Osteoporosis International

, Volume 20, Issue 3, pp 371–377 | Cite as

Geographical variations in hip fracture risk for women: strong effects hidden in standardised ratios

  • S. Barbier
  • R. Ecochard
  • A.-M. Schott
  • C. Colin
  • P. D. Delmas
  • S. B. Jaglal
  • C. M. Couris
Original Article

Abstract

Summary

There was 75% variation in the trend in hip fracture incidence with age in women aged 50 to 85 in France. In southwest France, the women are at higher risk of hip fracture at younger ages. This finding should be taken into account when examining risk factors.

Introduction

Few studies have analysed the geographical variations in the relationship between age and hip fracture incidence. Our goal was to assess these variations among women under 85 within the same country.

Methods

The study population included women aged 50 to 85 who were living in France in 2004. Hip fracture cases were identified in the French Diagnosis Related Groups (DRG)-like database using the diagnosis code for closed hip fractures and procedural codes for treatment. The Moran index and a spatial model using latitude and longitude were used to assess the geographical heterogeneities of cumulative incidence risk (CIR) and age effect.

Results

A total of 29,218 hip fracture cases were identified. A south-to-north CIR gradient ranging from 7 to 16% was observed. The variation in the number of years until double hip fracture incidence was 75% (i.e. 1.49 to 2.57 years). In the south, and more markedly in southwest France, the women are at higher risk of hip fracture at a younger age.

Conclusion

The risk of fracture may be different between women of the same age. This may be hidden in a comparison of standardised ratios. This finding should be considered when examining risk factors and implementing public health interventions.

Keywords

Epidemiology Hip fracture risk Osteoporosis Population studies Women 

Notes

Conflicts of interest

None.

