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Epidemiology of hip fracture: Worldwide geographic variation

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Abstract

Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north–south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates) and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.

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References

  1. Mithal A, Dhingra V, Lau E. The asian audit: Epidemiology, costs and burden of osteoporosis in Asia. Beizing, China: An International Osteoporosis Foundation (IOF) publication; 2009.

    Google Scholar 

  2. Cooper C, Campion G, Melton L J 3rd. Hip fractures in the elderly: A world-wide projection. Osteoporos Int 1992;2:285–9.

    Article  CAS  PubMed  Google Scholar 

  3. Johnell O, Gullberg B, Allander E, Kanis JA. The apparent incidence of hip fracture in Europe: A study of national register sources. MEDOS Study Group. Osteoporos Int 1992;2:298–302.

    Article  CAS  PubMed  Google Scholar 

  4. Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R. Increasing incidence of hip fracture in Tottori Prefecture, Japan: Trend from 1986 to 2001. Osteoporos Int 2005;16:1963–8.

    Article  PubMed  Google Scholar 

  5. Koh LK, Saw SM, Lee JJ, Leong KH, Lee J; National Working Committee on Osteoporosis. Hip fracture incidence rates in Singapore 1991–1998. Osteoporos Int 2001;12:311–8.

    Article  CAS  PubMed  Google Scholar 

  6. Lim S, Koo BK, Lee EJ, Park JH, Kim MH, Shin KH, et al. Incidence of hip fractures in Korea. J Bone Miner Metab 2008;26:400–5.

    Article  PubMed  Google Scholar 

  7. Lau EM, Cooper C, Fung H, Lam D, Tsang KK. Hip fracture in Hong Kong over the last decade—a comparison with the UK. J Public Health Med 1999;21:249–50.

    Article  CAS  PubMed  Google Scholar 

  8. Lau EM, Cooper C, Wickham C, Donnan S, Barker DJ. Hip fracture in Hong Kong and Britain. Int J Epidemiol 1990;19:1119–21.

    Article  CAS  PubMed  Google Scholar 

  9. Xu L, Lu A, Zhao X, Chen X, Cummings SR. Very low rates of hip fracture in Beijing, People’s Republic of China the Beijing Osteoporosis Project. Am J Epidemiol 1996;144:901–7.

    Article  CAS  PubMed  Google Scholar 

  10. Moayyeri A, Soltani A, Larijani B, Naghavi M, Alaeddini F, Abolhassani F. Epidemiology of hip fracture in Iran: Results from the Iranian multicenter study on accidental injuries. Osteoporos Int 2006;17:1252–7.

    Article  CAS  PubMed  Google Scholar 

  11. Memon A, Pospula WM, Tantawy AY, Abdul-Ghafar S, Suresh A, Al-Rowaih A. Incidence of hip fracture in Kuwait. Int J Epidemiol 1998;27:860–5.

    Article  CAS  PubMed  Google Scholar 

  12. Riera-Espinoza G. Epidemiology of osteoporosis in Latin America 2008. Salud Publica Mex 2009;51:S52–5.

    Article  PubMed  Google Scholar 

  13. Clark P, Lavielle P, Franco-Marina F, Ramírez E, Salmerón J, Kanis JA, et al. Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: A population-based study. Osteoporos Int 2005;16:2025–30.

    Article  PubMed  Google Scholar 

  14. Morosano M, Masoni A, Sanchez A. Incidence of hip fractures in the city of Rosario, Argentina. Osteoporos Int 2005;16:1339–44.

    Article  PubMed  Google Scholar 

  15. Zebaze RM, Seeman E. Epidemiology of hip and wrist fractures in Cameroon, Africa. Osteoporos Int 2003;14:301–5.

    Article  PubMed  Google Scholar 

  16. El Maghraoui A, Koumba BA, Jroundi I, Achemlal L, Bezza A, Tazi MA. Epidemiology of hip fracture in 2002 in Rabat, Morocco. Osteoporos Int 2005;16:597–602.

    Article  PubMed  Google Scholar 

  17. Saeed I, Carpenter RD, Leblanc AD, Li J, Keyak JH, Sibonga JD, et al. Quantitative computed tomography reveals the effects of race and sex on bone size and trabecular and cortical bone density. J Clin Densitom 2009;12:330–6.

    Article  PubMed  Google Scholar 

  18. Melton LJ 3rd, Crowson CS, O’Fallon WM. Fracture incidence in Olmsted County, Minnesota: Comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 1999;9:29–37.

    Article  PubMed  Google Scholar 

  19. Melton LJ 3rd, Therneau TM, Larson DR. Long-term trends in hip fracture prevalence: The influence of hip fracture incidence and survival. Osteoporos Int 1998;8:68–74.

    Article  PubMed  Google Scholar 

  20. Rodriguez JG, Sattin RW, Waxweiler RJ. Incidence of hip fractures, United States, 1970-83. Am J Prev Med 1989; 5:175–81.

    Article  CAS  PubMed  Google Scholar 

  21. Bacon WE. Secular trends in hip fracture occurrence and survival: Age and sex differences. J Aging Health 1996;8:538–53.

    Article  CAS  PubMed  Google Scholar 

  22. Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: Age-specific incidence rates in the Framingham Study. Am J Public Health 2002;92:858–62.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Evans JG, Seagroatt V, Goldacre MJ. Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968-86. J Epidemiol Community Health 1997;51:424–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 1999;353:802–5.

