Lower Incidence Of Hip Fractures Research Articles

Integrating traditional Chinese Medicine reduced the risk of hip fracture in patients with dementia

Background/purposeThe high incidence of hip fracture is an important problem among dementia patients because of their higher risk of falls and balance deficits due to a lack of physical activity. The aim of this study was to investigate whether traditional Chinese medicine (TCM) therapy could reduce the risk of hip fracture in dementia patients. MethodsWe identified 38,071 patients who were first diagnosed with dementia from January 1, 2000, to December 31, 2017, from the database of the 2000 Longitudinal Generation Tracking Database (LGTD 2000) provided by the Health and Welfare Data Science Center (HWDC) in Taiwan. Patients who received TCM treatment after the initial diagnosis of dementia were assigned to the TCM group, and patients who never received TCM treatment were assigned to the non-TCM group. After performing 1:1 propensity score matching (1:1) based on age, sex, comorbidities and medication between the TCM and non-TCM groups, there were 902 patients in each group. Patients were followed up to December 31, 2018, and incidences of hip fracture after the initial diagnosis of dementia between the two groups were compared with Cox regression analysis. ResultsNinety-four patients in the non-TCM group (10.42%) and 58 patients in the TCM group (6.43%) suffered from hip fracture during the follow-up period. Patients in the TCM group had a lower incidence of hip fracture than those in the non-TCM group (adjusted hazard ratio = 0.54, 95% confidence interval = 0.38–0.76). ConclusionsIntegrating TCM health care for dementia patients might reduce the risk of hip fracture.

Prescription of vitamin D was associated with a lower incidence of hip fractures

Patients with osteoporosis are prone to fragility fractures. Evidence of the effects of active forms of vitamin D on hip fracture prevention is insufficient. We examined the association between vitamin D prescription and incidence of new fractures using the data of osteoporotic patients from the nationwide health insurance claims database of Japan. The follow-up period was 3 years after entry. The untreated patients were never prescribed vitamin D during follow-up (n = 422,454), and the treated patients had a vitamin D medication possession ratio of ≥ 0.5 at all time points (n = 169,774). Propensity score matching was implemented on these groups, yielding 105,041 pairs, and subsequently, the control and treatment groups were established and analyzed. The incidence of new fractures was significantly lower in the treatment group compared with the control group (6.25% vs. 5.69%, hazard ratio 0.936 [95% confidence interval 0.904–0.970], p < 0.001*). By site, hip fractures significantly decreased (0.89% vs. 0.42%, p < 0.001), but not vertebral and radial fractures. Subgroup analysis by vitamin D type showed a significantly lower incidence of total fractures only in alfacalcidol (hazard ratio 0.676 [95% confidence interval 0.628–0.728], p < 0.001*). The results suggest that vitamin D prescription was associated with a reduced incidence of hip fractures.

Sex- and ethnic-specific patterns in the incidence of hip fracture among older US Asian and non-Hispanic White adults.

Asian and Pacific Islander (Asian/PI) adults have lower hip fracture incidence than non-Hispanic White (NHW) adults, but data regarding Asian/PI subgroups are limited. We compared hip fracture incidence among older US Asian/PI and NHW populations, including ethnic subgroup differences. Using observational data from a California healthcare system, we identified Asian/PI and NHW adults aged ≥50 years (2000-2019) and followed subjects to 2021 for hip fracture determined by principal/primary hospital diagnosis or by secondary hospital diagnosis with hip/femur procedure codes. Age-adjusted hip fracture incidence was calculated with 95% confidence intervals (CIs). Log-Poisson regression was used to determine fracture incidence rate ratios (IRRs, [CI]; NHW or Chinese as reference) adjusting for age and year. Among 215,359 Asian/PI and 776,839 NHW women, hip fracture incidence was 1.34 (1.28-1.40) and 2.97 (2.94-3.01) per 1000 person-years, respectively, with IRR 0.45 (0.43-0.47). Among 188,328 Asian/PI and 697,046 NHW men, hip fracture incidence was 0.62 (0.58-0.67) and 1.81 (1.78-1.84) per 1000 person-years, respectively, with IRR 0.34 (0.32-0.37). For the four largest Asian/PI subgroups, Filipina women (IRR 0.85 [0.75-0.96]) had lower, and Japanese (IRR 1.36 [1.20-1.54]) and South Asian (IRR 1.36 [1.07-1.72]) women had higher hip fracture incidence compared to Chinese women. Hip fracture incidence was only higher among South Asian (IRR 1.61 [1.21-2.14]) compared to Chinese men. Hip fracture incidence among US Asian/PI adults was 55% (women) and 66% (men) lower than NHW adults, but incidence varied by Asian/PI subgroup. The heterogeneity among Asian/PI adults highlights the importance of examining fracture risk by ethnic subgroup.

