Skip to main content
SpringerLink
Log in

Secular trends in the incidence of hip fractures

  • Clinical Investigations
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Summary

To explore possible changes in proximal femur (hip) fracture incidence over time, an earlier study among Rochester, Minnesota residents for 1928–1977 was updated through 1982. Reanalysis of data demonstrated rising age-adjusted rates for men over this time. Crude rates rose for women as well, but age adjusted rates leveled off in the mid-1950s, as did overall rates, since the majority of hip fractures were in women. Secular trends were primarily due to changes in the incidence of initial hip fractures associated with moderate trauma, the sort usually attributed to osteoporosis. No differences were noted in trends for cervical vs. intertrochanteric femur fractures; and, excluding the low values for 1928–1942, no significant trends were noted for women within various age groups. Our results for women conflict with estimates from a number of other studies, but these differences may provide a basis for hypothesis development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lindsay R, Dempster DW, Clemens T, Herrington BS, Wilt S (1985) Incidence, cost, and risk factors of fracture of the proximal femur in the USA. In: Christiansen C, Arnaud CD Nordin BEC, Parfitt AM, Peck WA, Riggs BL (eds) Osteoporosis. Copenhagen, pp 311–315

  2. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd K (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiologic Reviews 7:178–208

    PubMed  CAS  Google Scholar 

  3. Baker MR (1980) An investigation into secular trends in the incidence of femoral neck fracture using hospital activity analysis. Public Health (London) 94:368–374

    CAS  Google Scholar 

  4. Lewis AF (1981) Fracture of neck of the femur: changing incidence. Br Med J 283:1217–1220

    CAS  Google Scholar 

  5. Wallace WA (1983) The increasing incidence of fractures of the proximal femur: an orthopaedic epidemic. Lancet 1:1413–1414

    Article  PubMed  CAS  Google Scholar 

  6. Swanson AJG, Murdoch G (1983) Fractured neck of femur: pattern of incidence and implications. Acta Orthop Scand 54:348–355

    PubMed  CAS  Google Scholar 

  7. Nilsson BE, Obrant KJ (1978) Secular tendencies of the incidence of fracture of the upper end of the femur. Acta Orthop Scand 49:389–391

    PubMed  CAS  Google Scholar 

  8. Zetterberg C, Andersson GBJ (1982) Fractures of the proximal end of the femur in Göteborg, Sweden, 1940–1979. Acta Orthop Scand 53:419–426

    PubMed  CAS  Google Scholar 

  9. Frandsen PA, Kruse T (1983) Hip fractures in the county of Funen, Denmark. Acta Orthop Scand 54:681–686

    PubMed  CAS  Google Scholar 

  10. Evans JG, Prudham D, Wandless I (1979) A prospective study of fractured proximal femur: incidence and outcome. Public Health (London) 93:235–241

    CAS  Google Scholar 

  11. Jensen JS (1980) Incidence of hip fractures. Acta Orthop Scand 51:511–513

    PubMed  CAS  Google Scholar 

  12. Engesaeter LB, Søreide O (1984) Incidence of hip fractures based on hospital admission rates. Acta Orthop Scand (Abstract) 55:707

    Google Scholar 

  13. Holbrook TL, Grazier K, Kelsey JL, Stauffer RN (1984) The frequency of occurrence, impact and cost of selected musculoskeletal conditions in the United States. American Academy of Orthopaedic Surgeons

  14. Kurland LT, Molgaard CA (1981) The patient record in epidemiology Sci Am 245:54–63

    Article  PubMed  CAS  Google Scholar 

  15. Kurland LT, Elveback LR, Nobrega FT (1970) Population studies in Rochester and Olmsted County, Minnesota, 1900–1968. In: Kessler H, Levin ML (eds) The community as an epidemiologic laboratory: a casebook of community studies. Johns Hopkins Press, Baltimore, Maryland, pp 47–70

    Google Scholar 

  16. Schroeder DJ, Offord KP (1982) A SAS Macro which utilizes local and reference population counts appropriate for incidence, prevalence, and mortality rate calculations in Rochester and Olmsted County, Minnesota. Technical Report Series, No. 20, Section of Medical Research Statistics, Mayo Clinic, Rochester, Minnesota

