Skip to main content
SpringerLink
Log in

Incidence of hip fractures in the elderly: A cross-national analysis

  • Review Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

This paper reviews international data on incidence rates of hip fracture in persons 50 years of age and older, based on a bibliographic search of articles published since 1960. Incidence rates are higher in white populations than in black, Asian, and Hispanic populations. In both sexes and in all ethnic groups and geographic areas, incidence rates increase markedly with age. The steep increase with age, however, occurs later in black, Asiatic and Hispanic populations than in whites. The ratio of female to male incidence rates is higher than 1.0 in whites, while in blacks and Asians it has often been the reverse, with higher rates among men. In recent years in Hong Kong incidence rates in females have increased more rapidly than incidence rates in males, so that now the incidence rates in females are higher than those in males. In addition to the study in Hong Kong, most studies in Northern Europe and North America show an increase in age-adjusted hip fracture incidence rates over time over the past few decades.

Methodological differences among the various studies (including differences in the definition of hip fracture, in case ascertainment, and in the selection and sample size of the study population) necessitate cautious interpretation of the findings of this report.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Knowelden J., Buhr AJ, Dunbar O. Incidence of fractures in persons over 35 years of age. A report to the MRC Working Party on Fractures in the Elderly. Br J Prev Soc Med 1964; 18: 130.

    CAS  PubMed  Google Scholar 

  2. Wong PCN. Fracture epidemiology in a mixed South-east Asian community (Singapore). Clin Orthop 1966; 45: 55.

    CAS  PubMed  Google Scholar 

  3. Chalmers J, Ho KC. Geographical variations in senile osteoporosis. J Bone Jt Surg [Br] 1970; 52: 667.

    CAS  Google Scholar 

  4. Levine S, Makin M, Menczel J. Incidence of fractures of the proximal end of the femur in Jerusalem. J Bone Jt Surg [Am] 1970; 52: 1193.

    CAS  Google Scholar 

  5. Alhava EM, Puittinen J. Fractures of the upper end of the femur as an index of senile osteoporosis in Finland. Ann Clin Res 1973; 5: 389.

    Google Scholar 

  6. Pogrund H, Makin M, Robin G et al. The epidemiology of femoral neck fractures in Jerusalem. Clin Orthop Res 1977; 122: 141.

    Google Scholar 

  7. Solomon L. Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Jt Surg [Br] 1968; 50: 2.

    CAS  Google Scholar 

  8. Matkovic V, Kostial K, Simonovic I et al. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 1979; 32: 540.

    CAS  PubMed  Google Scholar 

  9. Evans JG. Fractured proximal femur in Newcastie-upon-Tyne. Age Ageing 1979; 8: 31.

    Google Scholar 

  10. Baker MR. An investigation into the secular trends in the incidence of femoral neck fracture using hospital activity analysis. Public Health 1980; 94: 368.

    Article  CAS  PubMed  Google Scholar 

  11. Stott S, Stevenson W. The incidence of femoral neck fracture in New Zealand. NZ Med J Jan 9, 1980; 91: 5.

    Google Scholar 

  12. Gallagher JC, Melton LJ, Riggs BL et al. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Rei Res 1980; 150: 163.

    Google Scholar 

  13. Frandsen PE, Kruse T. Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates. Acta Orthop Scand 1983; 54: 681.

    Article  CAS  PubMed  Google Scholar 

  14. Swanson AJG, Murdoch G. Fractured neck of femur. Acta Orthop Scand 1983; 54: 348.

    Article  CAS  PubMed  Google Scholar 

  15. Farmer ME, White LR, Brody JA et al. Race and sex differences in hip fracture incidence. AJPH 1984; 74: 1374.

    Article  CAS  Google Scholar 

  16. Elabdien ZBS, Olerud S, Karlstrom G et al. Rising incidence of hip fracture in Uppsala, 196–1980. Acta Orthop Scand 1984; 55: 284.

    Article  Google Scholar 

  17. Falch JA, Ilebekk A, Siungaard U. Epidemiology of hip fractures in Norway. Acta Orthop Scand 1985; 56: 12.

    Article  CAS  PubMed  Google Scholar 

  18. Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet 1985; i: 150.

    Article  Google Scholar 

  19. Finsen V, Benum P. Changing incidence of hip fractures in rural and urban areas of central Norway. Clin Orthop Rel Res 1987; 218: 104.

    Google Scholar 

  20. Mannius S, Mellstrom D, Owen A et al. Incidence of hip fracture in western Sweden 1974–1982. Acta Orthop Scand 1987; 58: 38.

    Article  CAS  PubMed  Google Scholar 

  21. Hedlund R, Lindgren U, Ahlborn A. Age- and sex-specific incidence of femoral neck and trochanteric fractures. Clin Orthop Rel Res 1987; 222: 132.

