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The incidence of hip fracture in Europe

  • Session I: Epidemiology Of Osteoporosis
  • Published:
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Abstract

Fragility fractures are now recognized as a major public health problem. Although the prevalence of all fractures is similar among men and women, the vast majority of osteoporotic fractures occur in elderly women. These comprise vertebral compression fractures, Colles' fracture at the wrist and hip fracture, and to a lesser extent fractures at other sites. The fracture of greatest socioeco-nomic consequence in Europe is hip fracture, which increases exponentially in incidence with age. The reasons for differences in age- and sex-specific incidence relate in part to the lower bone density of women at the time of maturity (peak bone density) and the accelerated bone loss that occurs after the menopause. Women live significantly longer than men, so that the prevalence of osteoporosis amongst elderly women is six-fold that of men. The age-specific incidence of hip fracture is rising in men and women in many countries, and if the current trends in the United Kingdom continue then the number of hip fractures occurring each year will more than double over the next 20 years. There is a marked geographic distribution in the incidence of hip fractures, even in Europe. Indeed the differences in incidence between communities is greater than the differences in incidence between sexes within communities. This suggests that the importance of gonadal insufficiency in women has been overemphasized and that other factors, probably relating to genetic or lifestyle factors affecting peak bone density, account for ecological differences in incidence of hip fracture between communities.

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References

  1. Cummings SR, Kelsey JL, Newitt MC, O'Dowd KJ. Epidemiology of osteoporotic fractures. Epidemiol Rev 1985;7:178–200.

    Google Scholar 

  2. Obrant KJ, Bengner U, Johnell O, Nilsson BE, Sernbo I. Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif Tissue Int 1989;44:157–67.

    Google Scholar 

  3. Kanis JA, Pitt FA. Epidemiology of osteoporosis. Bone 1991 (in press).

  4. Kanis JA, Caulin F, Russell RGG. Problems in the design of clinical trials in osteoporosis. In: St J Dixon A, Russell RGG, Stamp TCB, editors. Osteoporosis: a multidisciplinary problem. R Soc Med Int Congr Symp Ser 1983;55:205–21.

    Google Scholar 

  5. Hui SL, Slemenda CS, Johnston CC. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988; 1804–9.

  6. Gardsell P, Johnell O, Nilsson B. Predicting fractures in women by using forearm bone densitometry. Calcif Tissue Int 1989;44:235–42.

    Google Scholar 

  7. Ross PD, Wasnich RD, MacLean CJ, Hagimo R, Vogel JM. A model for estimating the potential costs and savings of osteoporosis prevention strategies. Bone 1988;9:337–47.

    Google Scholar 

  8. Kanis JA. Treatment of osteoporotic fracture. Lancet 1984;1:27–33.

    Google Scholar 

  9. Hoffenberg R, James OFW, Brocklehurst JC, Green ID, Horrocks P, Kanis JA, et al. Fractured neck of femur: prevention and management. J R Coll Physicians Lond 1989;23:8–12.

    Google Scholar 

  10. Kanis JA, and the MEDOS Study Group. The epidemiology of hip fracture in Europe: the MEDOS study. In: Christiansen C, Overgaard K, editors. Osteoporosis 1990, Copenhagen, Osteopress, 1990:42–7.

  11. Johnell O, Gullberg B, Allender A, Kanis JA and the MEDOS Study Group. The apparent incidence of hip fracture in Europe. Osteoporosis Int 1992;2:298–302.

    Google Scholar 

  12. Grimely Evans J, Prudham D, Wandless I. A prospective study of fracture of the proximal femur: incidence and outcome. Publ Health 1979;93:235–41.

    Google Scholar 

  13. Pemberton J. Are hip fractures underestimated as a cause of death? The influence of coroners and pathologists on the death rate. Community Med 1988;10:87–8.

    Google Scholar 

  14. Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg [Am] 1978;60:930–4.

    Google Scholar 

  15. Lewinnek G, Kelsey J, White A, Kreiger N. The significance and comparative analysis of the epidemiology of hip fractures. Clin Orthop 1980;152:35–42.

    Google Scholar 

  16. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980s. J Bone Joint Surg [Am] 1987;69:1335–9.

    Google Scholar 

  17. Knowelden J, Buhr AJ, Dunbar O. Incidence of fractures in persons over 35 years of age. Br J Prev Sec Med 18:130–41.

  18. Phillips S, Fox N, Jacobs J, Wright WE. The direct medical cost of osteoporosis for American men and women aged 45 years and older. Bone 1988;9:271–9.

