BASIC EPIDEMIOLOGY OF FRACTURES OF THE UPPER AND LOWER-LIMB AMONG AMERICANS OVER 65 YEARS OF AGE

Current knowledge regarding the basic epidemiology of fractures is lar gely limited to a few fracture sites, notably those of the hip and dis tal forearm. To clarify the patterns of incidence of limb fractures in the elderly, we used data from a 5% sample of the U.S. Medicare popul ation over age 65 years during the years 1986-1990. We identified inci dent fractures of the proximal humerus, other parts of the humerus, pr oximal radius/ulna, shaft of the radius/ulna, distal radius/ulna, pelv is, hip, other parts of the femur, patella, ankle, and other parts of the tibia/fibula from diagnoses and procedures coded on claims for inp atient services, outpatient facility use, and physician services. We u sed Poisson regression to investigate the relation between demographic factors and fracture risk at these sites. Fractures at the hip were t he most common, accounting for 38% of the fractures identified. The pr oximal humerus, distal radius/ulna, and ankle also were common fractur e sites. A pattern of rapidly rising rates with age was seen for fract ures of the pelvis, hip, and other parts of the femur among women. Fra ctures distal to the elbow or knee, however, had, at most, modest incr eases in incidence with age over 65 years. For each of the fractures s tudied, women had higher rates than men of the same race, and whites g enerally had higher rates than blacks of the same gender. Gender-relat ed differences in risk were larger among whites than among blacks, and racial differences in risk were more marked among women than among me n.