Lower incidence of hip fractures among elderly Ethiopian immigrants to Israel: first assessment from the Israel National Trauma Registry (INTR) 2011-2020.

The incidence of osteoporotic fractures in the aging Ethiopian population that immigrated to Western countries has not been reported. This study sought to provide a first assessment of the incidence of hip fractures in Ethiopian immigrants in Israel, as a proxy for osteoporosis in this population. This is an epidemiologic study of the incidence of hip fractures (HF) in people aged ≥ 50years in Israel, between 2011 and 2020. Data were extracted from the Israel National Trauma Registry (INTR). Annual age-adjusted HF incidence rates (IR), and standardized incidence ratios (SIR) among Ethiopian-born (EB) relative to non-EB subjects (others) were computed. During the study period, among subjects age ≥ 50 in the INTR, only 20.1% of the EB suffered a HF, in contrast to 32.3% of subjects from other origins (P < 0.0001). Although EB subjects were generally younger than their non-EB counterparts, the age at which they sustained a HF was similar: 80.45 ± 11.7years for EB vs. 79.44 ± 10.32years, P = 0.19. EB men were more likely to sustain a HF, as they represented 41.8% of all HF in their respective group, in comparison with 33.6% for others (P = 0.02). Annual IR of HF were lower for EB subjects throughout the study. Despite an initial rise in the SIR, these were also lower for most of the period. In Israel, EB subjects ≥ 50years still enjoy protection from HF. Our data require confirmation from other Western countries where the Ethiopian diaspora is aging. If a secular upward trend is observed, contributing risk factors should be identified to enable preventative measures.

Effect of fall direction on the lower hip fracture risk in athletes with different loading histories: A finite element modeling study in multiple sideways fall configurations.

Physical loading makes bones stronger through structural adaptation. Finding effective modes of exercise to improve proximal femur strength has the potential to decrease hip fracture risk. Previous proximal femur finite element (FE) modeling studies have indicated that the loading history comprising impact exercises is associated with substantially higher fracture load. However, those results were limited only to one specified fall direction. It remains thus unclear whether exercise-induced higher fracture load depends on the fall direction. To address this, using magnetic resonance images of proximal femora from 91 female athletes (mean age 24.7years with >8years competitive career) and their 20 non-athletic but physically active controls (mean age 23.7years), proximal femur FE models were created in 12 different sideways fall configurations. The athletes were divided into five groups by typical loading patterns of their sports: high-impact (H-I: 9 triple- and 10 high-jumpers), odd-impact (O-I: 9 soccer and 10 squash players), high-magnitude (H-M: 17 powerlifters), repetitive-impact (R-I: 18 endurance runners), and repetitive non-impact (R-NI: 18 swimmers). Compared to the controls, the FE models showed that the H-I and R-I groups had significantly (p<0.05) higher fracture loads, 11-17% and 22-28% respectively, in all fall directions while the O-I group had significantly 10-11% higher fracture loads in four fall directions. The H-M and R-NI groups did not show significant benefit in any direction. Also, the analyses of the minimum fall strength (MFS) among these multiple fall configurations confirmed significantly 15%, 11%, and 14% higher MFSs in these impact groups, respectively, compared to the controls. These results suggest that the lower hip fracture risk indicated by higher fracture loads in athletes engaged in high impact or repetitive impact sports is independent of fall direction whereas the lower fracture risk attributed to odd-impact exercise is more modest and specific to the fall direction. Moreover, in concordance with the literature, the present study also confirmed that the fracture risk increases if the impact is imposed on the more posterolateral aspect of the hip. The present results highlight the importance of engaging in the impact exercises to prevent hip fractures and call for retrospective studies to investigate whether specific impact exercise history in adolescence and young adulthood is also associated with lower incidence of hip fractures in later life.

