THE VARIABLE INCIDENCE OF HIP FRACTURE IN SOUTHERN EUROPE - THE MEDOSSTUDY

We assessed the incidence of hip fracture and ecological correlates in residents of 14 communities in six countries of Southern Europe. Hip fracture cases were recorded prospectively in defined catchment areas over a 1-year interval. A retrospective questionnaire was used to asse ss ecological differences between communities. During a 1-year period of observation of total of 3629 men and women over the age of 50 years were identified with hip fracture from a catchment of 3 million. In a ll communities the fracture rate increased exponentially with age. The re were large and significant differences between centres in the doubl ing time for hip fracture risk with age and in crude and age-standardi zed rates. Greater than 4-fold and 13-fold differences in age-standard ized risk were found amongst men and women respectively. The lowest ra tes were observed from Turkey and the highest from Seville, Crete and Porto. Fractures were significantly more frequent among women than men with the exception of three rural Turkish centres. Indeed, in rural T urkey the normal female/male ratio were greater than the differences w ithin centres between sexes, and there was a close and significant cor relation between incidence rates for men and those for women in the re gions studied. Excess female morbidity increased progressively from th e age of 50 years but attained a plateau after the age of 80 years, su ggesting a finite duration of the effect of the menopause. The retrosp ective questionnaire completed by 80% of cases suggested that differen ces in incidence between the communities studied could not be explaine d by differences in gonadal status in women. In both men and women rel ated to age or socioeconomic prosperity, the majority of which disappe ared after adjustment for age. We conclude that there are marked and s izeable differences in the incidence rates of hip fracture throughout southern Europe. The reasons for these differences are not known but a ffect both men and women, and are likely to be related to lifestyle or genetic factors rather than to differences in endocrine status.