Osteoporosis International

, Volume 21, Issue 3, pp 417–423

Does inadequate diet during childhood explain the higher high fracture rates in the Southern United States?

Original Article

DOI: 10.1007/s00198-009-0997-8

Cite this article as:
Paulozzi, L.J. Osteoporos Int (2010) 21: 417. doi:10.1007/s00198-009-0997-8



Southern states have the highest age-adjusted hip fracture rates among older adults in the United States. Regional hip fracture rates in the United States in 1986–1993 correlate with death rates from rickets in the 1940s. Historical patterns of bone nutrition early in life might explain contemporary geographic patterns in bone fragility.


State of residence early in life is a better predictor of the risk of hip fracture after age 65 than state of current residence. Therefore, the geography of rickets mortality in the United States before 1950 was compared with the geography of hip fracture rates among older adults in the United States during 1986–1993.


Vital statistics data for the US white population for 1942–1948 allowed calculation of the ratio of deaths from rickets to live births for each geographic division of the USA. These ratios were correlated with previously published, standardized hip fracture rates among whites 65–89 years old during 1986–1993 by census division.


During 1942–1948, the rickets mortality ratio among whites was 3.11 in the South, 1.91 in the Northeast, 1.75 in the Midwest, and 1.04 in the West. The correlation of mortality with risk of hip fracture was 0.71 (p = 0.03) for both sexes combined and 0.86 (p = 0.01) for women.


Inadequate nutrition during skeletal formation early in life might explain the higher incidence of hip fracture among older adults in the South.


Calcium Cohort Hip fracture Osteoporosis Rickets Vitamin D 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  1. 1.Division of Unintentional Injury PreventionNational Center for Injury Prevention and Control, Centers for Disease Control and PreventionAtlantaUSA

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