Bone Abstracts

Osteoporotic fractures are a major worldwide epidemic. Worldwide, age-standardized rates in hip fracture vary >200-fold in women and >140-fold in men when comparing incidence rates in the highest vs lowest country. 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 men with an average ratio of ~2:1. In all populations studied to date, hip fracture rates increase with age in both men and women. However, the correlation in age-specific rates was greatest in older individuals (> age 75) with weak correlations between older (> age 75) and younger (< age 60) individuals. The incidence of radiographic vertebral fractures is much higher than hip fractures while incidence rates of clinical vertebral fractures mirror hip fracture rates in most countries. Methodological challenges of defining and ascertaining vertebral fractures limits the interpretation of these data. Secular declines in hip fracture 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 fractures. Most fractures occur because of a fall and the differences in the incidence of falls and risk factors for falls may also contribute to the geographic variability in hip fractures. Improvements in fracture assessment, in particular non-hip fractures and identification of factors that contribute to this variability, might substantially impact our understanding of osteoporotic fracture aetiology and provide new avenues for prevention.