Key Points
-
Hip fracture rates increase with age, especially in women; rates in younger and older patients are not correlated, perhaps reflecting differences in the aetiology of hip fracture
-
When comparing countries, age-standardized rates of hip fracture vary >200-fold in women and >140-fold in men; the hip fracture rate ratio in women to men is approximately 2:1
-
Radiographic incidence of vertebral fractures is much higher than that of hip fractures, whereas the incidence of clinical vertebral fracture is similar to that of hip fractures in most countries where data are available
-
Differences in the incidence of hip fractures between individuals of different ethnic backgrounds have been reported throughout the world
-
Secular hip fracture rate declines have been reported since the 1990s in Europe, North America and Oceania; rates are increasing in Mexico and China but decreasing in Hong Kong and Taiwan
-
Countries with higher socioeconomic development indices have higher hip fracture rates than less developed regions, suggesting that lifestyle might contribute to hip fracture risks
Abstract
Osteoporotic fractures are a major worldwide epidemic. Here, we review global variability, ethnic differences and secular changes in osteoporotic fractures. Worldwide, age-standardized incidence rates of hip fracture vary >200-fold in women and >140-fold in men when comparing the country in which incidence rates are the highest with that in which they are the lowest. Median age-standardized rates are highest in North America and Europe, followed by Asia, Middle East, Oceania, Latin America and Africa. Globally, rates of hip fracture are greater in women than in men, with an average ratio of ∼2:1. The incidence of radiographic vertebral fractures is much higher than that of hip fractures, whereas the incidence rates of clinical vertebral fractures mirror hip fracture rates in most countries. Methodological challenges of defining and ascertaining vertebral fractures limit the interpretation of these data. Secular declines in hip fracture rates have been reported in populations from North America, Europe and Oceania. These declines are especially notable in women, suggesting that reproductive factors might contribute to this reduction. By contrast, hip fracture rates are increasing in parts of Asia and Latin America. Global indicators of health, education and socioeconomic status are positively correlated with fracture rates suggesting that lifestyles in developed countries might contribute to hip fracture. Improvements in fracture assessment, in particular for nonhip fractures, and identification of factors that contribute to this variability might substantially influence our understanding of osteoporotic fracture aetiology and provide new avenues for prevention.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kinsella, K. & Wan, H. An Aging World: 2008. U.S. Census Bureau, International Population Reports. P95/09–01 [online], (2009).
Cauley, J. A. Public health impact of osteoporosis. J. Gerontol. A Biol. Sci. Med. Sci. 68, 1243–1251 (2013).
Gullberg, B., Johnell, O. & Kanis, J. A. World-wide projections for hip fracture. Osteoporos. Int. 7, 407–413 (1997).
Center, J. R., Nguyen, T. V., Schneider, D., Sambrook, P. N. & Eisman, J. A. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353, 878–882 (1999).
Burge, R. et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J. Bone Miner. Res. 22, 465–475 (2007).
Melton, L. J. 3rd, Chrischilles, E. A., Cooper, C., Lane, A. W. & Riggs, B. L. Perspective. How many women have osteoporosis? J. Bone Miner. Res. 7, 1005–1010 (1992).
Cooper, C. Epidemiology of osteoporosis. Osteoporos. Int. 9 (Suppl. 2), S2–S8 (1999).
Harvey, N., Dennison, E. & Cooper, C. Osteoporosis: impact on health and economics. Nat. Rev. Rheumatol. 6, 99–105 (2010).
Cummings, S. R., Black, D. M. & Rubin, S. M. Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch. Intern. Med. 149, 2445–2448 (1989).
Kado, D. M. et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos. Int. 14, 589–594 (2003).
Kado, D. M. et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch. Intern. Med. 159, 1215–1220 (1999).
Cauley, J. A., Thompson, D. E., Ensrud, K. C., Scott, J. C. & Black, D. Risk of mortality following clinical fractures. Osteoporos. Int. 11, 556–561 (2000).
Nevitt, M. C. et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann. Intern. Med. 128, 793–800 (1998).
Oleksik, A. et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J. Bone Miner. Res. 15, 1384–1392 (2000).
Bliuc, D. et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301, 513–521 (2009).