SUN-373 Addressing the Burden of Hip Fracture in Older Men

INTRODUCTION: Men have a lower incidence of hip fracture compared to women. However, hip fractures comprise a greater proportion of overall fractures in men and result in greater morbidity and mortality. In 2015, a new high-risk fracture prevention program was implemented in our medical group, targeting men aged 70-85y with hip, pelvic, humerus, wrist or vertebral fracture for osteoporosis treatment within 6 months of the fracture event. In this study, we examined patient characteristics, site of hip fracture, treatment initiation and time to treatment initiation in men who experienced a hip fracture before and after implementation of this new fracture prevention program.METHODS: This study examines data from 1114 men age 70-85y (81% white race) who experienced a hip fracture during 2013-2014 (N=527) and 2015-2016 (N = 587), based on a principal hospital discharge diagnosis, excluding men who had received osteoporosis treatment in the prior year. Initiation of osteoporosis treatment within 6 months following the hip fracture and time to initiation of osteoporosis treatment (bisphosphonate, teriparatide, denosumab) were examined. The following covariates were ascertained using data from electronic health records and databases: age, race/ethnicity, smoking status, body mass index (BMI), and history of diabetes mellitus with diabetes pharmacotherapy. A Charlson Comorbidity Index was derived using health record data form the prior year. The site of hip fracture was classified as femoral neck or pertrochanter. Subgroups were compared using the Chi-square test.RESULTS: Among the 1114 men with hip fracture (mean age 79 ± 4 years), half (54%) experienced a fracture in the femoral neck and the remainder (46%) in the pertrochanter. Nearly 1 in 5 (17%) men were current smokers, 13% were obese (BMI ≥30 kg/m2), 25% had diabetes mellitus, and 42% had a comorbidity index ≥3. One fourth (24%) had a clinical fracture diagnosed in the past 2 years. Osteoporosis treatment initiation post-hip fracture increased from 16% in 2013-2014 to 29% in 2015-2016 with implementation of the high-risk program targeting men (p<0.01). Time to treatment examination of 2013-2014 vs 2015-2016 revealed that the largest increase in treatment initiation was seen at 2-4 months (4% vs 12%, p<0.01) whereas non-significant differences were seen at ≤2 (7% vs 10%) and 4-6 (4% vs 7%) months following hip fracture.CONCLUSION: Implementing targeted post-hip fracture intervention in men dramatically increased osteoporosis treatment following fracture, with the largest intervention seen 2-4 months after fracture. The high burden of prevalent fractures, smoking, and diabetes highlights the need for post-fracture intervention and counseling for modifiable risk factors.

Mediterranean diet and hip fracture incidence among older adults: the CHANCES project.

Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults. A total of 140,775 adults (116,176 women, 24,599 men) 60years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis. A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, pheterogeneity = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence. In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

Preference for wine is associated with lower hip fracture incidence in post-menopausal women.

BackgroundPast studies of relationships between alcohol and hip fracture have generally focused on total alcohol consumed and not type of alcohol. Different types of alcohol consist of varying components which may affect risk of hip fracture differentially. This study seeks to examine the relationship between alcohol consumption, with a focus on type of alcohol consumed (e.g. beer, wine, or hard liquor) and hip fracture risk in post-menopausal women.MethodsThe longitudinal cohort consisted of U.S. post-menopausal women aged 50–79 years enrolled between 1993–1998 in the Women’s Health Initiative Clinical Trials and Observational Study (N=115,655).ResultsWomen were categorized as non-drinkers, past drinkers, infrequent drinkers and drinkers by preference of alcohol type (i.e. those who preferred wine, beer, hard liquor, or who had no strong preference). Mean alcohol consumption among current drinkers was 3.3 servings per week; this was similar among those who preferred wine, beer and liquor. After adjustment for potential confounders, alcohol preference was strongly correlated with hip fracture risk (p = 0.0167); in particular, women who preferred wine were at lower risk than non-drinkers (OR=0.78; 95% CI 0.64-0.95), past drinkers (OR=0.85; 95% CI 0.72-1.00), infrequent drinkers (OR=0.73; 95% CI 0.61-0.88), hard liquor drinkers (OR=0.87; 95% CI 0.71-1.06), beer drinkers (OR=0.72; 95% CI 0.55-0.95) and those with no strong preference (OR=0.89; 95% CI 0.89; 95% CI 0.73-1.10).ConclusionsPreference of alcohol type was associated with hip fracture; women who preferentially consumed wine had a lower risk of hip fracture compared to non-drinkers, past drinkers, and those with other alcohol preferences.

