Osteoporosis International

, Volume 16, Issue 6, pp 597–602 | Cite as

Epidemiology of hip fractures in 2002 in Rabat, Morocco

  • Abdellah El Maghraoui
  • Boris A. Koumba
  • Imane Jroundi
  • Lahsen Achemlal
  • Ahmed Bezza
  • Mohamed A. Tazi
Original Article


Hip fracture has never been studied before, either in Morocco or in the adjacent countries of the south bank of the Mediterranean Sea. The aim of this study was to investigate the incidence rate of hip fracture in 2002 in Rabat Province, a large area in the northwest of The Kingdom of Morocco, by the use of register information and medical records collected from the five public hospitals of the region. The hip fracture data were restricted to cervical or trochanteric types. There was a total of 150 hip fractures (83 in women and 67 in men) in the over-50-year-old population in the Province of Rabat during 2002. The age-adjusted 1-year cumulative incidence of hip fracture was 52.1/100,000 [95% confidence interval (CI) 40.9–63.3/100,000] in women and 43.7/100,000 (95% CI 33.3–52.2/100,000) in men. The standardized incidence rate against the 1985 US population was 80.7/100,000 (95% CI 78.5–93.0/100,000) for women and 58.5/100,000 (95% CI 47.9–68.1/100,000) for men. The mean (standard deviation) age of patients with a hip fracture was 70.7 (9.4) years for women and 70.4 (10.0) years for men. The overall female-to-male ratio of hip fracture was 1.19 for age-adjusted hip fracture incidence and 1.30 for standardized incidence. A marked increase in incidence rate was found for both men and women with increasing age, becoming exponential after the age of 50 years. The mean age for hip fracture was 70.7 (9.4) years in women and 70.4 (10.0) years in men (P>0.05). Women had a cervical-to-trochanteric ratio of 0.97 compared to men, at 1.03. The characteristics of hip fractures described in this study suggest that fragility fractures occur in North Africa, although substantially less frequently than in most European, North American and Asian countries but more frequently than sub-Saharan African countries, in agreement with the north–south gradient observed in the epidemiology of osteoporosis. The low incidence of hip fragility fracture rate is most likely the result of reduced longevity in Morocco.


Epidemiology Hip fracture Incidence Morocco 



The authors thank the orthopedic departments of the five public hospitals of Rabat Province (Avicenna Hospital, Military Hospital of Mohammed V, Moulay Abdellah Hospital of Salé, Sidi Lahcen Hospital of Temara, Provincial Hospital of Khemisset) for help and assistance during the data collection.


