Cross-cultural perspective on hip fractures

When it comes to data regarding hip fractures — the most devastating and costly of all osteoporotic fractures — I’m interested in the cross-cultural perspective.

Across the different continents, we see a great variation in hip fracture incidence. For example, hip fractures are almost unheard of in African and South American popula

tions living traditional lifestyles, while 1 out of 6 Caucasian women in the U.S. who are 50 years or older will experience a hip fracture during her lifetime.

Worldwide, hip fractures are projected to increase nearly fourfold by 2050 due to rising life expectancy and increased abandonment of traditional lifestyles. It is projected, that half of these fractures will occur in Asia.

What do worldwide studies tell us?

1. Current studies report that the highest hip fracture rates are in the US and northern Europe, while the lowest rates are in Africa and Latin America. Asian countries currently exhibit intermediate rates of hip fracture. With industrialization and westernization, hip fracture incidence rises dramatically. This was seen in Taiwan a few decades ago and is now occurring in China where, in Beijing between the early 1990s and 2006, the age-specific (50+) rate of hip fracture increased 2.76 fold in women and 2 fold in men.

2. The vast majority of hip fractures occur in the elderly — by age 90, 32% of U.S. Caucasian women will have experienced a hip fracture.

3. Vitamin D deficiency and probably life-long vitamin D inadequacy as well, are the major underlying causes of bone weakness that predisposes people to fracture. Studies in the United States and Europe report that 75% to 95% of patients with hip fractures are vitamin D insufficient. Low vitamin D results in bone weakness, and bone loss.

4. Ninety-five percent of osteoporotic hip fractures result from a fall. Only about 5% appear to be spontaneous in which a person feels a fracture, then falls.

I’ve devoted an entire section to my website to fracture prevention and healing. I encourage you to start with my article “Fractures 101” for an overview of the physiology, physics, types and risks of fractures.

References:

Dhanwal , D. K., E. M. Dennison, N. C. Harvey, and C. Cooper. 2011. Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal of Orthopaedics 45(1):15–22.

Kanis, J. A., A. Odén, E. V. McCloskey, H. Johansson, D. A. Wahl, C. Cooper, and the IOF Working Group on Epidemiology and Quality of Life. 2012. A systemic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International 23:2239–2256.

Kolata, G. 2009. Study finds steady drop in hip fracture rates, but reasons are unclear. New York Times (August 25).

Lumbers, M., S. A. New, S. Gibson, and M. c. Murphy. 2001. Nutritional status in elderly female hip fracture patients: Comparison with an age-matched home living group attending day centres. British Journal of Nutrition 85(6):733–740.

Xia, W. B., S. L. He, L. Xu, A. M. Liu, Y. Jiang, M. Li, O. Wang, X. P. Xing, Y. Sun, and S. R. Cummings. 2012. Rapidly increasing rates of hip fracture in Beijing, China. Journal of Bone and Mineral Research 27(1):125–129.