    Google Scholar 

  22. Holmberg S, Thorngren KG. Statistical analysis of femoral neck fractures based on 3053 cases. Clin Orthop 1987; 218: 33.

    Google Scholar 

  23. Lizaur-Utrilla A, Puchades Orts A, Sanchez del Campo F et al. Epidemiology of trochanteric fractures of the femur in Alicante, Spain, 1974–1982. Clin Orthop 1987; 218: 24.

    PubMed  Google Scholar 

  24. Sernbo I, Johnell O. Changes in bone mass and fracture type in patients with hip fractures. A comparison between the 1950s and the 1980s in Malmo, Sweden. Clin Orthop Rel Res 1989; 238: 139.

    Google Scholar 

  25. Bauer RL. Ethnic differences in hip fracture: A reduced incidence in Mexican Americans. Am J Epidemiol 1989; 127: 145.

    Google Scholar 

  26. Silverman SL, Madison RE. Decreased incidence of hip fracture in Hispanics, Asians, and Blacks: California Hospital discharge data. AJPH 1988; 78: 1482.

    Article  CAS  Google Scholar 

  27. Naessen T, Parker R, Persson I et al. Time trend in incidence rates of first hip fracture in the Uppsala health care region, Sweden, 1965–1983. Am J Epidemiol 1989; 130: 289.

    CAS  PubMed  Google Scholar 

  28. Rodriguez JG, Sattin RW, Waxweiler RJ. Incidence of hip fractures, United States, 1970–83. Am J Prev Med 1989; 5: 175.

    CAS  PubMed  Google Scholar 

  29. Martin AD, Silverthorn KG, Houston CS et al. Hip fracture trends in Saskatchewan, 1972–1984. In: Aging and health: Linking research and public policy. Chelsea, Michigan: Lewis Publishers. 1989: 41.

    Google Scholar 

  30. Caniggia M, Morreale P. Epidemiology of hip fracture in Siena, Italy, 1975–1985. Clin Orthop Rei Res 1989; 238: 131.

    Google Scholar 

  31. Ray WA, Griffin MR, West R et al. Incidence of hip fracture in Saskatchewan, Canada, 1976-1985. Am J Epidemiol 1990; 131: 502–9. or]32. Lau E. A survey on fractured proximal femur in Hong Kong. MD thesis, University of Hong Kong 1989.

    CAS  PubMed  Google Scholar 

  32. Kellie SE, Brody JA. Sex-specific and race-specific hip fracture rates. AJPH 1990; 80: 326.

    Article  CAS  Google Scholar 

  33. Nilsson BE, Obrant KJ. Secular tendencies of the incidence of fracture of the upper end of the femur. Acta Orthop Scand 1978; 49: 389.

    Article  CAS  PubMed  Google Scholar 

  34. Evans JG, Prudham D, Wandless I. A prospective study of fractured proximal femur: Incidence and outcome. Public Health 1979; 93: 235.

    Article  CAS  PubMed  Google Scholar 

  35. Jensen JS. Incidence of hip fractures. Acta Orthop Scand 1980; 51: 511.

    Article  CAS  PubMed  Google Scholar 

  36. Lewis AF. Fracture of neck of the femur: Changing incidence. Br Med J 1981; 283: 1217.

    Article  CAS  Google Scholar 

  37. Zetterberg C, Andersson GJ. Fractures of the proximal end of the femur in Göteborg, Sweden, 1940–1979. Acta Orthop Scand 1982; 53: 419.

    Article  CAS  PubMed  Google Scholar 

  38. Wallace WA. The increasing incidence of fractures of the proximal femur: An orthopaedic epidemic. Lancet 1989; ii: 1413.

    Google Scholar 

  39. Johnell O, Nilsson B, Obrant K, Sernbo I. Age and sex patterns of hip fracture. Changes in 30 years. Acta Orthop Scand 1984; 55: 290.

    Article  CAS  PubMed  Google Scholar 

  40. Hedlund R, Ahlbom A, Lindgren U. Hip fracture incidence in Stockholm 1972–1981. Acta Orthop Scand 1985; 57: 30.

    Google Scholar 

  41. Melton LJ, O’Fallon WM, Riggs BL. Secular trend in the incidence of hip fractures. Calcif Tissue Int 1987; 41: 57.

    Article  PubMed  Google Scholar 

  42. Spector TD, Cooper C, Fenton Lewis A. Trends in admissions for hip fracture in England and Wales, 1968–85. Br Med J 1990; 300: 1173–4.

    Article  CAS  Google Scholar 

  43. Rees JL. Accuracy of hospital activity analysis data in estimating the incidence of proximal femoral fracture. Br Med J 1982; 284: 1856.

