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Epidemiology of hip fracture in Iran: results from the Iranian Multicenter Study on Accidental Injuries

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Abstract

Introduction

The incidence of hip fracture varies substantially between countries. As a result of improving life expectancy, the number of elderly people susceptible to hip fractures is increasing rapidly in the developing world. Little is known, however, about the epidemiology of hip fractures in the Middle Eastern countries. In this study, our objective was to estimate the incidence of hip fracture in Iran and compare it with other populations.

Methods

The data used were obtained from the Iranian Multicenter Study on Accidental Injuries, a large-scale population-based study conducted in nine provinces across the country. All of the hospitals in these provinces, which provide services to about 9.5 million people, were prospectively surveyed for any incident injury resulting from accidental events occurring in the study period of 135 days (4.5 months). All patients aged ≥50 with radiographically confirmed proximal femur fractures were included in this study. A total of 555 new cases of hip fracture (284 male, 271 female) were recorded during the study period. The annual incidence of hip fracture per 100,000 person-years was 115.2 (95% CI: 107.2–123.7) in men and 115.6 (95% CI: 107.4–124.3) in women; of these,73.2 and 89.2%, respectively, were fall-related fractures. The female-to-male ratios for fall-induced and total hip fracture rates were 1.2 and 1.0, respectively.

Results

The incidence rates increased exponentially after the age of 60 years in both genders and nearly tripled with each successive decade. When these results are compared to those of other studies, the Iranian age-standardized incidence rates of 127.3 (men) and 164.6 (women) per 100,000 person-years are considerably lower than those of all Western countries when standardized to data on the U.S. population in 2000. When compared with incidence rates reported for other Asian countries, those of Iranian females are the lowest next to China.

Conclusion

The low incidence rate of hip fracture for older Iranian women may be the result of several potential factors related to genetic or lifestyle differences between Iranians and people of other countries. Further studies are required to investigate contributing factors in more detail.

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References

  1. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208

    PubMed  CAS  Google Scholar 

  2. Schwartz AV, Kelsey JL, Maggi S et al (1999) 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 9:242–253

    Article  PubMed  CAS  Google Scholar 

  3. Lippuner K, von Overbeck J, Perrelet R, Bosshard H, Jaeger P (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 7:414–425

    Article  PubMed  CAS  Google Scholar 

  4. Wildner M, Clark DE (2001) Hip fracture incidence in east and West Germany: reassessment ten years after unification. Osteoporos Int 12:136–139

    Article  PubMed  CAS  Google Scholar 

  5. Balasegaram S, Majeed A, Fitz-Clarence H (2001) Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Public Health Med 23:11–17

    Article  PubMed  CAS  Google Scholar 

  6. Paspati I, Galanos A, Lyritis GP (1998) Hip fracture epidemiology in Greece during 1977–1992. Calcif Tissue Int 62:542–547

    Article  PubMed  CAS  Google Scholar 

  7. Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674

    Article  PubMed  CAS  Google Scholar 

  8. Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS (2004) Hip fracture incidence in central Norway: a follow-up study. Clin Orthop Relat Res 419:173–178

    Article  PubMed  Google Scholar 

  9. Lofthus CM, Osnes EK, Falch JA et al (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Ho SC, Bacon WE, Harris T, Looker A, Maggi S (1993) Hip fracture rates in Hong Kong and the United States, 1988 through 1989. Am J Public Health 83:694–697

    Article  PubMed  CAS  Google Scholar 

  12. Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China the Beijing Osteoporosis Project. Am J Epidemiol 144:901–907

    PubMed  CAS  Google Scholar 

  13. Yan L, Zhou B, Prentice A, Wang X, Golden MH (1999) Epidemiological study of hip fracture in Shenyang, People’s Republic of China. Bone 24:151–155

    Article  PubMed  CAS  Google Scholar 

  14. Lau EM, Lee JK, Suriwongpaisal P et al (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243

    Article  PubMed  CAS  Google Scholar 

  15. Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T (1999) Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone 24:265–270

    Article  PubMed  CAS  Google Scholar 

  16. Chie WC, Yang RS, Liu JP, Tsai KS (2004) High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int 15:998–1002

    Article  PubMed  CAS  Google Scholar 

  17. Memon A, Pospula WM, Tantawy AY, Abdul-Ghafar S, Suresh A, Al-Rowaih A (1998) Incidence of hip fracture in Kuwait. Int J Epidemiol 27:860–865