Hip fractures in Hefei, China: the Hefei osteoporosis project

Hip fracture incidence rates in Hefei, China, over a period of 1year (2010) were assessed. The aim of this study was to investigate the incidence and epidemiology of hip fracture in Hefei and compare it with other populations. All the hip fracture records were obtained from the Hefei Hospital Discharge Register for the entire population ≥50years of age and restricted to cervical or trochanteric types. The incidence of hip fracture was standardized to the 2010 World population. A total of 1518 (aged≥50) hip fractures (628 in men, 890 in women) were recorded during the study period. The age-adjusted incidence rate for 1year was 144/100,000 (95% CI=135-153/100,000) for women and 97/100,000 (95% CI=85-109/100,000) for men. The standardized incidence rate against the 2010 World population was 151.7/100,000 for women and 98.2/100,000 for men. The mean age of patients with a hip fracture was 74.5±10.1years for women and 71.9±11.9years for men. The overall female to male ratio of hip fracture was 1.48:1 for hip fracture incidence and 1.54:1 for standardized incidence. Simple fall accounted for 85% hip fractures in total cases. Hefei has a lower incidence of hip fracture compared with Beijing and other countries from the five continents in recent studies, but a higher incidence than those cities in north-east China in the early 1990s. The inequality incidence in different geographic areas could be due to the urbanization or life expectancy of the population, but further investigation needs to be done to confirm this hypothesis. We also found a higher incidence in women than in men. Simple fall may be the main mechanism of injury for hip fracture.

Effectiveness of risedronate and alendronate on nonvertebral fractures: an observational study through 2 years of therapy

This observational study showed that after 2 years, both risedronate and alendronate lowered the risk of hip and nonvertebral fractures compared with patients filling in a single bisphosphonate prescription. Post hoc analyses of the placebo-controlled trials suggested earlier effects for risedronate (6-12 months) than for alendronate (18-24 months). The present study extends our 1-year observational data that confirmed an earlier fracture reduction with risedronate and evaluated the absolute and relative effectiveness of alendronate and risedronate in clinical practice over 2 years. We observed three cohorts of women aged 65 years and older who initiated once-a-week dosing of bisphosphonate therapy; (1) patients adherent to alendronate (n = 21,615), (2) patients adherent to risedronate (n = 12,215), or (3) patients filling only a single bisphosphonate prescription (n = 5,390) as a referent population. Proportional hazard modeling compared the incidence of hip and nonvertebral fractures among the cohorts over 2 years after the initial prescription. In this cohort, we previously showed at 12 months a significant reduction of hip and nonvertebral fractures with risedronate but not with alendronate. At the end of 2 years, the cumulative incidence of hip fractures in the referent cohort was 1.9 %, and incidence of nonvertebral fractures was 6.3 %. Relative to the referent, 6 months after initiating therapy and continuing through 2 years, both risedronate and alendronate cohorts had approximately a 45 % lower incidence of hip fractures and a 30 % lower incidence of nonvertebral fractures. These observations suggest that both risedronate and alendronate are effective at reducing the risk of hip and nonvertebral fracture after 2 years of treatment and support the post hoc analyses of placebo-controlled trials indicating an earlier effect of risedronate.

