A systematic review of hip fracture incidence and probability of fracture worldwide
J. A. Kanis
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A. Odn
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E. V. McCloskey
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H. Johansson
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D. A. Wahl
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C. Cooper
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on behalf of the IOF Working Group on Epidemiology
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Quality of Life
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D. A. Wahl International Osteoporosis Foundation
, Nyon,
Switzerland
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The members of the IOF Working Group on Epidemiology and Quality of Life are Adachi J
, Borgstrm F, Clark P, Cooper C, Cummings S, Diaz Curiel M, Dimai HP, Hiligsmann M, Kanis JA, Lau E, Lewiecki EM, Lips P, Lorenc R, McCloskey E, Ortolani S, Papaioannou A, Silverman S, Yoshimura N, and Szulc P
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C. Cooper MRC Lifecourse Epidemiology Unit, University of Southampton and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford
,
Oxford, UK
Summary The country-specific risk of hip fracture and the 10-year probability of a major osteoporotic fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Introduction The present study aimed to update the available information base available on the heterogeneity in the risk of hip fracture on a worldwide basis. An additional aim was to document variations in major fracture probability as determined from the available FRAX models. Methods Studies on hip fracture risk were identified from 1950 to November 2011 by a Medline OVID search.
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The clinical manifestation of osteoporosis is in the fractures
that arise. Hip fractures are a useful surrogate for
determining the international burden of osteoporosis. Although they
account for less than 20% of all osteoporotic fractures [1, 2],
they account for the majority of fracture-related health care
expenditure and mortality in men and women over the age
of 50 years [14]. In addition, the vast majority of hip
fracture cases come to medical attention and require hospital
facilities. As a result, much more is known of the
epidemiology of hip fracture than for other fractures associated with
osteoporosis.
A variety of studies have examined hip fracture rates
in different regions of the world [511]. Greater than
10-fold differences have been found, largely on the
basis of register studies undertaken on a regional or
national level and at different calendar years. The aim
of the present study was to provide the most accurate
assessment of hip fracture risk in all countries for which
data were available. In addition, we wished to examine
the heterogeneity of major fracture probability in those
countries where a FRAX model was available.
Literature survey
We updated a systematic search conducted by Cauley et
al. on behalf of the International Task Force for the
ISCD IOF FRAX Initiative [12, 13]. This was a
Medline OVID search covered between 1 January 1950 and
10 May 2010. Details regarding the search strategy and
MeSH terms used are provided in Cauley et al. [12,
13]. The three primary concepts were: fracture,
incidence and the country or their related terms. The three
concepts were searched singly, and then merged
together through the AND term. The information base was
updated by the International Osteoporosis Foundation using
the same search terms with a cut-off date of 7 November 2011.
Additional sources were reviews by Kanis et al. [14] and
Cheng et al. [5]. We also supplemented this search by
handsearching the references of all papers to identify any additional
articles of interest. In several instances additional information
was provided by the authors of papers to aid in the assessment
of study quality or to provide additional detail not reported in
the original publication.
Exclusion and inclusion criteria
Abstracts and full papers identified by the search were
reviewed. We included non-English articles. All papers
that reported age- and sex-specific incidence rates of hip
fracture in a general population were eligible for a more
detailed review. Further exclusion criteria comprised
data that could not be standardised to the world population
(age categories incomplete from the age of 50 years or age
categories >10 years), an uncertain population base or
illdefined cases.
For the remaining studies, a quality assessment, originally
developed by Cauley et al. [13], was adapted to provide three
grades:
Good: Evidence includes consistent results from
welldesigned, well-conducted studies in representative
populations. Selection of hip fracture cases was based
on health care records, and the methodology was
well described. At least four of the following
criteria should be met: prospective study, study
population representative of the entire population, study
duration of 1 year or more and adequate definition
of fracture or use of ICD codes, ethnicities defined
when applicable.
Fair: Evidence is sufficient to determine effects on
outcomes, but the strength of the evidence is limited
by the number, quality or consistency of the
individual studies, i.e. studies that did not meet the criteria for
either good or poor and met some but (...truncated)