Osteoporosis International

, Volume 18, Issue 8, pp 1063–1072 | Cite as

Urban-rural differences in distal forearm fractures: Cohort Norway

  • A. J. Søgaard
  • T. K. Gustad
  • E. Bjertness
  • G. S. Tell
  • B. Schei
  • N. Emaus
  • H. E. Meyer
  • On behalf of the Norwegian Epidemiological Osteoporosis Studies (NOREPOS) Research Group
Original Article



The prevalence of forearm fractures increased with increasing degree of urbanization for both genders in the population-based study “Cohort Norway” with more than 180,000 participants. The differences were not explained by available risk factors. Prospective studies with information on bone mineral density and falls are warranted.


The purpose was to investigate urban-rural gradients in self-reported forearm fractures and assess the contribution of possible explanatory factors.


“Cohort Norway” comprises ten population-based surveys inviting 309,742 individuals age 20 years and older. All 181,891 participants underwent a standardized examination and answered 50 common questions, including one concerning former forearm fractures. Based on the home-addresses, participants were divided into three population density groups: cities, densely populated areas and sparsely populated areas. Analyses were limited to 149,725 participants 30 years or over with valid information on exposure and outcome. Of these, 21,627 reported having suffered a forearm fracture.


The prevalence of forearm fractures increased with increasing degree of urbanization for both genders. After adjustment for age and explanatory factors, the odds ratio of having sustained a forearm fracture in men living in densely populated areas and in cities were 1.12 (95% CI, 1.04–1.21) and 1.38 (95% CI, 1.30–1.46), respectively, compared to rural areas. Similar odds ratios were observed among women.


Prospective studies are needed to verify whether lower bone mineral density, different lifestyle and/or more falls may explain the higher proportion of self-reported forearm fractures found in urban compared to rural areas.


Epidemiology Forearm Fractures Rural population Urban population Wrist 



the collaborative Norwegian study “Cohort Norway”


bone mineral density


body mass index


standard deviation


odds ratio


confidence interval



All data used in this paper were obtained from Cohort Norway. The authors gratefully acknowledge the services of CONOR and the contributing research centers delivering data to CONOR. Our sincere thank you goes to all participants as well as to staff-members dealing with data collection in the health surveys contributing to the CONOR database.

We would like to thank Luai Awad Ahmed, PhD, Institute of Community Medicine, University of Tromsø, Norway for his preliminary analyses of forearm fractures from the Fracture Registry at the University Hospital in Tromsø.


The CONOR collaborative group has received financial support from the Ministry of Social Affairs. The NOREPOS research group has received financial support from the Research Council of Norwegian and the Norwegian Osteoporosis Society.