  1. 1.
    Cummings SR, Melton LJ III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMedGoogle Scholar
  2. 2.
    Lau EMC (2001) Epidemiology of osteoporosis. Best Pract Res Clin Rheum 15:335–344CrossRefGoogle Scholar
  3. 3.
    Hollmann FW (1993) Current population reports P25–1095. US population estimates, by age, sex, race, and Hispanic origin:1980 to 1991. US Department of Commerce, Economics and Statistics Administration, Bureau of the CensusGoogle Scholar
  4. 4.
    Maggi S, Kelsey JL, Litvak J, Heyse SP (1991) Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int 1:232–241PubMedGoogle Scholar
  5. 5.
    Memon A, Pospula WM, Tantawy AY, Abdul-Ghafar S, Suresh A, Al-Rowaih A (1998) Incidence of hip fracture in Kuwait. Int J Epidemiol 27: 860–865CrossRefPubMedGoogle Scholar
  6. 6.
    Koh LKH, Saw S-M, Lee JJM, et al (2001) Hip fracture incidence rates in Singapore 1991–1998. Osteoporos Int 12:311–318CrossRefPubMedGoogle Scholar
  7. 7.
    Elffors I, Allander E, Kanis JA, Gullerg B, Johnell O, Dequeker J (1994) The variable incidence of hip fracture in southern Europe: The MEDOS study. Osteoporos Int 4:253–263PubMedGoogle Scholar
  8. 8.
    Schwartz AV, Kelsey JL, Maggi S, et al (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 9:242–253CrossRefPubMedGoogle Scholar
  9. 9.
    Rogmark C, Sernbo I, Johnell O, Nilsson, J-Å (1999) Incidence of hip fractures in Malmö, Sweden, 1992–1995: a trend-break. Acta Orthop Scand 70:19–22PubMedGoogle Scholar
  10. 10.
    Falch JA, Aho H, Berglund K, Düppe H, Finsen V, Hagstrom I, Jarvinen M, Johnell O, Kaastad TS, Lauritzen JB, et al (1995) Hip fractures in Nordic cities: difference in incidence. Ann Chir Gynaecol 84:286–290PubMedGoogle Scholar
  11. 11.
    Ho SC, Bacon WE, Harris T, Looker A, Maggi S (1993) Hip fracture rates in Hong Kong and the United States, 1988 through 1989. Am J Public Health 83:694–697PubMedGoogle Scholar
  12. 12.
    Silverman SL, Madison RL (1988) Decreased incidence of hip fracture in Hispanics, Asians, and Blacks: California Hospital discharge data. Am J Public Health 78:1482–1483PubMedGoogle Scholar
  13. 13.
    Gallagher JC, Melton LJ, Riggs BL, et al (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 150:163–171PubMedGoogle Scholar
  14. 14.
    Boereboom FTJ, Raymakers JA, de Groot RRM, Duursma SA (1992) Epidemiology of hip fractures in the Netherlands: women compared with men. Osteoporos Int 2:279–284PubMedGoogle Scholar
  15. 15.
    Nydegger V, Rizzoli R, Rapin CH, Vasey H, Bonjour JP (1991) Epidemiology of fractures of the proximal femur in Geneva: incidence, clinical and social aspects. Osteoporos Int 2:42–47PubMedGoogle Scholar
  16. 16.
    Jequier V, Burnand B, Vader JP, Paccaud F (1995) Hip fracture incidence in the Canton of Vaud, Switzerland, 1986–1991. Osteoporos Int 5:191–195PubMedGoogle Scholar
  17. 17.
    Mazzuoli GF, Gennari C, Passeri M, Celi FS, Acca M, Camporeale A, Pioli G, Pedrazzoni M (1993) Incidence of hip fracture: an Italian survey. Osteoporos Int [1 Suppl]:S8–9Google Scholar
  18. 18.
    Vaz AL (1993) Epidemiology and costs of osteoporotic hip fractures in Portugal. Bone 14:S9CrossRefPubMedGoogle Scholar
  19. 19.
    Dretakis EK, Giaourakis G, Steriopoulos K (1992) Increasing incidence of hip fracture in Crete. Acta Orthop Scand 63:150–151PubMedGoogle Scholar
  20. 20.
    Lau LMC, Cooper C, Wikham C, Donnan S, Barber DJP (1990) Hip fracture in Hong Kong and Britain. Int J Epidemiol 19:1119–1121PubMedGoogle Scholar
  21. 21.
    Bagur A, Mautalen C, Rubin Z (1994) Epidemiology of hip fractures in an urban population of central Argentina. Osteoporos Int 4:332–335PubMedGoogle Scholar
  22. 22.
    Scott S, Gray DM (1980) The incidence of femoral neck fractures in New Zealand. N Z J Med 91:6–9Google Scholar
  23. 23.