Evaluation of Compressive Strength Index of the Femoral Neck in Caucasians and Chinese

Compressive strength index (CSI) of the femoral neck is a parameter that integrates the information of bone mineral density (BMD), femoral neck width (FNW), and body weight. CSI is considered to have the potential to improve the performance of assessment for hip fracture risk. However, studies on CSI have been rare. In particular, few studies have evaluated the performance of CSI, in comparison with BMD, FNW, and bending geometry, for assessment of hip fracture risk. We studied two large populations, including 1683 unrelated U.S. Caucasians and 2758 unrelated Chinese adults. For all the study subjects, CSI, femoral neck BMD (FN_BMD), FNW, and bending geometry (section modulus [Z]) of the samples were obtained from dual-energy X-ray absorptiometry scans. We investigated the age-related trends of these bone phenotypes and potential sex and ethnic differences. We further evaluated the performance of these four phenotypes for assessment of hip fracture risk by logistic regression models. Chinese had significantly lower FN_BMD, FNW, and Z, but higher CSI than sex-matched Caucasians. Logistic regression analysis showed that higher CSI was significantly associated with lower risk of hip fracture, and the significance remained after adjusting for covariates of age, sex, and height. Each standard deviation (SD) increment in CSI was associated with odds ratios of 0.765 (95% confidence interval, 0.634, 0.992) and 0.724 (95% confidence interval, 0.569, 0.921) for hip fracture risk in Caucasians and Chinese, respectively. The higher CSI in Chinese may partially help explain the lower incidence of hip fractures in this population compared to Caucasians. Further studies in larger cohorts and/or longitudinal observations are necessary to confirm our findings.

Bone mass and soy isoflavones in socially housed, premenopausal macaques

Background: Soy consumption is associated with a lower incidence of hip fracture in Asian than in Western women, an effect often attributed to estrogen-like compounds (isoflavones) in soy. It is not known whether premenopausal soy exposure initiated in adulthood can increase bone mass and thereby reduce fracture risk.Objective: We aimed to determine whether a high-isoflavone soy diet influences bone mass in soy-naïve, premenopausal cynomolgus monkeys (Macaca fascicularis).Design: Ninety-four skeletally mature females were randomly assigned to consume diets whose protein content came from either high-isoflavone soy or casein and lactalbumin. Animals were socially housed. Bone mass and circulating isoflavone concentrations were measured at baseline and 19 and 31 mo after the start of treatment; bone biomarkers were measured at baseline and 31 mo.Results: There were no significant differences at any timepoint in whole-body bone mineral content between casein-fed (112.5 ± 2.1, 119.2 ± 1.9, and 120.7 ± 2.1 g) and soy-fed (117.2 ± 2.1, 122.4 ± 2.0, and 125.4 ± 2.3 g; P = 0.12) monkeys. Similar results were seen for spinal bone mineral density (casein-fed: 0.46 ± 0.01, 0.50 ± 0.01, and 0.52 ± 0.01 g/cm2; soy-fed: 0.47 ± 0.01, 0.51 ± 0.01, and 0.52 ± 0.01 g/cm2; P = 0.30) and bone biomarker measurements—bone-specific alkaline phosphatase (soy-fed: 82.3 ± 4.1 and 63.2 ± 3.4 ng/mL; casein-fed: 94.1 ± 4.5 and 61.7 ± 4.3 ng/mL; P = 0.22) and C-terminal crosslink of type 1 collagen (soy-fed: 0.944 ± 0.06 and 0.89 ± 0.08 nmol/L; casein-fed: 0.97 ± 0.07 and 0.78 ± 0.06 nmol/L; P = 0.20).Conclusion: A soy diet high in isoflavones does not significantly affect bone characteristics in initially soy-naïve premenopausal monkeys.

Population-Based Analysis of the Relationship of Whole Bone Strength Indices and Fall-Related Loads to Age- and Sex-Specific Patterns of Hip and Wrist Fractures

