International Journal of Biometeorology

, Volume 59, Issue 10, pp 1511–1522 | Cite as

Systematic review of the association between climate and hip fractures

  • Carmen Román Ortiz
  • José María TeníasEmail author
  • Marisa Estarlich
  • Ferran Ballester
Review Paper


This study aims to systematically review epidemiological studies that evaluate the relationship between meteorology and the incidence of hip fracture (HF). After a search in Scopus, PubMed, and Embase, two independent authors assessed the relevance of studies and extracted data for description. From each study, we extracted the geographic and temporal scope, design, study variables (meteorological and related to HF), statistical analysis, and estimated associations. Of a total of 134 works, 20 studies were selected. All use an ecological design but one case-crossover. Most studies have been conducted in northern latitudes. The analysis methodology did not take into account the temporal structure of the data in 10 studies (regression and linear correlations); the rest used Poisson regression (7) and ARIMA model (3). Most studies showed significant positive associations with rainfall, especially in the form of snow: HF relative risk (RR) on days with precipitation vs. days without precipitation that ranged from 1.14 (95 % confidence interval (CI)1.04 to 1.24) to 1.60 (95 % CI 1.06 to 2.41), the temperature, with RR by one degree Celsius decline from 1.012 (95 % CI 1.004 to 1.020) to 1.030 (95 % CI 1.023 to 1.037), and wind (3) RR FC windiest days vs. calm days: 1.32 (95 % CI 1.10 to 1.58) to 1.35 (95 % CI 0.88 to 2.08). This review shows that analytic methods are very heterogeneous and poorly adapted to the temporary nature of the data. Studies confirm a certain seasonality, with more fractures in winter and meaningful relationships with meteorological conditions typical of this season.