Edwards, B. J., Song, J., Dunlop, D. D., Fink, H. A. & Cauley, J. A. Functional decline after incident wrist fractures—Study of Osteoporotic Fractures: prospective cohort study. BMJ 341, c3324 (2010).
Cauley, J. A. et al. Official positions for FRAX® clinical regarding international differences from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J. Clin. Densitom. 14, 240–262 (2011).
Ballane, G., Cauley, J. A., Arabi, A. & El-Hajj Fuleihan, G. in Osteoporosis 4th edn (eds Marcus, R., Dempster, D. W., Luckey, M. & Cauley, J. A.) 623–644 (Academic Press, 2013).
Kanis, J. A. et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos. Int. 23, 2239–2256 (2012).
Hernlund, E. et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch. Osteoporos. 8, 136 (2013).
Svedbom, A. et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch. Osteoporos. 8, 137 (2013).
United Nations, Department of Economic and Social Affairs Population Division Population Estimates and Projections Section. World population prospects: The 2012 revision [online], (2012).
United Nations Development Programme. Human Development Report 2011 [online], (2011).
Cooper, C., Atkinson, E. J., O'Fallon, W. M. & Melton, L. J. 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J. Bone Miner. Res. 7, 221–227 (1992).
Fink, H. A. et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J. Bone Miner. Res. 20, 1216–1222 (2005).
Gehlbach, S. H. et al. Recognition of vertebral fracture in a clinical setting. Osteoporos. Int. 11, 577–582 (2000).
Jacobsen, S. J. et al. Regional variation in the incidence of hip fracture. US white women aged 65 years and older. JAMA 264, 500–502 (1990).
Silverman, S. L. & Madison, R. E. Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am. J. Public Health 78, 1482–1483 (1988).
Fang, J., Freeman, R., Jeganathan, R. & Alderman, M. H. Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City. Ethn. Dis. 14, 280–284 (2004).
Solomon, L. Osteoporosis and fracture of the femoral neck in the South African Bantu. J. Bone Joint Surg. Br. 50, 2–13 (1968).
Xia, W. B. et al. Rapidly increasing rates of hip fracture in Beijing, China. J. Bone Miner. Res. 27, 125–129 (2012).
Tsang, S. W., Kung, A. W., Kanis, J. A., Johansson, H. & Oden, A. Ten-year fracture probability in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores. Osteoporos. Int. 20, 1939–1945 (2009).
Dhanwal, D. K. et al. Incidence of hip fracture in Rohtak district, North India. Arch. Osteoporos. 8, 135 (2013).
Orimo, H. et al. Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends. Arch. Osteoporos. 4, 71–77 (2009).
Lau, E. M. et al. The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos. Int. 12, 239–243 (2001).
Lesnyak, O. et al. Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Arch. Osteoporos. 7, 67–73 (2012).
Lim, S. et al. Incidence of hip fractures in Korea. J. Bone Miner. Metab. 26, 400–405 (2008).
Chie, W. C., Yang, R. S., Liu, J. P. & Tsai, K. S. High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos. Int. 15, 998–1002 (2004).
Stepan, J. J. et al. Hip fracture incidence from 1981 to 2009 in the Czech Republic as a basis of the country-specific FRAX model. Calcif. Tissue Int. 90, 365–372 (2012).
Pentek, M. et al. Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003. Osteoporos. Int. 19, 243–249 (2008).
Siggeirsdottir, K. et al. Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989–2008. Osteoporos. Int. 25, 211–219 (2014).
Piscitelli, P. et al. Updated fracture incidence rates for the Italian version of FRAX®. Osteoporos. Int. 24, 859–866 (2013).
Emaus, N. et al. Hip fractures in a city in Northern Norway over 15 years: time trends, seasonal variation and mortality: the Harstad Injury Prevention Study. Osteoporos. Int. 22, 2603–2610 (2011).
Stoen, R. O. et al. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. Osteoporos. Int. 23, 2527–2534 (2012).
de Pina, M. F., Alves, S. M., Barbosa, M. & Barros, H. Hip fractures cluster in space: an epidemiological analysis in Portugal. Osteoporos. Int. 19, 1797–1804 (2008).
Grigorie, D., Sucaliuc, A., Johansson, H., Kanis, J. A. & McCloskey, E. Incidence of hip fracture in Romania and the development of a Romanian FRAX model. Calcif. Tissue Int. 92, 429–436 (2013).
