Archives of Osteoporosis

, 14:47 | Cite as

Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil

  • Dalisbor Marcelo Weber SilvaEmail author
  • Marise Lazaretti-Castro
  • Cristiano Augusto de Freitas Zerbini
  • Vera Lúcia Szejnfeld
  • Sergio Ragi Eis
  • Victoria Zeghbi Cochenski Borba
Original Article



Osteoporosis is a very common disease, and data on its epidemiology is important for health care strategy implementation. Brazil is a developing country; its population is aging, leading to an expected increase in hip fractures and their undesirable consequences.


Assess the incidence of osteoporotic hip fractures and subsequent mortality in Southern Brazil as part of a large epidemiological study aiming to reinforce the data for FRAX Brazil.

Study design

This study evaluated all admissions for fragility hip fractures between April 1, 2010, and March 31, 2012, in the city of Joinville, including both genders of patients 50 years old or older, which corresponded to 19.2% of the local population. Joinville was chosen because it is the third largest city in the south of Brazil, with a representative population predominantly composed of descendants of European immigrants.


There were 213 cases of hip fractures, predominantly in Caucasians (n = 204, 96.7%) whose mean age was 77.7, ± 10.5, of which 143 (67.1%) were women (79.5 ± 9.6 years) and 70 (32.9%) were men (74 ± 11.3 years). The annual incidence of hip fractures was 268.8 for women and 153.0 for men/100,000 inhabitants. In the 60 to 64-year group, the overall incidence was 92.1/100,000, with an age-related increase of 1410.1/100,000 in the 80 to 84-year group. The mortality rate during hospitalization was 7.5%, and 25% died during the 12 months following their fractures.


The incidence of hip fractures among the oldest in this predominantly Caucasian population living in Southern Brazil was similar to that of European populations from the northern hemisphere. The annual incidence of fragility hip fractures among people in their 80s was 59 times higher than that among people in their 50s. The mortality rate was 4.3 times higher in the first year after hip fracture than in the age-related local population.


Epidemiology Hip fracture Osteoporosis Incidence of hip fracture Mortality after hip fracture 



We acknowledge the work of the Document Sector employees of the Hospital Municipal São José, Centro Hospitalar Unimed and Hospital Dona Helena, in Joinville, SC. We further cordially thank Ms. Mercedes Terezinha Weber Silva for her support in telephone interviews with patients and Ms. Marcia Olandoski for her statistical work.

Compliance with ethical standards

The three hospitals’ Research Ethics Committees approved the study. Cases were analyzed after we obtained the informed consent form by telephone.

Conflicts of interest

Dalisbor Marcelo Weber Silva has received research grants from Servier do Brasil; Marise Lazaretti-Castro, Cristiano Augusto de Freitas Zerbini, Vera Lúcia Szejnfeld, and Sergio Ragi Eis are members of the committee for this study; and Victoria Zeghbi Cochenski Borba declares that she has no conflict of interest. This study was supported by the Servier do Brasil Ltda.