    Article  CAS  PubMed  Google Scholar 

  25. Zingmond DS, Melton LJ 3rd, Silverman SL. Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 2004;15:603–10.

    Article  PubMed  Google Scholar 

  26. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA 2009;302:1573–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Leslie WD, O’Donnell S, Lagace C, Walsh P, Bancej C, Jean S, et al. Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int 2010;21:1317–22.

    Article  CAS  PubMed  Google Scholar 

  28. Zain Elabdien BS, Olerud S, Karlstrom G, Smedby B. Rising incidence of hip fracture in Uppsala, 1965-1980. Acta Orthop Scand 1984;55:284–9.

    Article  CAS  PubMed  Google Scholar 

  29. Sernbo I, Gullberg B, Johnell O. Hip fracture in Malmo over three decades. Bone 1993;14:S19–22.

    Article  PubMed  Google Scholar 

  30. Rogmark C, Sernbo I, Johnell O, Nilsson JA. Incidence of hip fractures in Malmo, Sweden, 1992-1995. A trend-break. Acta Orthop Scand 1999;70:19–22.

    Article  CAS  PubMed  Google Scholar 

  31. Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, et al. Epidemiology of hip fractures in Oslo, Norway. Bone 2001;29:413–8.

    Article  CAS  PubMed  Google Scholar 

  32. Giversen IM. Time trends of age-adjusted incidence rates of first hip fractures: A register-based study among older people in Viborg County, Denmark, 1987-1997. Osteoporos Int 2006;17:552–64.

    Article  CAS  PubMed  Google Scholar 

  33. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Nationwide decline in incidence of hip fracture. J Bone Miner Res 2006;21:1836–8.

    Article  PubMed  Google Scholar 

  34. Lonnroos E, Kautiainen H, Karppi P, Huusko T, Hartikainen S, Kiviranta I, et al. Increased incidence of hip fractures. A population based-study in Finland. Bone 2006;39:623–7.

    Article  PubMed  Google Scholar 

  35. Spector TD, Cooper C, Lewis AF. Trends in admissions for hip fracture in England and Wales, 1968-85. BMJ 1990;300:1173–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Balasegaram S, Majeed A, Fitz-Clarence H. Trends in hospital admissions for fractures of the hip and femur in England, 1989-1990 to 1997-1998. J Public Health Med 2001;23:11–7.

    Article  CAS  PubMed  Google Scholar 

  37. Boereboom FT, de Groot RR, Raymakers JA, Duursma SA. The incidence of hip fractures in The Netherlands. Neth J Med 1991;38:51–8.

    CAS  PubMed  Google Scholar 

  38. Goettsch WG, de Jong RB, Kramarz P, Herings RM. Developments of the incidence of osteoporosis in The Netherlands: A PHARMO study. Pharmacoepidemiol Drug Saf 2007;16:166–72.

    Article  PubMed  Google Scholar 

  39. Icks A, Haastert B, Wildner M, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: A populationbased study. Osteoporos Int 2008;19:1139–45.

    Article  CAS  PubMed  Google Scholar 

  40. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R. Incidence of hip fracture over a 10-year period (1991-2000): Reversal of a secular trend. Bone 2007;40:1284–9.

    Article  CAS  PubMed  Google Scholar 

  41. Mann E, Icks A, Haastert B, Meyer G. Hip fracture incidence in the elderly in Austria: An epidemiological study covering the years 1994 to 2006. BMC Geriatr 2008;8:35.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pentek M, Horvath C, Boncz I, Falusi Z, Toth E, Sebestyen A, et al. Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999-2003. Osteoporos Int 2008;19:243–9.

    Article  CAS  PubMed  Google Scholar 

  43. Agnusdei D, Camporeale A, Gerardi D, Rossi S, Bocchi L, Gennari C. Trends in the incidence of hip fracture in Siena, Italy, from 1980 to 1991. Bone 1993;14:S31–4.

    Article  PubMed  Google Scholar 

  44. Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M, et al. Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 2006;17:464–70.

    Article  PubMed  Google Scholar 

  45. Rockwood PR, Horne JG, Cryer C. Hip fractures: A future epidemic? J Orthop Trauma 1990;4:388–93.

    Article  CAS  PubMed  Google Scholar 

  46. Fielden J, Purdie G, Horne G, Devane P. Hip fracture incidence in New Zealand, revisited. N Z Med J 2001;114:154–6.

    CAS  PubMed  Google Scholar 

  47. Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J Bone Miner Res 2004;19:532–6.

    Article  PubMed  Google Scholar 

  48. Boufous S, Finch CF, Lord SR. Incidence of hip fracture in New South Wales: Are our efforts having an effect? Med J Aust 2004;180:623–6.

    Article  PubMed  Google Scholar 

  49. Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jonsson PV, et al. International variation in the incidence of hip fractures: Cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 1999;9:242–53.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. MRC Epidemiology Resource Center, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK

    Elaine M. Dennison, Nick C. Harvey & Cyrus Cooper

  2. Botnar Research Center, Institute of Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK

    Cyrus Cooper

  3. Department of Medicine (Endocrinology), Maulana Azad Medical College, New Delhi, 110002, India

    Dinesh K. Dhanwal

Authors
  1. Dinesh K. Dhanwal
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  2. Elaine M. Dennison
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  3. Nick C. Harvey
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  4. Cyrus Cooper
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Correspondence to Dinesh K. Dhanwal.

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Dhanwal, D.K., Dennison, E.M., Harvey, N.C. et al. Epidemiology of hip fracture: Worldwide geographic variation. IJOO 45, 15–22 (2011). https://doi.org/10.4103/0019-5413.73656

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  • DOI: https://doi.org/10.4103/0019-5413.73656

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