Lippuner, K., Johansson, H., Kanis, J. A. & Rizzoli, R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos. Int. 20, 1131–1140 (2009).
Tuzun, S. et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos. Int. 23, 949–955 (2012).
Morosano, M., Masoni, A. & Sanchez, A. Incidence of hip fractures in the city of Rosario, Argentina. Osteoporos. Int. 16, 1339–1344 (2005).
Silveira, C., Medeiros, M. & Coelho-Filho, J. Incidencia de fratura do quadril em area urbana do Nordeste brasileiro [Portuguese]. Cad. Saude Publica 21, 907–912 (2005).
Jaller-Raad, J. J. et al. Incidence of hip fracture in Barranquilla, Colombia, and the development of a Colombian FRAX model. Calcif. Tissue Int. 93, 15–22 (2013).
Orces, C. H. Epidemiology of hip fractures in Ecuador. Rev. Panam. Salud Publica 25, 438–442 (2009).
Johansson, H. et al. Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican institute of social security. Osteoporos. Int. 22, 2359–2364 (2011).
Riera-Espinoza, G., Lopez, D. & Kanis, J. A. Life time risk of hip fracture and incidence rates in Carabobo, Venezuela. Osteoporos. Int. 19 (Suppl. 2), S356 (2008).
Soveid, M., Serati, A. R. & Masoompoor, M. Incidence of hip fracture in Shiraz, Iran. Osteoporos. Int. 16, 1412–1416 (2005).
Memon, A. et al. Incidence of hip fracture in Kuwait. Int. J. Epidemiol. 27, 860–865 (1998).
Sibai, A. M. et al. Hip fracture incidence in Lebanon: a national registry-based study with reference to standardized rates worldwide. Osteoporos. Int. 22, 2499–2506 (2011).
El Maghraoui, A. et al. Epidemiology of hip fractures in 2002 in Rabat, Morocco. Osteoporos. Int. 16, 597–602 (2005).
al-Nuaim, A. R., Kremli M, al-Nuaim, M. & Sandkgi, S. Incidence of proximal femur fracture in an urbanized community in Saudi Arabia. Calcif. Tissue Int. 56, 536–538 (1995).
Leslie, W. D. et al. Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos. Int. 22, 817–827 (2011).
Ettinger, B., Black, D. M., Dawson-Hughes, B., Pressman, A. R. & Melton, L. J. 3rd. Updated fracture incidence rates for the US version of FRAX. Osteoporos. Int. 21, 25–33 (2010).
Crisp, A. et al. Declining incidence of osteoporotic hip fracture in Australia. Arch. Osteoporos. 7, 179–185 (2012).
Brown, P., McNeil, R., Radwan, E. & Willingale, J. The burden of osteoporosis in New Zealand: 2007–2020 [online], (2007).
O'Neill, T. W. et al. The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J. Bone Miner. Res. 11, 1010–1018 (1996).
Chen, P. et al. Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk. J. Bone Miner. Res. 24, 495–502 (2009).
Fujiwara, S. et al. Fracture prediction from bone mineral density in Japanese men and women. J. Bone Miner. Res. 18, 1547–1553 (2003).
Clark, P. et al. The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos. Int. 20, 275–282 (2009).
Tsang, S. W. et al. Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture. Osteoporos. Int. 22, 667–674 (2011).
European Prospective Osteoporosis Study et al. Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J. Bone Miner. Res. 17, 716–724 (2002).
Nevitt, M. C. et al. Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J. Bone Miner. Res. 20, 131–140 (2005).
Cauley, J. A. et al. Long-term risk of incident vertebral fractures. JAMA 298, 2761–2767 (2007).
Van der Klift, M., De Laet, C. E., McCloskey, E. V., Hofman, A. & Pols, H. A. The incidence of vertebral fractures in men and women: the Rotterdam Study. J. Bone Miner. Res. 17, 1051–1056 (2002).
Jitapunkul, S., Thamarpirat, J., Chaiwanichsiri, D. & Boonhong, J. Incidence of vertebral fractures in Thai women and men: a prospective population-based study. Geriatr. Gerontol. Int. 8, 251–258 (2008).