    Article  CAS  Google Scholar 

  44. Cummings SR. Are patients with hip fractures more oesteoporotic? Review of the evidence. Am J Med 1985; 78: 487.

    Article  CAS  PubMed  Google Scholar 

  45. Aitken JM. Relevance of osteoporosis in women with fracture of the femoral neck. Br Med J 1984; 288: 597–601.

    Article  CAS  Google Scholar 

  46. Firooznia H, Rafii M, Golimbu C et al. Trabecular mineral content of the spine in women with hip fracture: CT measurement. Radiology 1986; 159: 557.

    Google Scholar 

  47. Cooper C, Barker DJP, Morris J, Briggs RSJ. Osteoporosis, falls, and age in fracture of the proximal femur. Br Med J 1987; 295: 13.

    Article  CAS  Google Scholar 

  48. Makin M. Osteoporosis and proximal femoral fractures in the female elderly of Jerusalem. Clin Orthop Rel Res 1987; 218: 19.

    Google Scholar 

  49. Solomon L. Bone density in ageing Caucasian and African populations. Lancet 1979; iv: 1326.

    Article  Google Scholar 

  50. Mazess RB. Bone mineral in Vilcabamba, Ecuador. AJR 1978; 130: 671.

    CAS  PubMed  Google Scholar 

  51. Yano K, Wasnich RD, Vogel JM, Heilbrun LK. Bone mineral measurements among middle-aged and elderly Japanese residents in Hawaii. Am J Epidemiol 1984; 119: 751.

    CAS  PubMed  Google Scholar 

  52. Nordin BEC. International patterns of osteoporosis. Clin Orthop 1966; 45: 17

    CAS  PubMed  Google Scholar 

  53. Cohn SH, Abesamis C, Yasumura S et al. Comparative skeletal mass and radial bone mineral content in Black and White women. Metabolism 1977; 26: 171.

    Article  CAS  PubMed  Google Scholar 

  54. Kumanyika S. Obesity in Black women. Epidemiol Rev 1987; 9: 31.

    CAS  PubMed  Google Scholar 

  55. Moldawer M, Zimmerman SJ, Collins LC. Incidence of osteoporosis in elderly Whites and elderly Negroes. JAMA 1965; 194: 859.

    Article  CAS  PubMed  Google Scholar 

  56. Melton LJ,Ilstrup DM, Bechenbaugh RD, Riggs BL. Hip fracture recurrence: a population-based study. Clin Orthop 1982; 167: 131–8.

    PubMed  Google Scholar 

  57. Solomon L. Hip fracture and cortical bone density in aging African and Causasian populations. In: Uhthoff HK, Stahl E, eds. Current concepts of bone fragility. 1986. Berlin, Heidelberg: Springer-Verlag, 1986: 377–84.

    Google Scholar 

  58. Eriksson SAV, Lindgren JU. Outcome of falls in women: Endogenous factors associated with fracture. Age Ageing 1989; 18: 303.

    Article  CAS  PubMed  Google Scholar 

  59. Ray WA, Griffin MR, Schaffner W et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316: 363.

    CAS  PubMed  Google Scholar 

  60. Melton LJ, Wahner HW, Richelson LS et al. Osteoporosis and the risk of hip fracture. Am J Epidemiol 1986; 124: 254.

    PubMed  Google Scholar 

  61. Finsen V. Improvements in general health among the elderly: A factor in the rising incidence of hip fracture. J Epidemiol Comm Health 1988; 42: 200.

    Article  CAS  Google Scholar 

  62. Bollet AJ, Engh G, Parson W. Epidemiology of osteoporosis. Arch Intern Med 1965; 116: 191.

    CAS  PubMed  Google Scholar 

  63. Lewinnek GE, Kelsey JL, White AA. The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthop Rel Res 1980; 152: 35.

    Google Scholar 

  64. Melton LJ III. Epidemiology of fractures. In: Riggs BL, Melton LJ III Osteoporosis: aetiology, diagnosis and management. New York: Raven Press 1988: 133.

    Google Scholar 

  65. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Regional variation in the incidence of hip fracture. JAMA 1990; 264: 500.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Office of Disease Prevention, Epidemiology and Clinical Applications, National Institute of Arthritis and Musculoskeletal and Skin Diseases, USA

    S. Maggi MD, M.P.H. & S. P. Heyse

  2. Research Program on Aging; Program on Health of the Elderly; World Health Organization, National Institutes of Health, Building 31, Room 2B63, 9000 Rockville Pike, 20892, Bethesda, Maryland, USA

    S. Maggi MD, M.P.H. & J. Litvak

  3. Division of Epidemiology, Columbia University, School of Public Health, New York, USA

    J. L. Kelsey

Authors
  1. S. Maggi MD, M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. L. Kelsey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Litvak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. P. Heyse
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maggi, S., Kelsey, J.L., Litvak, J. et al. Incidence of hip fractures in the elderly: A cross-national analysis. Osteoporosis Int 1, 232–241 (1991). https://doi.org/10.1007/BF03187467

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03187467

Keywords

Search

Navigation