Chapter 27 - Geographic Variability in Hip and Vertebral Fractures

Abstract

Age-related bone loss and osteoporosis have been documented since antiquity, but substantial geographic and ethnic variations in fracture have been noted. This variation in fracture rates is most striking for hip fractures, with a 10-fold difference in standardized rates between the highest risk countries, in northern Europe, and the lowest, in some countries of South America, the Far East, and in South Africa; while vertebral fractures vary by only two- to four-fold worldwide. Although some of these variations are due to methodological issues related to assessing the true rates of fractures in a single country, as well as to those affecting the accuracy of comparisons of rates between countries, true geographic differences in hip and other fractures exist. Furthermore, changing demographics and secular trends are rapidly shifting the burden of hip fractures from the western world to Asia and the Middle East. This chapter details the epidemiology of fractures and overviews potential causes for differences in fracture rates. Such understanding is essential to accurate fracture risk assessment, healthcare resource allocation, and the development of nationally relevant care pathways.