The association between urban or rural locality and hip fracture in community-based adults: a systematic review

Abstract

Urban or rural locality has been suggested to influence musculoskeletal health, with lower bone mineral density (BMD) and greater prevalence of fracture identified in urban residents. A computer-aided search of Medline, EMBASE, CINAHL and PsychINFO, January 1966 to November 2007 was conducted to identify studies investigating the relationship between urban or rural locality and the occurrence of hip fracture. The methodological quality of studies was assessed, and a best-evidence synthesis was used to summarise the results. Fourteen cohort studies and one case-control study were identified for inclusion in this review, indicating a lack of literature in the field. Best-evidence analysis identified moderate evidence for residents of rural regions to have lower risk of hip fracture compared to urban residents. Examining principal mechanisms for the observed relationship between urban/rural locality and hip fracture, such as factors at the person or area level, may help to identify modifiable risk factors and inform appropriate prevention strategies.

Association between socioeconomic status and bone mineral density in adults: a systematic review

“…Our "best-evidence synthesis" was conducted as previously published [16,24] and consisted of five levels of evidence that reflected the study design used.…”

“…To assess the methodological quality of the included studies, two reviewers (SLB and YW) independently scored them using the adapted scoring system of Lievense et al [22,23] as presented in Table 1 and previously applied [16,24]. Each of the 14 items was scored as positive (1), negative (0), or unclear (?…”

“…Given the reviewed studies employed different methodology, a direct comparison between the studies was difficult, and thus, we performed a best-evidence analysis as previously published [16,[22][23][24]. We assessed the methodology of the studies and considered the strength of the association between SES and BMD in the higher-quality studies (scored >62.6%).…”

Nationwide data on municipal drinking water and hip fracture: Could calcium and magnesium be protective? A NOREPOS study

“…These variations could reflect differences in several underlying risk factors, such as ethnicity, body mass index, vitamin D and sun exposure, smoking patterns, physical activity and medication use [1,7,8]. Although the cause of the discrepancy is most likely multifactorial, it is plausible that environmental factors may play a role [6,8].We have previously reported that variations in drinking water quality across Norway, in particular a higher acidity level (lower pH) in urban compared to rural areas, may be related to self-reported fractures of the forearm [9]. The pH level is generally positively correlated with the concentrations of calcium and magnesium in the water.…”

Bone health in Gambian women: impact and implications of rural-to-urban migration and the nutrition transition

“…Predictions indicate that hip fracture incidence will increase 6-fold in Africa and Asia by 2050, partially attributed to demographic transition and population ageing (2) . Differences in areal bone mineral density (aBMD) between rural and urban locations indicate that urban regions of high income countries (HIC) have lower aBMD and a higher incidence of hip fracture (3) . The few studies conducted in low and middle income countries (LMIC) provide inconsistent results; in contrast to HIC, most have found higher aBMD in urban populations (4) .…”