  1. 1.
    Kanis JA, Oden A, Mccloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256CrossRefGoogle Scholar
  2. 2.
    Gerland P, Raftery AE, Sevcikova H, Li N, Gu D, Spoorenberg T et al (2014) World population stabilization unlikely this century. Science 346(6206):234–237CrossRefGoogle Scholar
  3. 3.
    Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a worldwide projection. Osteoporos Int 2:285–289CrossRefGoogle Scholar
  4. 4.
    Schemitsch E, Bhandari M (2009) Femoral neck fractures: controversies and evidence. J Orthop Trauma 23(6):385CrossRefGoogle Scholar
  5. 5.
    Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jónsson PV 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(3):242–253CrossRefGoogle Scholar
  6. 6.
    Gallagher JC, Melton LJ, Riggs BL, Bergstralh E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 150:163–171Google Scholar
  7. 7.
    Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29(5):413–418CrossRefGoogle Scholar
  8. 8.
    Bacon WE, Maggi S, Looker A, Harris T, Nair CR, Giaconi J et al (1996) International comparison of hip fracture rates in 1988–89. Osteoporos Int 6:69–75CrossRefGoogle Scholar
  9. 9.
    Frandsen PA, Kruse T (1983) Hip fractures in the county of Funen, Denmark: implications of demographic aging and changes in incidence rates. Acta Orthop 54(5):681–686CrossRefGoogle Scholar
  10. 10.
    Kanis JA, Johnell O, Oden A, Johansson H, Mccloskey E (2008) FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397CrossRefGoogle Scholar
  11. 11.
    Johnell O, Gullberg B, Allander E, Kanis JA (1992) The apparent incidence of hip fracture in Europe: a study of national register sources. MEDOS study group. Osteoporos Int 2:298–302CrossRefGoogle Scholar
  12. 12.
    Nydegger V, Rizzoli R, Rapin CH, Vasey H, Bonjour JP (1991) Epidemiology of fractures of the proximal femur in Geneva: incidence, clinical and social aspects. Osteoporos Int 2(1):42–47CrossRefGoogle Scholar
  13. 13.
    Baudoin C, Fardellone P, Potard V, Sebert JL (1993) Fractures of the proximal femur in Picardy, France, 1987. Osteoporos Int 3(1):43–49CrossRefGoogle Scholar
  14. 14.
    Ho SC, Bacon WE, Harris T, Looker A, Maggi S (1993) Hip fracture rates in Hong Kong and the United States, 1988 through 1989. Am J Public Health 83:694–697CrossRefGoogle Scholar
  15. 15.
    Bagur A, Mautalen C, Rubin Z (1994) Epidemiology of hip fractures in an urban population of Central Argentina. Osteoporos Int 4:332–335CrossRefGoogle Scholar
  16. 16.
    Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing osteoporosis project. Am J Epidemiol 144:901–907CrossRefGoogle Scholar
  17. 17.
    Caniggia M, Morreale P (1989) Epidemiology of hip fractures in Siena, Italy, 1975-1985. Clin Orthop Relat Res 238:131–138CrossRefGoogle Scholar
  18. 18.
    Morales-Torres J, Gutiérrez-Ureña S (2004) Osteoporosis Committee of Pan-American League of Associations for Rheumatology. The burden of osteoporosis in Latin America. Osteoporos Int 15(8):625–632CrossRefGoogle Scholar
  19. 19.
    Castro DA, Rocha FA, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14(6):496–499CrossRefGoogle Scholar
  20. 20.
    Silveira VA, Medeiros MM, Coelho-Filho JM, Mota RS, Noleto JC, Costa FS et al (2005) Hip fracture incidence in an urban area in Northeast Brazil. Cad Saude Publica 21(3):907–912CrossRefGoogle Scholar
  21. 21.
    Komatsu RS, Ramos LR, Szejnfeld VL (2004) Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging 8(5):362–367PubMedGoogle Scholar
  22. 22.
    Kanis JA (2008) On behalf of the WHO scientific group. Assessment of osteoporosis at the primary health-care level. Technical report. WHO Collaborating Centre, University of Sheffield, UK, Sheffield Google Scholar
  23. 23.
    Zerbini CAF, Szejnfeld VL, Albergaria BH, Mccloskey EV, Johansson H, Kanis JA (2003) Incidence of hip fracture in Brazil and the development of an FRAX model. Arch Osteoporos 10:28–34CrossRefGoogle Scholar
  24. 24.
    IBGE [Internet]. Censo Demográfico 2010: características da população e dos domicílios: resultados do universo. Available in: Accessed 07 April 2019
  25. 25.
    Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN (2014) A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag 10:937–948PubMedPubMedCentralGoogle Scholar
  26. 26.
    Melton J (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14:S1–S8CrossRefGoogle Scholar
