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Reira-Espinoza recently reviewed data from Latin America. Recently, hip fracture incidence has been reported from Rosario, Argentina. These values are similar to the values reported in people older than 65 years in the US.
With an increasing population of elderly individuals in this part of the world, as well as limited health care resources, clinicians and health authorities will face an enormous challenge in the coming years in Latin America. A few studies are available from Africa on the incidence of hip fracture. Osteoporosis and fragility fractures are believed to be uncommon in Africa. Zebaze et al. Similar low fracture rates have been reported from Morocco in Hip fracture rates among the US population are the highest in the world.
Melton et al. The annual age-adjusted incidence rates among women rose rapidly until , only to fall slowly thereafter. Age-adjusted rates in men rose more steadily before beginning a downturn after Incidence rates rose exponentially with age in both men and women. Another study from the US used the national hospital discharge survey which covers 0.
A second study using the same database looked at age-specific rates between and There was an overall improvement in the hospital survival rates in men aged over 85 years and females over 75 years of age. The Framingham study, a population-based cohort study conducted from to , found that compared with women born by , hip fracture incidence was 1. No significant change occurred among black or Asian women migrants to the US.
By contrast, the annual fracture rates amongst Hispanic women increased by 4. This supports the hypothesis that residence in early life has a much greater association with variation in hip fracture rates that does current region of residence. Another explanation may be that Hispanic men and women have been shown to partake in less physical activity and are more likely to have nutritional deficits than non-Hispanic whites.
The annual mean number of hip fractures was The age-adjusted incidence of hip fracture increased from to and then steadily declined from to Leslie et al. The age-adjusted fracture incidence was The majority of studies detailing hip fracture rates have been performed in the last five decades. Scandinavia has the highest reported incidence of hip fracture worldwide. There are a large number of studies looking at incidence rates as well as secular trends in this geographically northern region.
The incidence rates vary from North to South Europe, with the highest being in Sweden and Norway and the lowest in France and Switzerland.
A study on secular trends from Uppsala, Sweden, — showed an annual increase of 2. However, the most recent data from Malmo from — shows that this fracture rate is now steady, in line with many of the Northern American studies. The incidence of hip fractures in Oslo, Norway, between and was assessed using electronic diagnosis registers. Denmark used its national patient register to look at hip fracture incidence between and in Viborg County. One possibility is that only two time points were examined in this study, whereas most other studies have examined the secular trends; it is possible that a sharp rise in the rates may have occurred during the early part of the study period and then stabilized.
Overall, the epidemiological data from Scandinavia indicates that although early studies dating to thes described an increase in hip fracture incidence, the rates appear to have fallen in the most recent periods. The decline in fracture rate appears to have occurred several years later in Finland compared to Sweden and Norway. The rise in the incidence of hip fracture in Finland from the early s until the late s has been followed by declining fracture rates.
The exact reasons for this are unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns cannot be ruled out as possible causes.
The highest number of studies comes from the UK. The first study on this subject assessed hip fracture data from the hospital inpatient enquiry for England and Wales between — No further increases occurred in either sex up to The Oxford Record Linkage Study which looked at the period — found a similar pattern, although there was a more continuous trend. There was a clear cohort effect in both the studies and the difference in incidence rates was apparent from births in to in addition to the age.
A birth cohort effect was confirmed in subsequent analyses of the Framingham data, showing that in progressive birth cohorts from — there were age-specific increases in fracture incidence rate ratios up from 1.
In Germany, between and in a study using the national hospital discharge register the age- and sex-adjusted hip fracture incidence increased by 0. Interestingly, the increase was significantly higher in Eastern Germany compared to Western Germany, particularly in the older age-groups, which suggests that the differences between the East and West decreased over time.
Hip fracture trends in Geneva, Switzerland, between and have been studied using computerized medical records from the main hospital. The study found a significant decline of 1. Hip fracture rates in Hungary are available for the period — from the National Health Insurance Fund database.