    Article  PubMed  CAS  Google Scholar 

  18. Naghavi M, Jafari N, Alaeddini F, Akbari MS (eds) (2004) Epidemiology of injuries resulting from unintentional accidents, 2nd edn (in Persian). Ministry of Health and Medical Education, Undersecretary for Health, Tehran, Iran

  19. Website: http://www3.who.int/whosis/menu.cfm?path=evidence,burden&language=english; Last access in 5 February 2005

  20. Statistical Center of Iran (2004) Iran statistical yearbook of 2003 (in Persian). Statistical Center of Iran, Tehran, Iran

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Castro da Rocha FA, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14:496–499

    Article  PubMed  Google Scholar 

  23. Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in southern Europe: the MEDOS Study. Osteoporos Int 4:253–263

    Article  PubMed  CAS  Google Scholar 

  24. Dennison E, Yoshimura N, Hashimoto T, Cooper C (1998) Bone loss in Great Britain and Japan: a comparative longitudinal study. Bone 23:379–382

    Article  PubMed  CAS  Google Scholar 

  25. Larijani B, Soltani A, Pajouhi M et al (2003) Bone mineral density variation in 20 to 69-years-old population of Tehran-Iran (in Persian). Iran South Med J 1:41–49

    Google Scholar 

  26. Hashemipour S, Larijani B, Adibi H et al (2004) Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 4:38

    Article  PubMed  Google Scholar 

  27. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501

    Article  PubMed  CAS  Google Scholar 

  28. Prior JC, Barr SI, Chow R, Faulkner RA (1996) Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 5. Physical activity as therapy for osteoporosis. Can Med Assoc J 155:940–944

    CAS  Google Scholar 

  29. Meyer HE, Falch JA, O’Neill T, Tverdal A, Varlow J (1995) Height and body mass index in Oslo, Norway, compared to other regions of Europe: do they explain differences in the incidence of hip fracture? European Vertebral Osteoporosis Study Group. Bone 17:347–350

    Article  PubMed  CAS  Google Scholar 

  30. Nakamura T, Turner CH, Yoshikawa T et al (1994) Do variations in hip geometry explain differences in hip fracture risk between Japanese and white Americans? J Bone Miner Res 9:1071–1076

    Article  PubMed  CAS  Google Scholar 

  31. Keegan TH, Kelsey JL, King AC, Quesenberry CP Jr, Sidney S (2004) Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture. Am J Epidemiol 159:192–203

    Article  PubMed  Google Scholar 

  32. Yan L, Crabtree NJ, Reeve J et al (2004) Does hip strength analysis explain the lower incidence of hip fracture in the People’s Republic of China? Bone 34:584–588

    Article  PubMed  CAS  Google Scholar 

  33. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1991) Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984–1987. Am J Epidemiol 133:996–1004

    PubMed  CAS  Google Scholar 

  34. Douglas S, Bunyan A, Chiu KH et al (2000) Seasonal variation of hip fracture at three latitudes. Injury 31:11–19

    Article  PubMed  CAS  Google Scholar 

  35. Jacobsen SJ, Sargent DJ, Atkinson EJ et al (1995) Population-based study of the contribution of weather to hip fracture seasonality. Am J Epidemiol 141:79–83

    PubMed  CAS  Google Scholar 

  36. Parker MJ, Twemlow TR, Pryor GA (1996) Environmental hazards and hip fractures. Age Ageing 25:322–325

    Article  PubMed  CAS  Google Scholar 

  37. Boufous S, Finch CF, Lord SR (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626

    PubMed  Google Scholar 

  38. Sanders KM, Seeman E, Ugoni AM et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10:240–247

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from the Ministry of Health and Medical Education of Iran. We would like to thank Dr. N. Jafari and Dr. H. Tavakoli Shalmani for their personal assistance in collecting and analyzing the data. Special thanks are extended to the personnel of the Research Council of the Ministry of Health and Medical Education and all health officials who helped us in conducting this study.

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Correspondence to F. Abolhassani.

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Moayyeri, A., Soltani, A., Larijani, B. et al. Epidemiology of hip fracture in Iran: results from the Iranian Multicenter Study on Accidental Injuries. Osteoporos Int 17, 1252–1257 (2006). https://doi.org/10.1007/s00198-006-0105-2

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  • DOI: https://doi.org/10.1007/s00198-006-0105-2

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