Hip fracture Climate Epidemiology Systematic review 


  1. Aaron JE, Gallagher JC, Nordin BE (1974) Seasonal variation of histological osteomalacia in femoral-neck fractures. Lancet 2:84–85CrossRefGoogle Scholar
  2. Atherton WG, Harper WM, Abrams KR (2005) A year’s trauma admissions and the effect of the weather. Injury 36:40–46CrossRefGoogle Scholar
  3. Bastow MD, Rawlings J, Allison SP (1983) Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1:143–146CrossRefGoogle Scholar
  4. BCMA B. C. M. A. (2013) Osteoporosis: diagnosis, treatment and fracture prevention, p 17. Retrieved from
  5. Beynon C, Wyke S, Jarman I et al (2011) The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis. Environ Health 10:60CrossRefGoogle Scholar
  6. Bischoff-Ferrari HA (2012) Vitamin D and fracture prevention. Rheum Dis Clin North Am 38:107–113CrossRefGoogle Scholar
  7. Bischoff-Ferrari HA, Orav JE, Barrett JA, Baron JA (2007) Effect of seasonality and weather on fracture risk in individuals 65 years and older. Osteoporos Int 18:1225–1233CrossRefGoogle Scholar
  8. Bischoff-Ferrari HA, Can U, Staehelin HB et al (2008) Severe vitamin D deficiency in Swiss hip fracture patients. Bone 42:597–602CrossRefGoogle Scholar
  9. Bischoff-Ferrari HA, Dawson-Hughes B, Whiting SJ (2011) Vitamin D supplementation and fracture risk. Arch Intern Med 171:265CrossRefGoogle Scholar
  10. Bulajic-Kopjar M (2000) Seasonal variations in incidence of fractures among elderly people. Inj Prev 6:16–19CrossRefGoogle Scholar
  11. Burget F, Pleva L, Kudrna K, Kudrnová Z (2012) Incidence of proximal femur fractures in relation to seasons of the year and weather. Acta Chir Orthop Traumatol Cech 79:140–143Google Scholar
  12. Caniggia M, Morreale P (1989) Epidemiology of hip fractures in Siena, Italy, 1975–1985. Clin Orthop Relat Res 131–138Google Scholar
  13. Carter MI, Hinton PS (2014) Physical activity and bone health. Mo Med 111:59–64Google Scholar
  14. CASPe. Critical Appraisal Skills Programme Español. Accessed 3 June 2013
  15. Chesser TJS, Howlett I, Ward AJ, Pounsford JC (2002) The influence of outside temperature and season on the incidence of hip fractures in patients over the age of 65. Age Ageing 31:343–348CrossRefGoogle Scholar
  16. Chiu KY, Ng TP, Chow SP (1996) Seasonal variation of fractures of the hip in elderly persons. Injury 27:333–336CrossRefGoogle Scholar
  17. Cinar N, Harmanci A, Yildiz BO, Bayraktar M (2014) Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey. Eur J Intern Med 25:197–201CrossRefGoogle Scholar
  18. Crawford JR, Parker MJ (2003) Seasonal variation of proximal femoral fractures in the United Kingdom. Injury 34:223–225CrossRefGoogle Scholar
  19. Dennison E, Mohamed MA, Cooper C (2006) Epidemiology of osteoporosis. Rheum Dis Clin North Am 32:617–629CrossRefGoogle Scholar
  20. Douglas AS (1993) Seasonality of hip fracture and haemorrhagic disease of the newborn. Scott Med J 38:37–40Google Scholar
  21. Frihagen F, Pleva L, Kudrna K, Kudrnova Z (2011) Ice and snow in Oslo gave a marked increase in distal radius fractures, but not hip fractures. Osteoporos Int 22:S169–S170Google Scholar
  22. Furelos M, Colino AL, Trobajo JE, Quevedo LA (2001) Hip fractures, seasonal variations and influence of climatological parameters. Rev Ortop Traumatol 45:384–388Google Scholar
  23. Jacobsen SJ, Sargent DJ, Atkinson EJ et al (1995) Population-based study of the contribution of weather to hip fracture seasonality. Am J Epidemiol 141:79–83Google Scholar
  24. Kanis JA, Borgström F, Compston J et al (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8:144CrossRefGoogle Scholar
  25. Katsouyanni K, Schwartz J, Spix C et al (1996) Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol. J Epidemiol Community Health 50(Suppl 1):S12–S18CrossRefGoogle Scholar
  26. Lau EM, Gillespie BG, Valenti L, O’Connell D (1995) The seasonality of hip fracture and its relationship with weather conditions in New South Wales. Aust J Public Health 19:76–80CrossRefGoogle Scholar
  27. Lauritzen JB, Schwarz P, McNair P et al (1993) Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation. Osteoporos Int 3:133–137CrossRefGoogle Scholar
  28. Levy AR, Bensimon DR, Mayo NE, Leighton HG (1998) Inclement weather and the risk of hip fracture. Epidemiology 9:172–177CrossRefGoogle Scholar
  29. Lin H-C, Xiraxagar S (2006) Seasonality of hip fractures and estimates of season-attributable effects: a multivariate ARIMA analysis of population-based data. Osteoporos Int 17:795–806CrossRefGoogle Scholar
  30. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501CrossRefGoogle Scholar
  31. Lofthus CM, Osnes EK, Falch JA et al (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418CrossRefGoogle Scholar
  32. Mirchandani S, Aharonoff GB, Hiebert R et al (2005) The effects of weather and seasonality on hip fracture incidence in older adults. Orthopedics 28:149–155Google Scholar
  33. Modarres R, Ouarda TBMJ, Vanasse A et al (2012) Modeling seasonal variation of hip fracture in Montreal, Canada. Bone 50:909–916CrossRefGoogle Scholar
  34. Modarres R, Ouarda TBMJ, Vanasse A et al (2014) Modeling climate effects on hip fracture rate by the multivariate GARCH model in Montreal region, Canada. Int J Biometeorol 58:921–930CrossRefGoogle Scholar
  35. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefGoogle Scholar
  36. Morency P, Voyer C, Burrows S, Goudreau S (2012) Outdoor falls in an urban context: winter weather impacts and geographical variations. Can J Public Health 103:218–222Google Scholar
  37. Morgan SL (2013) Dietary supplements and medical foods for osteopenia and osteoporosis. J Clin Densitom 16:394–401CrossRefGoogle Scholar
  38. Morgenstern H (1995) Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health 16:61–81CrossRefGoogle Scholar
  39. Murray IR, Howie CR, Biant LC (2011) Severe weather warnings predict fracture epidemics. Injury 42:687–690CrossRefGoogle Scholar
  40. (NAMS), N. A. M (2010) Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause (New York, NY) 17(1):25–54. doi: 10.1097/gme.0b013e3181c617e6 CrossRefGoogle Scholar
  41. Parker MJ, Martin S (1994) Falls, hip fractures and the weather. Eur J Epidemiol 10:441–442CrossRefGoogle Scholar
  42. Parker MJ, Twemlow TR, Pryor GA (1996) Environmental hazards and hip fractures. Age Ageing 25:322–325CrossRefGoogle Scholar
  43. Pasco JA, Henry MJ, Kotowicz MA et al (2004) Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption, and fractures: the Geelong Osteoporosis Study. J Bone Miner Res 19:752–758CrossRefGoogle Scholar
  44. Romley JA, Jena AB, O'Leary JF, Goldman DP (2013) Spending and mortality in US acute care hospitals. Am J Manag Care 19:e46–e54Google Scholar
  45. Rothman KJ (2012) What is causation? In: Rothman KJ (ed) Epidemiology: an introduction. Oxford University Press, Oxford, p 282Google Scholar
  46. Schneider EL, Guralnik JM (1990) The aging of America. Impact on health care costs. JAMA 263:2335–2340CrossRefGoogle Scholar
  47. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefGoogle Scholar
  48. Tenías JM, Estarlich M, Fuentes-Leonarte V et al (2009) Short-term relationship between meteorological variables and hip fractures: an analysis carried out in a health area of the Autonomous Region of Valencia, Spain (1996–2005). Bone 45:794–798CrossRefGoogle Scholar
  49. Turner RM, Hayen A, Dunsmuir WTM, Finch CF (2011) Air temperature and the incidence of fall-related hip fracture hospitalisations in older people. Osteoporos Int 22:1183–1189CrossRefGoogle Scholar

Copyright information

© ISB 2014

Authors and Affiliations

  • Carmen Román Ortiz
    • 1
  • José María Tenías
    • 1
    • 2
    Email author
  • Marisa Estarlich
    • 2
    • 3
  • Ferran Ballester
    • 2
    • 3
    • 4
  1. 1.Research Support UnitLa Mancha Centro General HospitalAlcázar de San JuanSpain
  2. 2.Spanish Consortium for Research on Epidemiology and Public Health, (CIBERESP)BarcelonaSpain
  3. 3.Higher Center for Public Health Research (Centro Superior de Investigación en Salud Pública), CSISPValenciaSpain
  4. 4.University of ValenciaValenciaSpain

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