  27. 27.
    Rosengren BE, Karlsson MK (2014) The annual number of hip fractures in Sweden will double from year 2002 to 2050: projections based on local and nationwide data. Acta Orthop 85:234–237CrossRefGoogle Scholar
  28. 28.
    Siqueira FV, Facchini LA, Hallal PC (2005) The burden of fractures in Brazil: a population-based study. Bone 37(2):261–266CrossRefGoogle Scholar
  29. 29.
    Lin KB, Yang NP, Lee YH, Chan CL, Wu CH, Chen HC et al (2018) The incidence and factors of hip fractures and subsequent morbidity in Taiwan: an 11-year population-based cohort study. PLoS One 13(2):e0192388CrossRefGoogle Scholar
  30. 30.
    Contreras L, Kirschbaum A, Pumarino H (1991) Epidemiology of fractures in Chile. Rev Med Chil 119(1):92–98PubMedGoogle Scholar
  31. 31.
    Johansson H, Clark P, Carlos F, Oden A, Mccloskey EV, Janis JA (2011) Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social security. Osteoporos Int 22:2359–2364CrossRefGoogle Scholar
  32. 32.
    Silva DMW, Vitti A, Otero MSS, Damas TB, Ghanem O, Gonçalves ARR (2014) Prevalência de Deficiência de Vitamina D em Joinville-SC. Arq Bras Endocrinol Metabol 58:5347Google Scholar
  33. 33.
    Leboff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J (1999) Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 281(16):1505–1511CrossRefGoogle Scholar
  34. 34.
    Simonelli C, Weiss TW, Morency J, Swanson L, Chen YT (2005) Prevalence of vitamin D inadequacy in a minimal trauma fracture population. Curr Med Res Opin 21(7):1069–1074CrossRefGoogle Scholar
  35. 35.
    Pasco JA, Henry MJ, Kotowicz MA, Sanders KM, Seeman E, Pasco JR, Schneider RG, Nicholson GC (2004) Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption, and fractures: the Geelong osteoporosis study. J Bone Miner Res 19(5):752–758CrossRefGoogle Scholar
  36. 36.
    Johnell O, Kanis JA, Odén A et al (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15(3):175–179CrossRefGoogle Scholar
  37. 37.
    Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fracture. Am J Epidemiol 137:1001–1005CrossRefGoogle Scholar
  38. 38.
    Fortes EM, Raffaelli MP, Bracco OL, Takata ETT, Reis FB, Santilli C, Lazaretti-Castro M (2008) Elevada morbimortalidade e reduzida taxa de diagnóstico de osteoporose em idosos com fratura de fêmur proximal na cidade de São Paulo. Arq Bras Endocrinol Metabol 52:1106–1114CrossRefGoogle Scholar
  39. 39.
    Vidal EI, Coeli CM, Pinheiro RS, Camargo KR Jr (2006) Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil. Osteoporos Int 17(10):1569–1576CrossRefGoogle Scholar
  40. 40.
    Majumdar SR, Kim N, Colman I et al (2005) Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med 165(8):905–909CrossRefGoogle Scholar
  41. 41.
    Roberts SE, Goldacre MJ (2003) Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98 database study. BMJ. 327:771–776CrossRefGoogle Scholar
  42. 42.
    Garcia R, Leme MD, Garcez-Leme LE (2006) Evolution of Brazilian elderly with hip fracture secondary to a fall. Clinics 61(6):539–544CrossRefGoogle Scholar
  43. 43.
    Dorner T, Weichselbaum E, Lawrence K, Viktoria SK, Rieder A (2009) Austrian osteoporosis report: epidemiology, lifestyle factors, public health strategies. Wien Med Wochenschr 159:221–229CrossRefGoogle Scholar
  44. 44.
    Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB (2009) Clinical risk factors for osteoporotic fractures in Brazilian women and men: the BRAZilian Osteoporosis Study (BRAZOS). Osteoporos Int 20(3):399–408CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Dalisbor Marcelo Weber Silva
    • 1
    Email author
  • Marise Lazaretti-Castro
    • 2
  • Cristiano Augusto de Freitas Zerbini
    • 3
  • Vera Lúcia Szejnfeld
    • 4
  • Sergio Ragi Eis
    • 5
  • Victoria Zeghbi Cochenski Borba
    • 6
  1. 1.Medical School of UnivilleUniversidade da Região de JoinvilleJoinvilleBrazil
  2. 2.Osteometabolic Diseases Service of the Department of EndocrinologyUniversidade Federal de São PauloSão PauloBrazil
  3. 3.Paulista Center for Clinical ResearchSão PauloBrazil
  4. 4.Department of RheumatologyUniversidade Federal de São PauloSão PauloBrazil
  5. 5.Diagnosis and Research Center in Osteoporosis of Espirito SantoVitoriaBrazil
  6. 6.Endocrine Center of UFPRUniversidade Federal do ParanáCuritibaBrazil

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