    Google Scholar 

  19. Lewis AF. Fracture of the neck of the femur: changing incidence. BMJ 1981;283:1217–20.

    Google Scholar 

  20. Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet 1985;1:150–1.

    Google Scholar 

  21. Evans JG, Prudham D, Wandless I. A prospective study of the fractured proximal femur: incidence and outcome. Public Health 1979;93:235–41.

    Google Scholar 

  22. Melton LJ, Ilstrup DM, Riggs BL, Beckenbaugh RD. Fifty-year trend in hip fracture incidence. Clin Orthop 1982;162:144–9.

    Google Scholar 

  23. Johnell O, Nilsson B, Obrant KJ, Sernbo J. Age and sex patterns of hip fracture: changes in 30 years. Acta Orthop Scand 1984;55:290–2.

    Google Scholar 

  24. Falch JA, Ilebekk A, Slungaard U. Epidemiology of hip fractures in Norway. Acta Orthop Scand 1985;56:12–6.

    Google Scholar 

  25. 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.

    Google Scholar 

  26. Nagant de Deuxchaisnes C, Devogelaer JP. Increase in the incidence of hip fractures and of the ratio of trochanteric to cervical hip fractures in Belgium. Calcif Tissue Int 1988;42:201–3.

    Google Scholar 

  27. Wallace WA, The incidence of fractures of the proximal femur: an orthopedic epidemic. Lancet 1983;1:1413–4.

    Google Scholar 

  28. Bengner U, Johnell O, Redlund-Johnell I. Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif Tissue Int 1988;42:293–6.

    Google Scholar 

  29. Bengner U, Johnell O, Redlund-Johnell I. Changes in incidence of fracture of the upper end of the humerus during 30 years: a study of 2125 fractures. Clin Orthop 1988;231:179–82.

    Google Scholar 

  30. Bengner U, Johnell O, Redlund-Johnell I. Epidemiology of ankle fractures 1950 and 1980: increasing incidence in elderly women. Acta Orthop Scand 1986;57:35–7.

    Google Scholar 

  31. Bengner U, Johnell O. Increasing incidence of forearm fractures: a comparison of epidemiologic patterns 25 years apart. Acta Orthop Scand 1985;56:158–60.

    Google Scholar 

  32. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Regional variation in the incidence of hip fracture. JAMA 1990;264:500–2.

    Google Scholar 

  33. Chalmers J, Ho KC. Geographical variations in senile osteoporosis, Bone Joint Surg [Br] 1970;52:667–75.

    Google Scholar 

  34. Doren M, Schneider HPG. Overall rationale for hormonal substitution therapy after the menopause. In: L'Hermite, editor. Update on hormonal treatment in the menopause. Prog Reprod Biol Med 1989;13:1–15.

    Google Scholar 

  35. Lindsay R. The pharmacology of estrogens. Prog Basis Clin Pharmacol 1990;4:55–72.

    Google Scholar 

  36. Kanis JA, Passmore R. Calcium supplementation of the diet. BMJ 1989;296:137–40,205–8.

    Google Scholar 

  37. Matkovic V, Kostial K, Simonovic I, Buzina R, Brodarec A, Nordin BEC. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 1979;32:540–9.

    Google Scholar 

  38. Kanis JA. Requirement of calcium for optimal skeletal health in women. Calcif Tissue Int 1991;49[suppl]:s33–41.

    Google Scholar 

  39. Wickham CAC, Walsh K, Cooper C, Barker DJP, Margetts BM, Morris J, Bruce SA. Dietary calcium, physical activity and the risk of hip fracture: a prospective study. BMJ 1989;299:889–92.

    Google Scholar 

  40. Cooper C, Barker DJP, Wickham C. Physical activity, muscle strength and calcium intake in fracture of the proximal femur in Britain. BMJ 1988;297:1443–6.

    Google Scholar 

  41. Sernbo I, Johnell O, Andersson T. Differences in the incidence of hip fractures and some social conditions between an urban and rural population in southern Sweden. Acta Orthop Scand 1988;59:382–5.

    Google Scholar 

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Authors and Affiliations

  1. WHO Collaborating Centre for Metabolic Bone Diseases, Department of Human Metabolism, University of Sheffield, UK

    J. A. Kanis

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Kanis, J.A. The incidence of hip fracture in Europe. Osteoporosis Int 3 (Suppl 1), 10–15 (1993). https://doi.org/10.1007/BF01621853

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