    Google Scholar 

  17. Beyer Wh (ed) (1966) C.R.C. handbook of tables for probability and statistics. Chemical Rubber Company, Cleveland, pp 58–64

    Google Scholar 

  18. Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386

    Article  Google Scholar 

  19. Draper NR, Smith H (1966) Applied regression analysis. John Wiley and Sons, New York

    Google Scholar 

  20. Knowelden J, Buhr AJ, Dunbar O (1964) Incidence of fractures in persons over 35 years of age: a report to the M.R.C. working party on fractures in the elderly. Br J Prev Soc Med 18:130–141

    PubMed  CAS  Google Scholar 

  21. Hoogendoorn D (1982) Mededelingen stichting medische registratie. Ned T Geneesk 126:963–968

    PubMed  CAS  Google Scholar 

  22. Elabdien BSZ, Olerud S, Karlström G, Smedby B (1984) Rising incidence of hip fracture in Uppsala, 1965–1980. Acta Orthop Scand 55:284–289

    Google Scholar 

  23. Cave W, Nordin BEC (1972) International fracture survey first year report to the International Health Foundation, privately published

  24. Evans JG (1985) Incidence of proximal femoral fracture (Letter) Lancet 1:925–926

    PubMed  CAS  Google Scholar 

  25. Stewart IM (1958) Fracture of neck of femur: the rate risk and casualty planning. The Medical Officer 100:100

    Google Scholar 

  26. Boyce WJ, Vessey MP (1985) Rising incidence of fracture of the proximal femur. Lancet 1:150–151

    Article  PubMed  CAS  Google Scholar 

  27. Johnell O, Nilsson B, Obrant K, Sernbo I (1984) Age and sex patterns of hip fracture—changes in 30 years. Acta Orthop Scand 55:290–292

    PubMed  CAS  Google Scholar 

  28. Lüthje P (1983) Fracture of the proximal femur in Finland in 1980. Ann Chir Gynaecol 72:282–286

    PubMed  Google Scholar 

  29. Melton LJ, Ilstrup DM, Riggs BL, Beckenbaugh RD (1982) Fifty-year trend in hip fracture incidence. Clin Orthop 162:144–149

    PubMed  Google Scholar 

  30. Eddy TP (1972) Deaths from domestic falls and fractures. Br J Prev Soc Med 26:173–179

    PubMed  CAS  Google Scholar 

  31. Falch J, Ilebekk A (1978) Fractures of the proximal end of the femur: prevalence and incidence on Oslo, 1950–1975. Tidsskr Nor Laegeforen 98:738–739

    PubMed  CAS  Google Scholar 

  32. Hedlund R, Ahlbom A, Lindgren U (1985) Hip fracture incidence in Stockholm 1972–1981. Acta Orthop Scand 57: 30–34

    Google Scholar 

  33. Buhr AJ, Cooke AM (1959) Fracture patterns. Lancet 1:531–536

    Article  PubMed  CAS  Google Scholar 

  34. Evans JG (1979) Fractured proximal femur in Newcastle upon Tyne. Age Ageing 8:16–24

    Article  PubMed  CAS  Google Scholar 

  35. Alffram P-A (1964) An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population: analysis of 1,664 cases with special reference to etiologic factors. Acta Orthop Scand (Suppl) 65:9–109

    Google Scholar 

  36. Waris P, Kankaanpää, Karaharju E, Michelsson J-E, Ryöppy S, Snellman O (1979) Fractures of the proximal femur in Finland in 1975. Ann Chir Gynaecol (Suppl) 68: 86–89

    Google Scholar 

  37. Rees JL (1982) Accuracy of hospital activity analysis data in estimating the incidence of proximal femoral fracture. Br Med J 284:1856–1857

    Article  CAS  Google Scholar 

  38. Williams BT (1977) Femoral neck fractures. Br Med J 1:171–172

    Google Scholar 

  39. Baldwin JA (1982) Fracture of neck of the femur. (Letter) Br Med J 284:271

    CAS  Google Scholar 

  40. Melton LJ III, Stauffer RN, Chao EYS, Ilstrup DM (1982) Rates of total hip arthroplasty: a population-based study. N Engl J Med 307:1242–1245