    Sanders KM, Seeman E, Ugoni AM, et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10:240–247CrossRefPubMedGoogle Scholar
  24. 24.
    Hagino H, Yamamoto K, Teshima R, Kishimoto H, Kuranobu K, Nakamura T (1989) The incidence of fractures of the proximal femur and the distal radius in Tottori Prefecture, Japan. Arch Orthop Trauma Surg 109:43–44Google Scholar
  25. 25.
    Lau EMC, Lee JK, Suriwongpaisal P, et al (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243CrossRefPubMedGoogle Scholar
  26. 26.
    Yan L, Zhou B, Prentice A, Wang X, Golden MHN (1999) Epidemiological study of hip fracture in Shenyang, People’s Republic of China. Bone 24:151–155CrossRefPubMedGoogle Scholar
  27. 27.
    Kawashima T (1989) Epidemiology of the femoral neck fracture in 1985, Niigata Prefecture, Japan. J Bone Miner Metab 7:118 –126Google Scholar
  28. 28.
    Lau E, Cooper C, Donnan S, Barker DJ P (1990) Incidence and risk factors for hip fracture in Hong Kong Chinese. In: Christiansen G, Overgaard K (eds) Proceedings of the Third International Symposium on Osteoporosis. Osteopress, Copenhagen, pp 66–70Google Scholar
  29. 29.
    Rowe SM Ryang DH (1993) An epidemiological study of hip fracture in Honam, Korea. Int Orthop 17:139–143PubMedGoogle Scholar
  30. 30.
    Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fractures in Beijing, People’s Republic of China: the Beijing Osteoporosis Project. Am J Epidemiol 144:901–907PubMedGoogle Scholar
  31. 31.
    Hashimoto T, Sakata K, Yoshimura N (1997) Epidemiology of osteoporosis in Japan. Osteoporos Int 7 [Suppl 3]:S99–102Google Scholar
  32. 32.
    Solomon L (1968) Osteoporosis and fracture of femoral neck in the South African Bantu. J Bone Joint Surg 50B:2–13Google Scholar
  33. 33.
    Aspray TJ, Prentice A, Timothy JC, Yankuba S, Reeve J, Roger MF (1996) Low bone mineral content is common but osteoporotic fractures are rare in the elderly rural Gambian women. J Bone Miner Res 11:1009–1025Google Scholar
  34. 34.
    Adebajo AO, Cooper C, Grimley EJ (1997) Fractures of the hip and distal forearm in West Africa and the United Kingdom. Age Ageing 20:435–438Google Scholar
  35. 35.
    Zebaze RMD, Seeman E (2003) Epidemiology of hip and wrist fractures in Cameroon, Africa. Osteoporos Int 14:301–305CrossRefPubMedGoogle Scholar
  36. 36.
    Parkkari J, Kannus P, Niemi S, Pasanen M, Järvinen M, Luthje P, et al (1994) Increasing age-adjusted incidence of hip fractures in Finland: The number and incidence of fractures in 1970–1991 and prediction for the future. Calcif Tissue Int 55:342–345PubMedGoogle Scholar
  37. 37.
    Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R (1999) The changing picture of hip fractures: dramatic change in age distribution and no change in age-adjusted incidence within 10 years in Central Finland. Bone 24:257–259CrossRefPubMedGoogle Scholar
  38. 38.
    Melton LJ III (1996) Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18 [Suppl 3]: 121S–25SGoogle Scholar
  39. 39.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413PubMedGoogle Scholar
  40. 40.
    Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289PubMedGoogle Scholar
  41. 41.
    Mautalen CA, Vega EM, Einhorn TA (1996) Are the etiologies of cervical and trochanteric hip fractures different? Bone 18:133S–137SCrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Abdellah El Maghraoui
    • 1
  • Boris A. Koumba
    • 1
  • Imane Jroundi
    • 2
  • Lahsen Achemlal
    • 1
  • Ahmed Bezza
    • 1
  • Mohamed A. Tazi
    • 3
  1. 1.Rheumatology and Physical Rehabilitation DepartmentMilitary Hospital of Mohammed VRabatMorocco
  2. 2.Epidemiology DepartmentRabat Medicine and Pharmacy UniversityRabatMorocco
  3. 3.Epidemiology DepartmentMinistry of HealthRabatMorocco

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