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Racial/ethnic differences in hip and diaphyseal femur fractures

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Contemporary femur fracture rates were examined in northern California women and compared by race/ethnicity. During 2006–2012, hip fracture rates declined, but diaphyseal fracture rates increased, especially in Asians. Women with diaphyseal fracture were younger and more likely to be bisphosphonate-treated. These disparities in femur fracture should be further examined.


The epidemiology of diaphyseal femur fracture differs from proximal femur (hip) fracture, although few studies have examined demographic variations in the current era. This study examines contemporary differences in low-energy femur fracture by race/ethnicity in a large, diverse integrated health-care delivery system.


The incidence of hip and diaphyseal fracture in northern California women aged ≥50 years old during 2006–2012 was examined. Hip (femoral neck and pertrochanteric) fractures were classified by hospital diagnosis codes, while diaphyseal (subtrochanteric and femoral shaft) fractures were further adjudicated based on radiologic findings. Demographic and clinical data were obtained from health plan databases. Fracture incidence was examined over time and by race/ethnicity.


There were 10,648 (97.3 %) hip and 300 (2.7 %) diaphyseal fractures among 10,493 women. The age-adjusted incidence of hip fracture fell from 281 to 240 per 100,000 women and was highest for white women. However, diaphyseal fracture rates increased over time, with a significant upward trend in Asians (9 to 27 per 100,000) who also had the highest rate of diaphyseal fracture. Women with diaphyseal fracture were younger than women with hip fracture, more likely to be of Asian race and to have received bisphosphonate drugs. Women with longer bisphosphonate treatment duration were also more likely to have a diaphyseal fracture, especially younger Asian women.


During 2006 to 2012, hip fracture rates declined, but diaphyseal fracture rates increased, particularly among Asian women. The association of diaphyseal fracture and bisphosphonate therapy should be further investigated with examination of fracture pattern.

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This study was supported by a grant from the Kaiser Permanente Community Benefit Program. The authors would like to thank Joel Gonzalez for his help with data management and manuscript preparation.

Conflicts of interest

Joan Lo, Malini Chandra, and Rita Hui have received research funding from Amgen, Inc. Dr. Ettinger has received payments for expert testimony in litigation involving Fosamax. The remaining authors (Patricia Zheng, Christopher Grimsrud, Amer Budayr, Gene Lau, Maureen Baur, and Romain Neugebauer) have no conflict of interest to report.

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Correspondence to J. C. Lo.

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Lo, J.C., Zheng, P., Grimsrud, C.D. et al. Racial/ethnic differences in hip and diaphyseal femur fractures. Osteoporos Int 25, 2313–2318 (2014).

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