    Article  PubMed  Google Scholar 

  41. Melton LJ, Stauffer RN, Chao EYS, Ilstrup DM (1983) Rates of total hip arthroplasty: a population-based study (Letter). N Engl J Med 308:726–727

    Article  Google Scholar 

  42. Falch JA, Ilebekk A, Slungaard U (1985) Epidemiology of hip fractures in Norway. Acta Orthop Scand 56:12–16

    PubMed  CAS  Google Scholar 

  43. Burton JL, Ensell FJ, Leach JF, Hall KA (1975) Atmospheric ozone and femoral fractures. Lancet 1:795–796

    Article  PubMed  CAS  Google Scholar 

  44. Leach JF, Beadle PC, Pingstone AR (1978) Effect of ozone variation on disease in Great Britain. II. Femoral neck fracture. Aviat, Space, Environ Med 49:1014–1018

    CAS  Google Scholar 

  45. Stott S, Gray DH (1980) The incidence of femoral neck fractures in New Zealand. N Zealand Med J 91:6–9

    CAS  Google Scholar 

  46. Lawrence JS (ed) (1977) Diseases of bone. In: Rheumatism populations. William Heinemann Medical Books Ltd, London, pp 398–434

    Google Scholar 

  47. Lindsay R, Hart DM, Forrest C, Baird C (1980) Prevention of spinal osteoporosis in oophorectomised women. Lancet 2:1151–1154

    Article  PubMed  CAS  Google Scholar 

  48. Ettinger B, Genant HK, Cann CE (1985) Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med 102:319–324

    PubMed  CAS  Google Scholar 

  49. Hutchinson TA, Polansky SM, Feinstein AR (1979) Postmenopausal oestrogens protect against fractures of hip and distal radius: a case-control study. Lancet 2:705–709

    Article  PubMed  CAS  Google Scholar 

  50. Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR (1980) Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med 303:1195–1198

    Article  PubMed  CAS  Google Scholar 

  51. Paganini-Hill A, Ross RK, Gerkins VR, Henderson BE, Arthur M, Mack TM (1981) Menopausal estrogen therapy and hip fractures. Ann Intern Med 95:28–31

    PubMed  CAS  Google Scholar 

  52. Kreiger N, Kelsey JL, Holford TR, O'Connor T (1982) An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 116:141–148

    PubMed  CAS  Google Scholar 

  53. Annegers JF, Strom H, Decker DG, Dockerty MB, O'Fallon WM (1979) Ovarian cancer: incidence and case-control study. Cancer 43:723–729

    Article  PubMed  CAS  Google Scholar 

  54. McDonald TW, Annegers JF, O'Fallon WM, Dockerty MB, Malkasian GD, Kurland LT (1977) Exogenous estrogen and endometrial carcinoma: case-control and incidence study. Am J Obstet Gynecol 127:572–580

    PubMed  CAS  Google Scholar 

  55. Grodin JM, Siiteri PK, MacDonald PC (1973) Source of estrogen production in postmenopausal women. J Clin Endocrinol Metab 36:207–214

    Article  PubMed  CAS  Google Scholar 

  56. Bates GW, Whitworth NS (1982) Effects of obesity on sex steroid metabolism. J Chron Dis 35:893–896

    Article  PubMed  CAS  Google Scholar 

  57. Abraham S, Johnson CL, Najjar MF (1979) Weight by height and age for adults 18–74 years: United States, 1971–74. Data from the National Health Survey, Series 11, Number 208, DHEW Publication No. (PHS) 79-1656, Hyattsville, Maryland

  58. Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR (1982) Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695–699

    PubMed  CAS  Google Scholar 

  59. Baron JA (1984) Smoking and estrogen-related disease. Am J Epidemiol 119:9–22

    PubMed  CAS  Google Scholar 

  60. Harris JE (1979) Cigarette smoking in the United States, 1950–1978. In Smoking and health, a report of the surgeon general. Washington, DC, DHEW Publication No. (PHS) 79-50066, A-3–A-29