Sanders, K. M. et al. Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos. Int. 10, 240–247 (1999).
Bow, C. H. et al. Ethnic difference of clinical vertebral fracture risk. Osteoporos. Int. 23, 879–885 (2012).
Kanis, J. A. et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos. Int. 11, 669–674 (2000).
Hagino, H. et al. Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone 24, 265–270 (1999).
Singer, B. R., McLauchlan, G. J., Robinson, C. M. & Christie, J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J. Bone Joint Surg. Br. 80, 243–248 (1998).
Wright, N. C. et al. Recent trends in hip fracture rates by race/ethnicity among older US adults. J. Bone Miner. Res. 27, 2325–2332 (2012).
Koh, L. K. et al. Hip fracture incidence rates in Singapore 1991–1998. Osteoporos. Int. 12, 311–318 (2001).
Coleman, D. Immigration and ethnic change in low-fertility countries: A third demographic transition. Popul. Dev. Rev. 32, 401–446 (2006).
Lauderdale, D. S. et al. Hip fracture incidence among elderly Asian-American populations. Am. J. Epidemiol. 146, 502–509 (1997).
Shao, C. J., Hsieh, Y. H., Tsai, C. H. & Lai, K. A. A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone 44, 125–129 (2009).
Wikipedia. Demographics of New Zealand [online], (2014)
Leslie, W. D. et al. Fracture risk among First Nations people: a retrospective matched cohort study. CMAJ 171, 869–873 (2004).
Baron, J. A. et al. Racial differences in fracture risk. Epidemiology 5, 42–47 (1994).
Baron, J. A. et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 7, 612–618 (1996).
Griffin, M. R., Ray, W. A., Fought, R. L. & Melton, L. J. 3rd. Black-white differences in fracture rates. Am. J. Epidemiol. 136, 1378–1385 (1992).
Mackey, D. C. et al. Prediction of clinical non-spine fractures in older black and white men and women with volumetric BMD of the spine and areal BMD of the hip: the Health, Aging, and Body Composition Study*. J. Bone Miner. Res. 22, 1862–1868 (2007).
Cauley, J. A. et al. Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative. J. Bone Miner. Res. 22, 1816–1826 (2007).
Barrett-Connor, E. et al. Osteoporosis and fracture risk in women of different ethnic groups. J. Bone Miner. Res. 20, 185–194 (2005).
Cauley, J. A. et al. Prevalent vertebral fractures in black women and white women. J. Bone Miner. Res. 23, 1458–1467 (2008).
Cooper, C. et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos. Int. 22, 1277–1288 (2011).
Ballane, G., Cauley, J. A., Luckey, M. M. & El-Hajj Fuleihan, G. Secular trends in hip fractures worldwide: Opposing trends East versus West. J. Bone Miner. Res. http://dx.doi.org/10.1002/jbmr.2218.
Brauer, C. A., Coca-Perraillon, M., Cutler, D. M. & Rosen, A. B. Incidence and mortality of hip fractures in the United States. JAMA 302, 1573–1579 (2009).
Leslie, W. D. et al. Trends in hip fracture rates in Canada. JAMA 302, 883–889 (2009).
Evans, J. G., Seagroatt, V. & Goldacre, M. J. Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968–86. J. Epidemiol. Community Health 51, 424–429 (1997).
Paspati, I., Galanos, A. & Lyritis, G. P. Hip fracture epidemiology in Greece during 1977–1992. Calcif. Tissue Int. 62, 542–547 (1998).
Hartholt, K. A. et al. The epidemic of hip fractures: are we on the right track? PLoS ONE 6, e22227 (2011).
Nilson, F., Moniruzzaman, S., Gustavsson, J. & Andersson, R. Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J. Public Health (Oxf.) 35, 125–131 (2013).
Rosengren, B. E. et al. Secular trends in Swedish hip fractures 1987–2002: birth cohort and period effects. Epidemiology 23, 623–630 (2012).
Dretakis, E. K., Giaourakis, G. & Steriopoulos, K. Increasing incidence of hip fracture in Crete. Acta Orthop. Scand. 63, 150–151 (1992).
Chevalley, T. et al. Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40, 1284–1289 (2007).
Hiligsmann, M. et al. Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007). Arthritis Care Res. (Hoboken) 64, 744–750 (2012).