In an age- and sex-stratified population sample (n = 700), we estimated fall-related loads and bone strength indices at the UDR and FN. These load/strength ratios more closely simulated patterns of wrist and hip fractures occurring in the same population than did measurement of vBMD. Areal BMD measurements, although associated with fracture risk, incompletely explain patterns of fragility fractures. Moreover, population-based assessments relating applied loads and whole bone strength to fracture patterns have not been made. Using QCT, we assessed volumetric BMD (vBMD), cross-sectional geometry, and axial (EA) and flexural (EI) rigidities (indices of bone's resistance to compressive and bending loads, respectively) at the ultradistal radius (UDR) and femoral neck (FN) and estimated the loads applied to the wrist and hip during a fall. We used fall load (FL)/bone strength ratios to estimate fracture risk. vBMD in young adults was similar between sexes. Decreases in vBMD over life were also similar (30% and 28%) at UDR but were somewhat greater (46% and 34%) at FN in women versus men, respectively. In young adults, FL/strength ratios at UDR were 32-51% lower (better) in men than in women and increased (worsened) over life less in men (+4% to +22%) than in women (+20% to +33%). In young adults, FL/strength ratios at FN were only marginally better in men than in women but worsened less over life in men (+22% to +36%) than in women (+40% to +62%). The 6:1 female preponderance and the virtual immunity of men for age-related increases in wrist fractures are largely explained by the more favorable FL/strength ratios at UDR in young adult men (because of larger bone size and more favorable geometry) versus women and to maintaining this advantage over life. The 2-fold lower incidence of hip fractures in men versus women is largely explained by age-related increases (worsening) of FL/bone strength ratios that are only one-half of the increases in women. The moderate increases in these ratios with aging are insufficient to explain the >4-fold increase in hip fracture incidence after age 75 in both sexes, suggesting contributions of other factors, especially the well-documented increased frequency of injurious falls among the elderly.

Rapid loss of hip fracture protection after estrogen cessation: evidence from the National Osteoporosis Risk Assessment.

Since the findings from the Women's Health Initiative became available in July 2002, millions of women have discontinued postmenopausal hormone therapy (HT). The objective of this study was to evaluate the association between HT cessation and hip fracture risk. Women who participated in the National Osteoporosis Risk Assessment and completed the 12-month follow-up survey were studied. All participants were aged at least 50 years, were postmenopausal, and had no previous diagnosis of osteoporosis. Baseline and 12-month follow-up questionnaires assessed use of HT and incident fractures. Of the 140,584 women in this study, 269 reported an incident hip fracture. A logistic regression model was used to assess association between HT use and incident hip fracture, controlling for potential confounders. Consistent with the Women's Health Initiative, women in National Osteoporosis Risk Assessment who were currently on HT had a 40% lower incidence of hip fractures compared with those who never used HT. Women who stopped using HT more than 5 years earlier had similar hip fracture risk to never users, as expected. However, surprisingly, women who had discontinued HT within the previous 5 years had an increased hip fracture odds ratio of 1.65 (95% confidence interval 1.05, 2.59) relative to never users of HT. Postmenopausal women who have discontinued HT within the past 5 years have a risk for hip fracture that is at least as high as that in women who have never used HT. II-2

Hip fracture incidence in central norway: a followup study.

Studies in the 1980s, including one from central Norway, in most cases showed that the incidence of hip fractures was increasing. In the 1990s, however, studies from Sweden and the United States indicated that the increase may have stopped. We report the current incidence of hip fractures in subjects in central Norway and compare it with that previously reported. The number of cervical and trochanteric fractures in a defined region of Central Norway in 1992 to 1993 and in 1997 to 1998 was found by a thorough search and collation of the hand written surgery reports, the reports from radiology departments, and hospital discharge reports. One thousand three hundred twelve hip fractures were sustained during 1997 to 1998, 10% more than in the preceding period. This was almost entirely attributable to aging of the population. In contrast to the highly statistically significant increase in the actual incidence of 2% per year previously reported between 1972 to 1973 and 1983 to 1984, there was no statistically significant increase in incidence between 1983 to 1984 and 1997 to 1998 (0.55% per year). The incidence of hip fractures was 18% higher in subjects in urban areas than in subjects in rural areas in 1992 to 1993, and 33% higher in 1997 to 1998. Whereas the proportion of trochanteric fractures was 32% in 1972 to 1973 and in 1983 to 1984, it increased to 44% in 1992 to 1993 and to 68% in 1997 to 1998. There has been an insignificant increase in hip fracture incidence since 1983 to 1984. The lower incidence of hip fractures in subjects in rural areas persists, and there has been a dramatic increase in the proportion of trochanteric fractures.

Does hip strength analysis explain the lower incidence of hip fracture in the People's Republic of China?

