Ethnic and gender-specific incidence rates for hip fractures in South Africa:​ a multi-centre study

Dela, S. S.; Paruk, F.; Brown, S. L.; Lukhele, M.; Kalla, A. A.; Jordaan, J. D.; Conradie, M.; Mohamed, O.; Chutterpaul, P.; Cassim, B.

Affiliations

¹Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal (UKZN), South Africa

²Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa

³Mahatma Gandhi Memorial Hospital, Durban, South Africa

⁴Department of Orthopaedics, University of Witwatersrand, South Africa

⁵Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, South Africa

⁶Division of Orthopaedics, Stellenbosch University, South Africa

⁷Division of Endocrinology, Stellenbosch University, South Africa

⁸Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, South Africa

⁹Department of Geriatrics, SCM, College of Health Sciences, UKZN, South Africa

Abstract and keywords

Background: Limited data exist on the incidence of hip fractures in South Africa (SA). We report gender and ethnic specific incidence rates of hip fractures in SA.

Methods: In a multicentre prospective study, conducted in geographically defined municipalities of three provinces in SA, a structured questionnaire was administered to all subjects aged 40 years and over, presenting with a new atraumatic hip fracture, from 1 April 2017 to 31 March 2018. Gender and ethnic specific incidence rates (IR) of hip fractures were calculated using population statistics from Statistics SA.

Findings: Of the 2767 subjects enrolled, 1914 (69·2%) were women and 853 (30·8%) were men. The majority of subjects were from the White population (40·9%) followed by those from the African (26·4%), Coloured (18·7%) and Indian (13·9%) populations.

Men with hip fractures were significantly younger than women in the total group (69 [IQR 59–79] versus 77 years [IQR 68–84], p < 0·001) and in each ethnic group. White subjects were significantly older (p < 0·0001) and Africans significantly younger (p < 0·0001) than the other ethnic groups.

In women, the highest IR was noted in the White population (176·0 per 100,000), followed by that in the Indian (147·7 per 100,000), Coloured (73·2 per 100,000) and African populations (43·6 per 100,000). A similar pattern was seen in men albeit at lower rates, with the highest rate in White men at 76·5 per 100,000.

In the total study population and the African population, the IR was higher in men compared to women in subjects under 60 years. In the White population, the IR was higher in men compared to women in the 40–44 years age group. While in the Coloured and Indian populations the IR was higher in men compared to women in the 40–49 years and 45–54 years age groups, respectively.

There was an increase in the relative risk ratios with age in the total study population, and in all ethnic groups in both women and men.

Interpretation:

Hip fractures occur in all ethnic groups in South Africa with higher IRs in the White and Indian populations compared to the Coloured and African populations. Consistent with the published literature, the overall hip fracture IR was higher in women than in men, except in the younger age groups, and increased with age.

Funding: South African Medical Research Council and the University of KwaZulu-Natal Competitive Research Grant.

Keywords: Hip fractures; Incidence; South Africa; Ethnicity

Links

DOI: 10.1016/j.bone.2020.115253

PubMed: 31987987

WoS: 000517355400029

History

Received: 2019-09-6

Revised: 2020-01-21

Accepted: 2020-01-21

Online: 2020-01-25

Cited Works (5)

Year	Entry
2007	Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg M-A, La Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott A-M, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. August 2007;18(8):1033-1046.
1998	Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15 000 adults: the influence of age and gender. J Bone Joint Surg. March 1998;80B(2):243-248.
1996	Aspray TJ, Prentice A, Cole TJ, Sawo Y, Reeve J, Francis RM. Low bone mineral content is common but osteoporotic fractures are rare in elderly rural Gambian women. J Bone Miner Res. July 1996;11(7):1019-1025.
2002	Cummings SR, Melton LJ III. Epidemiology and outcomes of osteoporotic fractures. Lancet. May 18, 2002;359(9319):1761-1767.
2002	Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.

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