  1. 1.
    Falch JA (1983) Epidemiology of fractures of the distal forearm in Oslo, Norway. Acta Orthop Scand 54:291–295PubMedGoogle Scholar
  2. 2.
    Hove LM, Fjeldsgaard K, Reitan R et al (1995) Fractures of the distal radius in a Norwegian city. Scand J Plast Reconstr Surg Hand Surg 29:263–267PubMedGoogle Scholar
  3. 3.
    O’Neill TW, Cooper C, Finn JD et al (2001) Incidence of distal forearm fracture in British men and women. Osteoporos Int 12:555–558PubMedCrossRefGoogle Scholar
  4. 4.
    Earnshaw SA, Caute SA, Worley A et al (1998) Colles’ fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int 8:53–60PubMedCrossRefGoogle Scholar
  5. 5.
    Haugeberg G, Gjesdal CG, Gulseth HC (2005) Application of the Norwegian medicines agency osteoporosis treatment guidelines on male and female patients with wrist fractures in Norway [Abstract]. J Bone Miner Res 20(Suppl 1):S266Google Scholar
  6. 6.
    Cuddihy MT, Gabriel SE, Crowson CS et al (1999) Forearm fractures as predictors of subsequent osteoporotic fracture. Osteoporos Int 9:469–475PubMedGoogle Scholar
  7. 7.
    Klotzbuecher CM, Ross PD, Landsman PB (2000) Patients with prior fractures have an increased risk of future fractures: A summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  8. 8.
    Schousboe JT, Fink HA, Taylor BC et al (2005) Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic vertebral fractures in older women: a prospective study. J Bone Miner Res 20:100–106PubMedCrossRefGoogle Scholar
  9. 9.
    Finsen V, Benum P (1987) Changing incidence of hip fractures in rural and urban areas of central Norway. Clin Orthop Relat Res 218:104–110PubMedGoogle Scholar
  10. 10.
    Finsen V, Johnsen LG, Tranø G et al (2004) Hip fracture incidence in Central Norway: a follow-up study. Clin Orthop 419:173–178PubMedCrossRefGoogle Scholar
  11. 11.
    Larsson S, Eliasson P, Hansson LI (1989) Hip fractures in northern Sweden 1973–1984. Acta Orthop Scand 60:567–571PubMedCrossRefGoogle Scholar
  12. 12.
    Falch JA, Ilebekk A, Slungaard U (1985) Epidemiology of hip fractures in Norway. Acta Orthop Scand 56:12–16PubMedGoogle Scholar
  13. 13.
    Madhok R, Melton LJ III, Atkinson E et al (1993) Urban vs rural increase in hip fracture incidence. Acta Orthop Scand 64:543–548PubMedGoogle Scholar
  14. 14.
    Sanders KM, Nicholson GC, Ugoni AM et al (2002) Fracture rates lower in rural than urban communities: the geelong osteoporosis study. J Epidemiol Community Health 56:466–470PubMedCrossRefGoogle Scholar
  15. 15.
    Falch JA, Kaastad TS, Bohler G et al (1993) Secular increase and geographical differences in hip fracture incidence in Norway. Bone 14:643–645PubMedCrossRefGoogle Scholar
  16. 16.
    Mannius S, Mellstrom D, Oden A et al (1987) Incidence of hip fracture in western Sweden 1974–1982. Comparison of rural and urban populations. Acta Orthop Scand 58:38–42PubMedGoogle Scholar
  17. 17.
    Sernbo I, Johnell O, Andersson T (1988) Differences in the incidence of hip fracture. Comparison of an urban and a rural population in southern Sweden. Acta Orthop Scand 59:382–385PubMedGoogle Scholar
  18. 18.
    Chevalley T, Herrmann FR, Delmi M et al (2002) Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int 13:113–118PubMedCrossRefGoogle Scholar
  19. 19.
    Cooley HM, Jones G (2002) Symptomatic fracture incidence in southern Tasmania: does living in the country reduce your fracture risk? Osteoporos Int 13:317–322PubMedCrossRefGoogle Scholar
  20. 20.
    Jonsson B, Gardsell P, Johnell O et al (1992) Differences in fracture pattern between an urban and a rural population: a comparative population-based study in southern Sweden. Osteoporos Int 2:269–273PubMedCrossRefGoogle Scholar
  21. 21.
    Melton LJ 3rd, Crowson CS, O’Fallon WN (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9:29–37PubMedCrossRefGoogle Scholar
  22. 22.
    Engeland A, Søgaard AJ (2003) CONOR (Cohort NORway)-an overview of a unique research material [In Norwegian-English abstract]. Nor J Epidemiol 13:73–77, Available from:
  23. 23.
    CONOR (2006) Norwegian Institute of Public Health, Oslo, Norway. Available at: Accessed October 30
  24. 24.
    Søgaard AJ, Selmer R, Bjertness E et al (2004) The oslo health study. The impact of self-selection in a large, population-based survey. Int J Equity Health [serial online] May 6;3:3. Available from: BioMed Central Ltd. Online:
  25. 25.