To explore whether there are ethnic differences in calculated hip strength that might explain the low incidence of hip fracture in China, we used Lunar DPX ‘beta’ version of hip strength analysis (HAS) and hip axis length (HAL) programs to compare hip geometry, calculated strength and densitometric values from Chinese subjects in Shenyang to those of Caucasian subjects in Oslo and Leuven participating in the European Prospective Osteoporosis Study (EPOS). Subjects were 210 Chinese and 403 Caucasian men and women aged 53–77 years. Parameters investigated included bone mineral density (BMD), bone mineral content (BMC), bone area (BA), cross-sectional moment of inertia (CSMI) and section modulus (both indicating strength and rigidity of the femoral neck), HAL, neck length (NL), neck diameter, tensile stress (Tstress) and compressive stress (Cstress) (indicating the stress in the femoral neck at its weakest cross section arising from walking or a standard fall, respectively), safety factor (SF, indicating the resistance to fracture for forces generated during walking) and fall index (FI, indicating the resistance to fracture from force generated during a fall in the greater trochanter). The Chinese men and women were significantly shorter and lighter than their Caucasian counterparts ( P < 0.01) and had significantly lower BMD, BMC and BA of the femoral neck ( P < 0.01). After adjusting for BA, weight and height, there was no significant ethnic difference in either gender in BMC. CSMI and section modulus were significantly lower, and HAL, NL and neck diameter were significantly shorter in the Chinese men and women ( P < 0.01). These differences all remained after adjusting for weight and height. There were no significant differences in Tstress, Cstress, SF and FI between ethnic groups in either gender. Most of the parameters of calculated hip strength in the Chinese subjects were similar to or poorer than those in the Caucasian subjects. There was no evidence to indicate that Shenyang Chinese have superior BMD or BMC or better calculated hip strength. The short HAL and NL of the population, however, could be an independent factor contributing to the low incidence of hip fracture.

Epidemiological study of hip fracture in Shenyang, People’s Republic of China

The aim of this study was to investigate the incidence and epidemiology in 1994 of hip fracture in Shenyang, a large city in the northeast of The People’s Republic of China, using register information and medical records collected from the 36 hospitals in Shenyang. The hip fracture data were restricted to cervical or trochanteric types. A subset (59% of total) of medical records of hip fracture was used to investigate the causes of hip fracture. The causes were classified as simple fall, fall from a bicycle during cycling, bicycle accident, car accident, and fall from a height. There was a total of 453 hip fractures (206 in women and 247 in men) in the population over 50 years of age. The age-adjusted 1 year cumulative incidence rate was 67/100,000 (95% confidence interval [CI] = 58–76/100,000) for women and 81/100,000 (95% CI = 71–91/100,000) for men. The standardized incidence rate against the 1985 U.S. population was 87/100,000 (95% CI = 77–97/100,000) for women and 100/100,000 (95% CI = 89–111/100,000) for men. The mean (± standard deviation) age of patients with a hip fracture was 67.5 ± 9.8 years for men and 66.9 ± 9.0 years for women. The overall male-to-female ratio of hip fracture was 1.21:1 for age-adjusted hip fracture incidence and 1.15:1 for standardized incidence. Simple fall accounted for 70% hip fractures in women but caused only 49% in men (χ 2 = 11.2, degrees of freedom [ df] = 1, p = 0.0008). The frequency of hip fractures caused by a fall from a bicycle was higher in men (28%) than women (10%) (χ 2 = 13.0, df = 1, p = 0.0003). The results of this study indicate (1) a low incidence of hip fracture in a Chinese population compared with more affluent countries, and (b) a higher incidence in men than women that is related in part to a higher incidence of accidents, especially bicycle-related ones.

