International Variation in the Incidence of Hip Fractures: Cross-National Project on Osteoporosis for the World Health Organization Program for Research on Aging

Abstract

A cross-national study of hip fracture incidence was carried out in five geographic areas--Beijing, China; Budapest, Hungary; Hong Kong; Porto Alegre, Brazil; and Reykjavik, Iceland--during the years 1990-1992. Cases of hip fracture among women and men of age 20 years and older were identified using hospital discharge data in conjunction with medical records, operating room logs, and radiology logs. Estimated incidence rates varied widely, with Beijing reporting the lowest rates (age-adjusted rate per 100,000 population for men 20 years and older = 45.4; women = 39.6) and Reykjavik the highest rates (man = 141.3; women = 274.1). Rates were higher for women than for men in every area except Beijing. In every area except Budapest, review of the operating room or radiology logs identified additional cases that were not reported in the discharge list, increasing the estimated number of hip fractures by 11% to 62%, depending on the area. Review of medical records identified miscoding of hip fractures (ICD 9820) as 'shaft of femur and other femur fractures' (ICD 9821) in the discharge lists of every area except Budapest, increasing the estimated number of hip fractures by 1% to 30%. The final estimates of hip fracture incidence taking into account all investigated sources of undercount and overcount ranged from 15% lower to 89% higher than an estimate based on the discharge diagnoses alone. Although these results indicate substantial limitations in relying on hospital discharge data alone to estimate hip fracture incidence rates, the extent of errors found in the discharge lists is smaller than the large international variation found here and previously reported in incidence rates. The findings support the conclusion that the differences reported among countries mainly reflect genuine variation in the hip fracture incidence rates.

Epidemiology of osteoporotic hip fractures in Spain

“…The incidence rates in this study are similar to previously reported European incidence rates [22], although slightly lower than the Scandinavian values [17,18] and the rates from the United States of America [21]. However, the values are greater than those reported in the multinational study by Schwartz et al [22] and to those from other parts of the world, such as the Mediterranean countries [1] or the African countries [25].…”

“…This higher proportion of women has been explained by the higher incidence of osteoporosis among women and by aging. The incidence rates of hip fractures increase exponentially with age [1,4,18,19,22,25]. In our study, almost 50% of hip fractures appeared in people aged 80-90 years.…”

“…However, the values are greater than those reported in the multinational study by Schwartz et al [22] and to those from other parts of the world, such as the Mediterranean countries [1] or the African countries [25]. In the USA, the rates may differ within the same county between urban and rural populations, with the incidence of hip fracture being lower in rural areas [19].…”

Dietary Protein and Bone Health

“…Epidemiological studies suggest that populations with high soy intake (such as Asian populations) have a lower incidence of osteoporotic fractures (Adlercreutz & Mazur, 1997;Schwartz et al, 1999). Asian women typically consume about 20g of soy daily which provides 40 mg of isoflavones (Chen et al, 1999;Ho et al, 2003).…”

Association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil: cross-sectional study

“…1,2 These occur with higher frequency in places where there is a greater proportion of trabecular bone, since this type of bone has a higher rate of remodeling than shown by cortical bone, and it is more susceptible to estrogen deficiency. 2,3 Increasing prevalence of osteoporosis is projected around the world as a result of growing life expectancy and the consequent increase in the elderly population. It is the most common metabolic disease and the main cause of fractures due to skeletal fragility, and is considered to be one of the main public health problems because of the individual and social repercussions.…”