    Joakimsen RM, Fonnebø V, Søgaard AJ et al (2001) The Tromsø Study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int 12:1001–1005PubMedCrossRefGoogle Scholar
  26. 26.
    Ivers RQ, Cumming RG, Mitchell P et al (2002) The accuracy of self-reported fractures in older people. J Clin Epidemiol 55:452–457PubMedCrossRefGoogle Scholar
  27. 27.
    Hundrup YA, Hoidrup S, Obel EB et al (2004) The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 32:136–143PubMedCrossRefGoogle Scholar
  28. 28.
    Chen Z, Kooperberg C, Pettinger MB et al (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause 11:264–274PubMedCrossRefGoogle Scholar
  29. 29.
    Nevitt MC, Cummings SR, Browner WS et al (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499PubMedGoogle Scholar
  30. 30.
    Ismail AA, O’Neill TW, Cockerill W et al (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European prospective osteoporosis study group. Osteoporos Int 11:248–254PubMedCrossRefGoogle Scholar
  31. 31.
    Jonsson B, Gardsell P, Johnell O et al (1994) Remembering fractures: fracture registration and proband recall in southern Sweden. J Epidemiol Community Health 48:489–490PubMedGoogle Scholar
  32. 32.
    Barrett-Connor E, Siris E, Wehren LE et al (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194PubMedCrossRefGoogle Scholar
  33. 33.
    Wigg AE, Hearn TC, McCaul KA et al (2003) Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia. J Trauma 55:87–93PubMedCrossRefGoogle Scholar
  34. 34.
    Sanders KM, Pasco JA, Ugoni AM et al (1998) The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the geelong osteoporosis study. J Bone Mineral Res 13:1337–1342CrossRefGoogle Scholar
  35. 35.
    Alver K, Meyer HE, Falch JA et al (2006) Air pollution and bone mineral density in elderly men. Abstract. National Osteoporosis Society 11th Conference on Osteoporosis, Harrogate, United Kingdom, June 25–28Google Scholar
  36. 36.
    Thompson PW, Taylor J, Dawson A (2004) The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injuy 35:462–466CrossRefGoogle Scholar
  37. 37.
    Meyer HE, Berntsen GKR, Søgaard AJ et al (2004) Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol 160:1039–1046PubMedCrossRefGoogle Scholar
  38. 38.
    Gardsell P, Johnell O, Nilsson BE et al (1991) Bone mass in an urban and a rural population: a comparative, population-based study in southern Sweden. J Bone Miner Res 6:67–75, Erratum in: J Bone Miner Res 1991;6:428PubMedCrossRefGoogle Scholar
  39. 39.
    Pongchaiyakul C, Nguyen T, Kosulwat V et al (2005) Effect of urbanization on bone mineral density: a Thai epidemiological study. BMC Musculoskelet Disord [serial online]. Feb 4;6:5. Available from: BioMed Central Ltd. Online:
  40. 40.
    Jonsson B, Gardsell P, Johnell O et al (1993) Life-style and different fracture prevalence: a cross-sectional comparative population-based study. Calsif Tissue Int 52:425–433CrossRefGoogle Scholar
  41. 41.
    Ringsberg K, Gardsell P, Johnell O et al (2001) The impact of long-term moderate physical activity on functional performance, bone mineral density and fracture incidence in elderly women. Gerontology 47:15–20PubMedCrossRefGoogle Scholar
  42. 42.
    European Prospective Osteoporosis Study Group (2003) Risk factors for Colles’ fracture in men and women: results from the European prospective osteoporosis study. Osteoporos Int 14:213–218Google Scholar
  43. 43.
    Thorpe DL, Knutsen SF, Beeson WL, Fraser GE (2006) The effect of vigorous physical activity and risk of wrist fracture over 25 years in a low-risk survivor cohort. J Bone Miner Metab 24:476–483PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • A. J. Søgaard
    • 1
    • 2
  • T. K. Gustad
    • 1
    • 2
  • E. Bjertness
    • 2
  • G. S. Tell
    • 3
  • B. Schei
    • 4
  • N. Emaus
    • 5
  • H. E. Meyer
    • 1
    • 2
  • On behalf of the Norwegian Epidemiological Osteoporosis Studies (NOREPOS) Research Group
  1. 1.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  2. 2.Institute of General Practice and Community Medicine, Section for Preventive Medicine and EpidemiologyUniversity of OsloOsloNorway
  3. 3.Departement of Public Health and Primary Health CareUniversity of BergenBergenNorway
  4. 4.Departement of Community MedicineNorwegian University of Science and TechnologyTrondheimNorway
  5. 5.Institute of Community MedicineUniversity of TromsøTromsøNorway

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