Study shows vast geographic variation in hip fracture risk and probability

A 63-nation study of country-specific risk of hip fracture and 10-year probability of major fragility fractures has revealed a large geographic variation in fracture risk, according to findings published in Osteoporosis International.

Despite accounting for possible errors or limitations in the source data, the researchers found a 10-fold variation in hip fracture risk and fracture probability between countries, according to an International Osteoporosis Foundation (IOF) news release.

Researchers identified studies on hip fracture risk from 1950 to Nov. 2011 from a Medline OVID search and, reviewed them by country for quality and their ability to represent that country. According to the study abstract, the team used age-standardized incidence rates to reflect the 2010 world population of men, women and men and women combined. For those countries in which a Fracture Risk Assessment Tool or FRAX model was available, researchers computed the 10-year probability of major osteoporotic fractures in specific clinical scenarios, as noted in the abstract.

In all, the researchers determined age-standardized rates of hip fracture for 63 countries and gathered 45 FRAX models from 40 countries that were useful for determining probability of fracture. According to the results, the researchers found a greater than 10-fold variation in hip fracture risk and fracture probability between countries.

The lowest annual age-standardized fracture incidences were in Tunisia and Ecuador, with incidences per 100,000 individuals of 58 and 73, respectively. The highest incidences per 100,000 individuals were in northern European countries, with 574 and 563 in Denmark and Norway, respectively, according to the release.

John A. Kanis

Within individual countries, the age-standardized incidence of hip fracture in men was reported in the release to be about half that noted in women.

“The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population,” John A. Kanis, MD, FRCP, MRCPath, and co-authors wrote in their abstract. “Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of fractures.”

Reference:
Kanis JA, Oden A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012. doi: 10.1007/s00198-012-1964-3.

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