The variable incidence of hip fracture in Southern Europe: The MEDOS study

Abstract

We assessed the incidence of hip fracture and ecological correlates in residents of 14 communities in six countries of Southern Europe. Hip fracture cases were recorded prospectively in defined catchment areas over a 1-year interval. A retrospective questionnaire was used to assess ecological differences between communities. During a 1-year period of observation a total of 3629 men and women over the age of 50 years were identified with hip fracture from a catchment of 3 million. In all communities the fracture rate increased exponentially with age. There were large and significant differences between centres in the doubling time for hip fracture risk with age and in crude and age-standardized rates. Greater than 4-fold and 13-fold differences in age-standardized risk were found amongst men and women respectively. The lowest rates were observed from Turkey and the highest from Seville, Crete and Porto. Fractures were significantly more frequent among women than men with the exception of three rural Turkish centres. Indeed, in rural Turkey the normal female/male ratio was reserved. Variations in incidence between regions were greater than the differences within centres between sexes, and there was a close and significant correlation between incidence rates for men and those for women in the regions studied. Excess female morbidity increased progressively from the age of 50 years but attained a plateau after the age of 80 years, suggesting a finite duration of the effect of the menopause. The retrospective questionnaire completed by 80% of cases suggested that differences in incidence between the communities studied could not be explained by differences in gonadal status in women. In both men and women cross-cultural associations were found with factors related to age or socioeconomic prosperity, the majority of which disappeared after adjustment for age. We conclude that there are marked and sizeable differences in the incidence rates of hip fracture throughout Southern Europe. The reasons for these differences are not known but affect both men and women, and are likely to be related to lifestyle or genetic factors rather than to differences in endocrine status.

Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality

“…Factors related to socioeconomic development, such as a sedentary lifestyle and more frail survivors today, have been linked to the pathogenesis of osteoporosis. Moreover, because prevalence of osteoporosis is rising at an equal rate among men and women, the importance of postmenopausal oestrogen deficiency in development of osteoporosis may be overemphasized [3,15].…”

“…The mortality rate for hip fracture patients ranges from 17 to 33% for the first year after discharge from the hospital [7,[15][16][17][18][19]. Most of the excess mortality occurs in the first few months after the fracture [18].…”

“…For controlled clinical trials, radiographic documentation of vertebral fractures is the recommended endpoint of choice for determining vertebral fracture frequency [15] ; however, radiographic findings or densitometry results may not correlate with quality of life parameters. A study by Ettinger et al showed that, among 2992 women among population-based listings, those with a vertebral deformity had a 1n9 times higher risk of back pain and a 2n6 times higher risk of disability involving the back [23].…”

Fractura de cadera en el anciano: a propósito de un caso

“…El predominio del sexo femenino (tres de cada cuatro casos) y el aumento prácticamente exponencial, de la incidencia por grupos de edad está ampliamente descrito en la literatura (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Este aumento por grupos de edad se observa también analizando separadamente cada una de las CCAA (Datos no mostrados).…”

Health economics of osteoporosis

“…The incidence varies quite substantially between populations. In Europe, the variation in hip fracture risk between countries is about seven fold and worldwide more than tenfold [11,12]. The highest hip fracture risk in the world has been observed in the Scandinavian countries [13].…”