0.94\u20131.01). Longer LTL was weakly associated with reduced risk of any incident fracture in women (HR\/SD 0.96; 95% CI, 0.93\u20131.00) with less evidence in men (0.98; 95% CI, 0.93\u20131.02). Associations with incident outcomes were not materially altered by adjustment for heel eBMD, grip strength, gait speed, fat mass, or blood biomarker measures. In this, the largest study to date, longer LTL was associated with lower risk of incident knee or hip arthroplasty, but only weakly associated with lower risk of fracture. The relative risks were low at a population level, but our findings suggest that common factors acting on the myeloid and musculoskeletal systems might influence later life musculoskeletal outcomes. \u00a9 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4664","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T06:44:03Z","timestamp":1658817843000},"page":"1997-2004","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Telomere Length and Risk of Incident Fracture and Arthroplasty: Findings From UK Biobank"],"prefix":"10.1093","volume":"37","author":[{"given":"Elizabeth M.","family":"Curtis","sequence":"first","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre University of Southampton Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veryan","family":"Codd","sequence":"additional","affiliation":[{"name":"NIHR Leicester Biomedical Research Centre Glenfield Hospital Leicester UK"},{"name":"Department of Cardiovascular Sciences 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of Public Health and Primary Care University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Matthews","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences and UK Dementia Research Institute Centre Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Tobias","sequence":"additional","affiliation":[{"name":"Medical Research Council Integrative Epidemiology Unit University of Bristol Bristol UK"},{"name":"Musculoskeletal Research Unit University of Bristol Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Danesh","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Wellcome Sanger Institute Hinxton UK"},{"name":"Health Data Research UK Cambridge Wellcome Genome Campus and University of Cambridge Cambridge UK"},{"name":"British Heart Foundation Centre of Research Excellence University of Cambridge Cambridge UK"},{"name":"National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics University of Cambridge Cambridge UK"},{"name":"British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-0709","authenticated-orcid":false,"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre University of Oxford Oxford UK"},{"name":"National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre University of Southampton and University Hospital Southampton NHS Foundation Trust Southampton UK"},{"name":"MRC Lifecourse Epidemiology Centre University of Southampton Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh J.","family":"Samani","sequence":"additional","affiliation":[{"name":"NIHR Leicester Biomedical Research Centre Glenfield Hospital Leicester UK"},{"name":"Department of Cardiovascular Sciences University of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-2512","authenticated-orcid":false,"given":"Nicholas C.","family":"Harvey","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre University of Southampton and University Hospital Southampton NHS Foundation Trust Southampton UK"},{"name":"MRC Lifecourse Epidemiology Centre University of Southampton Southampton 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