  61. Beard CM, Annegers JF, Woolner LB, Kurland LT (1985) Bronchogenic carcinoma in Olmsted County, 1935–1979. Cancer 55:2026–2030

    Article  PubMed  CAS  Google Scholar 

  62. Matković V, Kostial K, Šimonović I, Buzina R, Brodarec A, Nordin BEC (1979) Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 32:540–549

    PubMed  Google Scholar 

  63. Wong PC (1964) Femoral neck fractures among the major racial groups in Singapore. Incidence patterns compared with non-Asian communities. No. II. Singapore Med J 5:150–157

    Google Scholar 

  64. Chalmers J, Ho KC (1970) Geographical varitions in senile osteoporosis: the association with physical activity. J Bone Joint Surg 52-B:667–675

    Google Scholar 

  65. Solomon L (1968) Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Joint Surg 50-B:2–13

    Google Scholar 

  66. Aaron JE, Gallagher JC, Nordin BEC (1974) Seasonal variation of histological osteomalacia in femoral-neck fractures. Lancet 2:84–85

    Article  PubMed  CAS  Google Scholar 

  67. Parfitt AM, Duncan H (1982) Metabolic bone disease affecting the spine. Chapter 13. In: Rothman RH, Simeone FA (eds) The spine. WB Saunders Company, Philadelphia, pp 775–905

    Google Scholar 

  68. Riggs BL (1984) Vitamin D and involutional osteoporosis. In: Kumar R (ed) Vitamin D: basic and clinical aspects. Martinus Nijhoff Publishing, Boston, pp 560–577

    Google Scholar 

  69. Evans JG (1982) Epidemiology of proximal femoral fractures. In: Recent advances in geriatric medicine, Vol. 2, Churchill-Livingstone, London, pp 201–214

    Google Scholar 

  70. Melton LJ III, Riggs BL (1983) Epidemiology of age-related fractures. In: Avioli LV (ed) The osteoporotic syndrome. Grune and Stratton, New York, pp 45–72

    Google Scholar 

  71. Melton LJ, Wahner HW, Richelson LS, O'Fallon WM, Riggs BL (1986) Osteoporosis and the risk of hip fracture. Am J Epidemiol 124:254–261

    PubMed  Google Scholar 

  72. Doyle F, Brown J, Lachance C (1970) Relation between bone mass and muscle weight. Lancet 1:391–393

    Article  PubMed  CAS  Google Scholar 

  73. Dalén N, Olsson KE (1974) Bone mineral content and physical activity. Acta Orthop Scand 45:170–174

    Article  PubMed  Google Scholar 

  74. Mazess RB, Whedon GD (1983) Immobilization and bone. Calcif Tissue Int 35:265–267

    Article  PubMed  CAS  Google Scholar 

  75. Cowan RS (1987) Less work for mother?. The American Heritage of Invention and Technology 2:57–63

    Google Scholar 

  76. Macdonald JB (1985) The role of drugs in falls in the elderly. Clin Geriatr Med 1:621–636

    PubMed  CAS  Google Scholar 

  77. Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ III (1987) Psychotropic drug use and the risk of hip fracture. N Engl J Med 316:363–369

    Article  PubMed  CAS  Google Scholar 

  78. Rodstein M (1964) Accidents among the aged: incidence, causes and prevention. J Chron Dis 17:515–526

    Article  PubMed  CAS  Google Scholar 

  79. Ashley MJ, Gryfe CI, Amies A (1977) A longitudinal study of falls in an elderly population. II. Some circumstances of falling. Age Ageing 6:211–220

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Statistics and Epidemiology, Mayo Clinic and Mayo Foundation, 55905, Rochester, Minnesota

    J. Joseph Melton III & W. Michael O'Fallon

  2. Division of Endocrinology and Internal Medicine, Mayo Clinic and Mayo Foundation, 55905, Rochester, Minnesota

    B. Lawrence Riggs

Authors
  1. J. Joseph Melton III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Michael O'Fallon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Lawrence Riggs
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Joseph Melton, J., O'Fallon, W.M. & Riggs, B.L. Secular trends in the incidence of hip fractures. Calcif Tissue Int 41, 57–64 (1987). https://doi.org/10.1007/BF02555245

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02555245

Key words

Search

Navigation