McGowan, B., Casey, M. C., Silke, C., Whelan, B. & Bennett, K. Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis. Osteoporos. Int. 24, 849–857 (2013).
Abrahamsen, B. & Vestergaard, P. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos. Int. 21, 373–380 (2010).
Dimai, H. P. et al. Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos. Int. 22, 685–692 (2011).
Mann, E., Icks, A., Haastert, B. & Meyer, G. Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr. 8, 35 (2008).
Hagino, H., Katagiri, H., Okano, T., Yamamoto, K. & Teshima, R. Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001. Osteoporos. Int. 16, 1963–1968 (2005).
Chan, D. C. et al. A 12-year ecological study of hip fracture rates among older Taiwanese adults. Calcif. Tissue Int. 93, 397–404 (2013).
Kung, A. W. C., Yates, S. & Wong, V. Changing epidemiology of osteoporotic hip fracture rates in Hong Kong. Arch. Osteoporos. 2, 53–58 (2007).
Cheung, E. et al. A secular increase in BMD in Chinese women. J. Bone Miner. Metab. 32, 48–55 (2014).
Zingmond, D. S., Melton, L. J. 3rd & Silverman, S. L. Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos. Int. 15, 603–610 (2004).
Ward, L, Mughal, M. Z. & Bachrach, L. K. in Osteoporosis 4th edn (eds Marcus, R., Dempster, D. W., Luckey, M. & Cauley, J. A.) 1037–1072 (Academic Press, 2013).
Langley, J., Samaranayaka, A., Davie, G. & Campbell, A. J. Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007. Osteoporos. Int. 22, 105–111 (2011).
Samelson, E. J., Zhang, Y., Kiel, D. P., Hannan, M. T. & Felson, D. T. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am. J. Public Health 92, 858–862 (2002).
Cooper, C., Atkinson, E. J., Kotowicz, M., O'Fallon, W. M. & Melton, L. J. 3rd. Secular trends in the incidence of postmenopausal vertebral fractures. Calcif. Tissue Int. 51, 100–104 (1992).
Islam, S., Liu, Q., Chines, A. & Helzner, E. Trend in incidence of osteoporosis-related fractures among 40- to 69-year-old women: analysis of a large insurance claims database, 2000–2005. Menopause 16, 77–83 (2009).
Bengnér, U., Johnell, O. & Redlund-Johnell, I. Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif. Tissue Int. 42, 293–296 (1988).
Jaglal, S. B. et al. Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J. Bone Miner. Res. 20, 898–905 (2005).
Boufous, S. et al. The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia. Bone 39, 1144–1148 (2006).
Compston, J. E. et al. Obesity is not protective against fracture in postmenopausal women: GLOW. Am. J. Med. 124, 1043–1050 (2011).
Looker, A. C., Melton L. J. 3rd, Borrud, L. G. & Shepherd, J. A. Changes in femur neck bone density in US adults between 1988–1994 and 2005–2008: demographic patterns and possible determinants. Osteoporos. Int. 23, 771–780 (2012).
Leslie, W. D., Rubin, M. R., Schwartz, A. V. & Kanis, J. A. Type 2 diabetes and bone. J. Bone Miner. Res. 27, 2231–2237 (2012).
Guilley, E. et al. Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women. Osteoporos. Int. 19, 1741–1747 (2008).
Mahon, P. et al. Low maternal vitamin D status and fetal bone development: cohort study. J. Bone Miner. Res. 25, 14–19 (2010).
Harvey, N. C. et al. Maternal antenatal vitamin D status and offspring muscle development: findings from the Southampton Women's Survey. J. Clin. Endocrinol. Metab. 99, 330–337 (2014).
van Lenthe, F. J., Avendano, M., van Beeck, E. F. & Mackenbach, J. P. Childhood and adulthood socioeconomic position and the hospital-based incidence of hip fractures after 13 years of follow-up: the role of health behaviours. J. Epidemiol. Community Health 65, 980–985 (2011).
Peacock, M., Turner, C. H., Econs, M. J. & Foroud, T. Genetics of osteoporosis. Endocr. Rev. 23, 303–326 (2002).
Ralston, S. H. & Uitterlinden, A. G. Genetics of osteoporosis. Endocr. Rev. 31, 629–662 (2010).