3rinking water fluoridation: Bone mineral density and hip fracture incidence

The role of drinking water fluoride content for prevention of osteoporosis remains controversial. Therefore, we analyzed the influence of drinking water fluoridation on the incidence of osteoporotic hip fractures and bone mineral density (BMD) in two different communities in eastern Germany: in Chemnitz, drinking water was fluoridated (1 mg/L) over a period of 30 years; in Halle, the water was not fluoridated. BMD was measured in healthy hospital employees aged 20–60 years (Halle: 214 women, 98 men; Chemnitz: 201 women, 43 men, respectively) using dual-energy X-ray absorptiometry. Hip fractures in patients ≥35 years admitted to the local hospitals in the years 1987–1989 were collected from the clinic registers. There was no difference in age, anthropometric, hormonal, or lifestyle variables between the two groups. Mean fluoride exposure in Chemnitz was 25.2 ± 7.3 years. No correlation was found between fluoride exposure and age-adjusted BMD. We found no significant difference in spinal or femoral BMD between subjects living in Halle and Chemnitz [lumbar spine: 0.997 ± 0.129 (g/cm 2) vs. 1.045 + 0.171 (g/cm 2), p = 0.08, for men; 1.055 ± 0.112 (g/cm 2) vs. 1.046 ± 0.117 (g/cm 2), p = 0.47, for women]. The fracture incidence showed an exponential increase with aging in men and women with an incidence about 3.5 times higher for women. In Chemnitz, we calculated an age-adjusted annual incidence of 142.2 per 100,000 for women and 72.5 per 100,000 for men, respectively. In Halle, the incidences were 178.5 per 100,000 for women and 89.2 per 100,000 for men. There was a lower hip fracture incidence after the age of 85 in women in Chemnitz (1391 per 100,000 in Chemnitz vs. 1957 per 100,000 in Halle, p = 0.006). Using the age-adjusted incidences, significantly fewer hip fractures occurred in Chemnitz in both men and women. In conclusion, our study suggests that optimal drinking water fluoridation (1 mg/L), which is advocated for prevention of dental caries, does not influence peak bone density but may reduce the incidence of osteoporotic hip fractures in the very old.

Differences in hip axis and femoral neck length in premenopausal women of Polynesian, Asian and European origin

There are substantial inter-racial differences in hip fracture incidence. Studies in several different ethnic groups have suggested that differences in the length of the femoral neck may contribute to these. The present study assesses femoral neck and hip axis lengths in three ethnic groups in which it has not been documented previously (Chinese, Indians and Polynesians) and compares these values with those in Europeans. Lengths were measured from dual-energy X-ray absorptiometry scans of the proximal femur in normal premenopausal women (n = 225). The Polynesian (1.65 m) and European (1.64 m) women were significantly taller than the two Asian groups (mean height in each, 1.58 m). There were also differences in mean body weight, the Polynesians being the heaviest (76 kg) and the Chinese the lightest (53 kg). Femoral neck lengths were (mean +/- SD) Chinese 61.5 +/- 4.4 mm, Indian 61.5 +/- 5.1 mm, Polynesian 68.2 +/- 4.3 mm and Europeans 66.0 +/- 4.8 mm. Hip axis lengths were Chinese 98.0 +/- 5.6 mm, Indian 94.5 +/- 5.2 mm, Polynesian 106.4 +/- 5.3 mm and European 102.3 +/- 5.3 mm. Each of the other groups were significantly different from the Europeans for both variables and, in general, this remained so after height adjustment. These data suggest that shorter femoral necks are common to the major Asian racial groups. However, in contrast to all other ethnic groups studied, Polynesians have longer femoral necks than Europeans and their low incidence of hip fracture is not explicable, therefore, in terms of their femoral neck length. This suggests that either higher bone density or other more subtle differences in proximal femoral geometry must account for the low hip fracture incidence in Polynesians.

Incidence rates of falls among Japanese men and women living in Hawaii

Japanese people in both Japan and in Hawaii have a lower incidence of hip fractures than white people in Hawaii or on the mainland of the United States. Hip fractures usually occur after a fall, and differing incidence rates of falls might contribute to the observed differences in hip fracture rates. To investigate this possibility, we undertook a prospective study of falls among elderly Japanese men and women living in Hawaii using intensive surveillance methods similar to those used in studies of predominantly white populations. For our Japanese participants, the incidence rates of total falls were 139 per 1000 person-years for men and 276 per 1000 person-years for women. Age-adjusted rate ratios of falls for predominately white populations compared with our Japanese participants ranged from 1.8 to 2.3 for women and from 2.6 to 4.7 for men. The risk of injuries when they did fall, however, was not lower for our Japanese participants than reported for white participants. For our Japanese population, past falls, female gender, and daytime hours were associated with an increased incidence of falls.