References

  1. 1.
    Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902PubMedCrossRefGoogle Scholar
  2. 2.
    Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893PubMedCrossRefGoogle Scholar
  3. 3.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRefGoogle Scholar
  4. 4.
    Goettsch WG, de Jong RB, Kramarz P, Herings RM (2007) Developments of the incidence of osteoporosis in The Netherlands: a PHARMO study. Pharmacoepidemiol Drug Saf 16:166–172PubMedCrossRefGoogle Scholar
  5. 5.
    Jaglal SB, Weller I, Mamdani M et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905PubMedCrossRefGoogle Scholar
  6. 6.
    Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE (1997) Current and projected rates of hip fracture in Canada. CMAJ 157:1357–1363PubMedGoogle Scholar
  7. 7.
    Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (1999) Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 353:802–805PubMedCrossRefGoogle Scholar
  8. 8.
    Lönnroos E, Kautiainen H, Karppi P et al (2006) Increased incidence of hip fractures. A population-based study in Finland. Bone 39:623–627PubMedCrossRefGoogle Scholar
  9. 9.
    Baudoin C, Fardellone P, Thelot B et al (1996) Hip fractures in France: the magnitude and perspective of the problem. Osteoporos Int 6 [Suppl 3]:1–10PubMedCrossRefGoogle Scholar
  10. 10.
    Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in southern Europe: the MEDOS Study. Osteoporos Int 4:253–263PubMedCrossRefGoogle Scholar
  11. 11.
    Ismail AA, Pye SR, Cockerill WC et al (2002) Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 13:565–571PubMedCrossRefGoogle Scholar
  12. 12.
    Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18:333–337PubMedCrossRefGoogle Scholar
  13. 13.
    Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244PubMedCrossRefGoogle Scholar
  14. 14.
    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 9:242–253PubMedCrossRefGoogle Scholar
  15. 15.
    Breslow N, Day NE (1987) Statistical methods in cancer research, vol II—the design and analysis of cohort studies. IARC, LyonGoogle Scholar
  16. 16.
    Chang KP, Center JR, Nguyen TV, Eisman JA (2004) Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 19:532–536PubMedCrossRefGoogle Scholar
  17. 17.
    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 24:257–259PubMedCrossRefGoogle Scholar
  18. 18.
    Lofman O, Berglund K, Larsson L, Toss G (2002) Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int 13:18–25PubMedCrossRefGoogle Scholar
  19. 19.
    Couris CM, Duclos A, Rabilloud M et al (2007) A seventy percent overestimation of the burden of hip fractures in women aged 85 and over. Bone 41:896–900PubMedCrossRefGoogle Scholar
  20. 20.
    Cliff A, Ord J (1981) Spatial processes: models and applications. Pion, LondonGoogle Scholar
  21. 21.
    O’Sullivan D, Unwin D (2002) Geographic information analysis. Wiley, New YorkGoogle Scholar
  22. 22.
    Hinton RY, Lennox DW, Ebert FR, Jacobsen SJ, Smith GS (1995) Relative rates of fracture of the hip in the United States. Geographic, sex, and age variations. J Bone Joint Surg Am 77:695–702PubMedGoogle Scholar
  23. 23.
    Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA (1996) Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol 143:677–682PubMedGoogle Scholar
  24. 24.
    Johnell O, Gullberg B, Kanis JA et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–1815PubMedCrossRefGoogle Scholar
  25. 25.
    Becker C, Crow S, Toman J et al (2006) Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17:410–416PubMedCrossRefGoogle Scholar
  26. 26.
    Meyer HE, Berntsen GK, Sogaard AJ et al (2004) Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol 160:1039–1046PubMedCrossRefGoogle Scholar
  27. 27.
    Sanders KM, Nicholson GC, Ugoni AM, Seeman E, Pasco JA, Kotowicz MA (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Community Health 56:466–470PubMedCrossRefGoogle Scholar
  28. 28.
    Zingmond DS, Soohoo NF, Silverman SL (2006) The role of socioeconomic status on hip fracture. Osteoporos Int 17:1562–1568PubMedCrossRefGoogle Scholar
  29. 29.
    Feskanich D, Willett W, Colditz G (2002) Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 288:2300–2306PubMedCrossRefGoogle Scholar
  30. 30.
    Robbins J, Aragaki AK, Kooperberg C et al (2007) Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 298:2389–2398PubMedCrossRefGoogle Scholar
  31. 31.
    McCabe LD, Martin BR, McCabe GP, Johnston CC, Weaver CM, Peacock M (2004) Dairy intakes affect bone density in the elderly. Am J Clin Nutr 80:1066–1074PubMedGoogle Scholar
  32. 32.
    Prince RL, Devine A, Dhaliwal SS, Dick IM (2006) Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med 166:869–875PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • S. Barbier
    • 1
    • 2
    • 3
  • R. Ecochard
    • 1
    • 2
    • 3
  • A.-M. Schott
    • 4
    • 5
    • 6
  • C. Colin
    • 4
    • 5
    • 6
  • P. D. Delmas
    • 7
    • 8
  • S. B. Jaglal
    • 9
  • C. M. Couris
    • 4
    • 5
    • 6
    • 10
  1. 1.Service de BiostatistiqueHospices Civils de LyonLyonFrance
  2. 2.5558 Equipe Biostatistique-SantéCNRS, UMRVilleurbanneFrance
  3. 3.5558 Laboratoire Biostatistique-SantéUniversité Lyon 1, UMRVilleurbanneFrance
  4. 4.Pôle Information Médicale Evaluation RechercheHospices Civils de LyonLyonFrance
  5. 5.Université LyonLyonFrance
  6. 6.Equipe d’Accueil Santé Individu SociétéLyonFrance
  7. 7.Hospices Civils de LyonLyonFrance
  8. 8.Unité INSERM 831LyonFrance
  9. 9.Department of Physical Therapy, Faculty of MedicineUniversity of TorontoTorontoCanada
  10. 10.Pôle Information Médicale Evaluation RechercheHospices Civils de LyonLyonFrance

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