This database covers the whole population of Hungary. A lesser number of studies are available from southern Europe; two of these have been chosen to represent hip fractures from this region. An Italian study looked at the incidence of hip fracture in the county of Sienna from — using records from the orthopedic departments of various hospitals. In females, no significant trend was observed.
Another study from Spain looked at hip fracture trends in northern Spain between and using clinical records from all hospitals in the region of Cantabria. Neither was there a noticeable trend in age-specific incidence rates. Increasing hip fracture incidence in California Hispanics, to Temporal and geographic variation in hip fracture rates for people aged 65 or older, New York State, Am J Orthop. Trends in hospital care for hip fractures.
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Privacy Policy Terms of Use. This Issue. Citations View Metrics. Twitter Facebook More LinkedIn. Original Contribution. While there are many documented risk factors for hip fracture, we focused on the factors that are part of the FRAX fracture risk assessment score, 11 because they are used to help clinicians judge the need for preventive medical treatment. Data regarding glucocorticoid use were not available before , and data regarding rheumatoid arthritis status were not available before We recorded estrogen use and bisphosphonate use when available.
We performed secondary analysis by repeating the age-period-cohort models on individuals who never smoked. For this analysis, individuals were classified as never smokers if they never reported smoking at any time between and We constructed a Cox proportional hazards model with the time-dependent covariates to estimate the hip fracture risk for each factor during the study.
Because the covariates could change over the course of the study eg, a participant might stop smoking during follow-up , time-dependent covariate models were used to ensure that the hazard ratios computed reflected the risk immediately preceding the event. Statistical analyses were done using SAS, version 9.
Owing to the range of ages at enrollment, the combined original and offspring cohorts provided a stable sample size and distribution of ages over the study period Figure 1. Over the year study period, the age-adjusted incidence of hip fracture decreased significantly by 4. The decrease in age-adjusted incidence net drift was significant for both men 5. Members of the offspring cohort exhibited a lower incidence of hip fracture for a given age range Figure 2.
Most risk factors for hip fracture were stable over the study period Figure 3. Diabetes increased from 4. Estrogen use among women increased from 2.
Bisphosphonates were used by 8. The hazard ratios for these risk factors are reported in Table 2 and the eFigure in the Supplement. The prevalence of smoking exhibited the most precipitous decrease over the study period. The prevalence of heavy drinking also decreased from 7. Heavy drinking was associated with smoking; for example, When only individuals who were never heavy drinkers were analyzed, the age-adjusted incidence decrease was 4.
When only smokers were studied, a significant decrease in hip fracture incidence was not observed age-adjusted incidence decrease of 1. Among individuals who never smoked, a significant age-adjusted incidence decrease of 3.
If the age-adjusted decrease of 3. The decrease in the incidence of hip fractures over the past 20 years has been observed in multiple countries and in both men and women. Thus, the factors associated with the decrease must affect broad populations over a sustained period of years. The age-adjusted decrease in hip fracture incidence in our study was 4. The availability of the prospectively collected Framingham Heart Study data allowed us to look further back in time than previous studies.
The decrease in the incidence of hip fracture began in , while bisphosphonates were first released in Bone mineral density testing did not become available until the s. In the best-case scenario, the 8.
These data do not contradict the demonstrated effectiveness of bisphosphonates to reduce hip fracture risk, 14 but highlight the possibility that other factors are associated with the decreasing incidence of hip fracture.
We observed an association between the birth cohort and incidence of hip fracture in that individuals born more recently had a significantly lower risk of hip fracture. Whether this lowered risk is due to better nutrition, a more active lifestyle, or changing demographics cannot be explained.
Our data suggest that reduction in smoking may be the largest factor in the decrease in hip fractures observed in the Framingham Heart Study cohorts. Active smoking is an independent risk factor for hip fracture, detrimental to bone mineral density and associated with leaner body mass and a less-active lifestyle. As has been observed previously, 12 we noted that body mass index remained nearly unchanged in the Framingham Heart Study cohorts while the incidence of diabetes increased.
Because the hip fracture incidence decreased in individuals who never smoked, additional factors may be associated with the decrease.
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