Estrada, K. et al. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nat. Genet. 44, 491–501 (2012).
Finkelstein, J. S. et al. Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J. Clin. Endocrinol. Metab. 87, 3057–3067 (2002).
Cauley, J. A. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin. Orthop. Relat. Res. 469, 1891–1899 (2011).
Nam, H. S. et al. Race/ethnic differences in bone mineral densities in older men. Osteoporos. Int. 21, 2115–2123 (2010).
Nam, H. S. et al. Racial/ethnic differences in bone mineral density among older women. J. Bone Miner. Metab. 31, 190–198 (2013).
Subramanian, S. V., Ozaltin, E. & Finlay, J. E. Height of nations: a socioeconomic analysis of cohort differences and patterns among women in 54 low- to middle-income countries. PLoS ONE 6, e18962 (2011).
Wang, X. F. & Seeman, E. Epidemiology and structural basis of racial differences in fragility fractures in Chinese and Caucasians. Osteoporos. Int. 23, 411–422 (2012).
El-Hajj Fuleihan, G. Vitamin D deficiency in the Middle East and its health consequences for children and adults. Clinic. Rev. Bone Miner. Metab. 7, 77–93 (2009).
Arabi, A., El Rassi, R. & El-Hajj Fuleihan, G. Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes. Nat. Rev. Endocrinol. 6, 550–561 (2010).
Wahl, D. A. et al. A global representation of vitamin D status in healthy populations. Arch. Osteoporos. 7, 155–172 (2012).
Orwoll, E. S. et al. Evidence for geographical and racial variation in serum sex steroid levels in older men. J. Clin. Endocrinol. Metab. 95, E151–E160 (2010).
Roy, D. K. et al. Falls explain between-center differences in the incidence of limb fracture across Europe. Bone 31, 712–717 (2002).
Diamond, J. The double puzzle of diabetes. Nature 423, 599–602 (2003).
Icks, A., Haastert, B., Wildner, M., Becker, C. & Meyer, G. Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos. Int. 19, 1139–1145 (2008).
Acknowledgements
The authors would like to acknowledge Ms S. Happe for her assistance with referencing and formatting the manuscript and Ms K. Fitzgerald for her assistance with the figures.
Author information
Authors and Affiliations
Contributions
J.A.C., D.C. and A.M.H. researched data for the article. J.A.C. wrote the manuscript. All authors made substantial contribution to discussion of the content, reviewed and edited the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Supplementary information
Supplementary Table 1
Studies used to complete Supplementary Table 2 and Table 3 (DOCX 42 kb)
Supplementary Table 2
Age-Specific Incidence of Hip Fracture (per 100,000) by Age (DOCX 45 kb)
Supplementary Table 3
Age-standardized Incidence of Hip Fracture (per 100,000) by country; Ratio of Rates in Women to Men (DOCX 26 kb)
Supplementary Table 4
Incidence of Clinical Vertebral Fracture (per 100,000) by Age (DOCX 21 kb)
Supplementary Table 5
Incidence of Forearm (per 100,000) by Age (DOCX 22 kb)
Supplementary Table 6
Summary of Differences in Hip Fracture within Country by Age in the US (6a), Singapore (6b) and New Zealand (6c). Incidence per 100,000 (DOCX 21 kb)
Rights and permissions
About this article
Cite this article
Cauley, J., Chalhoub, D., Kassem, A. et al. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10, 338–351 (2014). https://doi.org/10.1038/nrendo.2014.51
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrendo.2014.51
This article is cited by
-
The association between admission mean corpuscular volume and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study
BMC Musculoskeletal Disorders (2024)
-
Multidimensional characteristics of musculoskeletal pain and risk of hip fractures among elderly adults: the first longitudinal evidence from CHARLS
BMC Musculoskeletal Disorders (2024)
-
Epidemiological features of 1,332 cases of hip fracture in Shanghai, China (2015–2020)
Arthroplasty (2024)
-
Global burden of hip fracture: The Global Burden of Disease Study
Osteoporosis International (2024)
-
Evaluating adherence, tolerability and safety of oral calcium citrate in elderly osteopenic subjects: a real-life non-interventional, prospective, multicenter study
Aging Clinical and Experimental Research (2024)