![]() Many challenges are encountered in studying ethnic variation in BMD. Rates among Hispanic women or men changed minimally over time. Similar declines in Blacks (women, −10.7% men, −4.3%) and Asians (women, −11.4% men, −7.1%) were not significant, likely due to wide confidence intervals. A significant decreasing trend was present in White women (−11.6%) and men (−3.6%), with the largest decline for those at least 75 yr old. More recently, hip fracture incidence rates from 2000 through 2009 were assessed in Medicare data ( 18). California found significant decreases among White women between 19, whereas rates were stable in Black women and both Asian women and men, with an increase among Hispanic women and men ( 17). Declining hip fracture rates in the United States may not be shared equally across all ethnic groups. Increasing urbanization in developing countries such as China may contribute to increasing hip fractures ( 16). Hip fracture rates are declining in Western countries but increasing in many developing countries ( 10), with similar trends for other fracture sites ( 11– 15). Historical patterns in hip fractures are changing. Some have suggested that there may be much greater global variation in hip fracture rates than clinical vertebral fracture rates, although this requires further confirmation given the challenge of accurately measuring vertebral fracture rates ( 9). $10,000 in per capita gross domestic product) ( 8). Ecological studies have noted a relationship between 10-yr hip fracture probability and latitude (∼0.6% increase for each 10° increase in latitude) and also with economic prosperity (1.3% increase for each U.S. In broad terms, a band of high-risk countries stretched from Northern Europe through middle Europe and then south-eastward to eastern Europe and beyond. Differences between countries were much greater than the male-female differences within a country. Variation in Fracture RatesĪ systematic review identified greater than 10-fold variation in age-standardized hip fracture risk among 63 countries ( 7). This review summarizes some of the differences in bone mineral density (BMD) that have been observed between geographic and ethnic groups, and this may contribute to observed fracture rates. The burden of osteoporosis is projected to rise markedly over the next few decades ( 5), with the greatest increase among elderly non-Whites ( 6). Although osteoporosis occurs in all populations, not all populations are at equal risk, as highlighted in a Clinical Symposium at the annual meeting of The Endocrine Society in 2012 ( 4). Fifty-six million people worldwide were estimated to have suffered a prior osteoporotic fracture in 2000 ( 3). Osteoporosis is a global problem characterized by reduced bone strength and increased fracture risk ( 1, 2).
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