Osteoporosis International

, Volume 8, Issue 2, pp 192–195

Are annual fluctuations in hip fracture incidence dependent upon the underlying mortality rate?

  • O. Johnell
  • L. J. Melton
  • J. Å. Nilsson
Original Article


There is substantial variation in hip fracture incidence rates from one year to the next. To determine whether this is related to varying mortality rates in the underlying population, we carried out an ecological analysis in Rochester and Olmsted County, Minnesota. In a given year, mortality in the general population was not related to hip fracture incidence nor did the fracture incidence rates influence the overall death rate. There was a negative correlation between hip fracture incidence and mortality in the preceding year among women, but not men; the trend was statistically significant among women less than 80 years of age. Both cervical and intertrochanteric hip fractures in women had a similar relationship to mortality in the population the year before. There was no consistent relationship between hip fracture incidence and mortality rates two or three years previously. Although many hip fractures occur in frail individuals near the end of life, patterns of mortality in the underlying population cannot account for the annual variation in hip fracture incidence.


Epidemiology Hip fracture Incidence Mortality Secular trends 


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  1. 1.
    Melton LJ III, Atkinson EJ, Madhok R. Downturn in hip fracture incidence. Public Health Rep 1996;111:146–50.PubMedGoogle Scholar
  2. 2.
    Spector TD, Cooper C, Lewis AF. Trends in admissions for hip fracture in England and Wales, 1968–85. BMJ 1990;300:1173–4.PubMedGoogle Scholar
  3. 3.
    Melton LJ III. A ‘Gompertzian’ view of osteoporosis. Calcif Tissue Int 1990;46:285–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Melton LJ III. Epidemiology of fractures. In: Riggs BL, Melton LJ III, editors. Osteoporosis: etiology, diagnosis and management. 2nd ed. Philadelphia: Lippincott-Raven, 1995:225–47.Google Scholar
  5. 5.
    Jacobsen SJ, Sargent DJ, Atkinson EJ, O’Fallon WM, Melton LJ III. Population-based study of the contribution of weather to hip fracture seasonality. Am J Epidemiol 1995;141:79–83.PubMedGoogle Scholar
  6. 6.
    Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984–1987. Am J Epidemiol 1991;133:996–1004.PubMedGoogle Scholar
  7. 7.
    Agnusdei D, Camporeale A, Gerardi D, Rossi S, Bocchi L, Gennari C. Trends in the incidence of hip fracture in Siena, Italy, from 1980 to 1991. Bone 1993;14:S31–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Khosla S, Melton LJ III. Secondary osteoporosis. In: Riggs BL, Melton LJ III, editors. Osteoporosis: etiology, diagnosis and management. 2nd ed. Philadelphia: Lippincott-Raven, 1995:183–204.Google Scholar
  9. 9.
    Poór G, Atkinson EJ, O’Fallon WM, Melton LJ III. Predictors of hip fractures in elderly men. J Bone Miner Res 1995;10:1900–7.PubMedGoogle Scholar
  10. 10.
    Poór G, Atkinson EJ, O’Fallon WM, Melton LJ III. Determinants of reduced survival following hip fractures in men. Clin Orthop 1995;319:260–5.PubMedGoogle Scholar
  11. 11.
    Eickhoff TC, Sherman IL, Serfling RE. Observations on excess mortality associated with epidemic influenza. JAMA 1961;176:776–82.PubMedGoogle Scholar
  12. 12.
    Housworth J, Langmuir AD. Excess mortality from epidemic influenza, 1957–1966. Am J Epidemiol 1974;100:40–8.PubMedGoogle Scholar
  13. 13.
    Barker WH, Mullooly JP. Pneumonia and influenza deaths during epidemics: implications for prevention. Arch Intern Med 1982;142:85–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Cameron AS, Roder DM, Esterman AJ, Moore BW. Mortality from influenza and allied infections in South Australia during 1968–1981. Med J Austr 1985;142:14–7.Google Scholar
  15. 15.
    Diepersloot RJA, Bouter KP, Hoekstra JBL. Influenza infection and diabetes mellitus: case for annual vaccination. Diabetes Care 1990;13:876–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Melton LJ III. History of the Rochester Epidemiology Project. Mayo Clin Proc 1996;71:266–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Madhok R, Melton LJ III, Atkinson EJ, O’Fallon WM, Lewallen DG. Urban vs rural increase in hip fracture incidence: age and sex of 901 cases 1980–89 in Olmsted County, USA. Acta Orthop Scand 1993;64:543–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Bergstralh EJ, Offord KP, Chu C-P, Beard CM, O’Fallon WM, Melton LJ III. Calculating incidence, prevalence and mortality rates for Olmsted County, Minnesota: an update. Technical report series no. 49, Section of Biostatistics, Mayo Clinic, Rochester, MN, 1992.Google Scholar
  19. 19.
    Poór G, Jacobson SJ, Melton LJ III. Mortality following hip fracture. Facts Res Gerontol 1994;7:91–109.Google Scholar
  20. 20.
    Melton LJ III. Fluoride in the prevention of osteoporosis and fractures. J Bone Miner Res 1990;5(Suppl 1):S163–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Goldacre MJ. Cause-specific mortality: understanding uncertain tips of the disease iceberg. J Epidemiol Community Health 1993;47:491–6.PubMedGoogle Scholar
  22. 22.
    Finsen V. Improvements in general health among the elderly: a factor in the rising incidence of hip fractures? J Epidemiol Community Health 1988;42:200–3.PubMedGoogle Scholar
  23. 23.
    Johnell O, Gullberg B, Allander E, Kanis JA. The apparent incidence of hip fracture in Europe: a study of national register sources. MEDOS Study Group. Osteoporos Int 1992;2:298–302.PubMedCrossRefGoogle Scholar
  24. 24.
    Melton LJ III, Therneau TM, Larson DR. Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Osteoporos Int (in press).Google Scholar
  25. 25.
    Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992;2:285–9.PubMedCrossRefGoogle Scholar

Copyright information

© European Foundation for Osteoporosis and the National Osteoporosis Foundation 1998

Authors and Affiliations

  • O. Johnell
    • 1
    • 2
  • L. J. Melton
    • 1
  • J. Å. Nilsson
    • 3
  1. 1.Department of Health Sciences ResearchMayo Clinic and Mayo FoundationRochesterUSA
  2. 2.Department of OrthopaedicsMalmö University HospitalMalmöSweden
  3. 3.Department of StatisticsMalmö University HospitalMalmöSweden
  4. 4.Section of Clinical Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterUSA

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