骨质疏松性髋部骨折术后合理应用双膦酸盐类药物起始时间的临床分析

背景:目前研究认为骨折术后应用双膦酸盐类药物不会影响骨折的愈合,但关于合理应用双膦酸盐类药物的最佳起始时间尚无定论。目的:探讨骨质疏松性髋部骨折患者术后合理应用双膦酸盐的起始时间。方法:回顾性分析2008年1月至2014年12月行内固定手术治疗的373例骨质疏松性髋部骨折患者的临床资料,根据术后使用双膦酸盐类药物的不同起始时间分为A组(术后2周内,146例)、B组(术后2周至1个月内,115例)和C组(术后1~3个月内,112例)。通过X线片检查评估骨折愈合,对比分析平均愈合时间、术后6个月总体骨折愈合情况;术后6个月对患者进行Harris髋关节评分;采用双能X线骨密度仪测量术前、术后3个月及术后6个月腰部(L1-L4)骨密度变化;跟踪分析术后并发症情况。结果:A组、B组和C组患者骨折正常愈合的比例、平均骨折愈合时间、Harris髋关节评分等组间比较均无统计学差异(P>0.05)。术后3个月C组患者腰部骨密度均低于A组和B组(P=0.001,P=0.009)。术后6个月时,A组和B组患者腰部骨密度均较术前明显升高(P=0.000,P=0.001),C组患者腰部骨密度虽较术前有所升高,但无统计学差异(P=0.088),C组患者腰部骨密度均低于A组和B组(P=0.001,P=0.005)。三组患者再发骨折、内固定松动或移位、内固定感染、断钉、深静脉血栓等术后并发症无统计学差异(P>0.05)。结论:骨质疏松性髋部骨折术后不同起始时间应用双膦酸盐类药物不影响骨折的愈合,而术后早期进行抗骨质疏松治疗可以减少术后骨质流失。     

老年骨质疏松性髋部骨折患者的药物起始率及依从性分析

目的分析老年骨质疏松性髋部骨折患者使用抗骨质疏松药物的起始率及依从性。方法将326例行手术治疗的老年骨质疏松性髋部骨折患者根据性别分为男性组(148例)和女性组(178例)。采集患者入院时服用抗骨质疏松药物情况,并计算药物起始率;术后待患者恢复进食后给予抗骨质疏松治疗,统计患者术后1年期间服用抗骨质疏松药物情况,分析术后0~6、7~12个月两个随访阶段服用抗骨质疏松药物情况及药物依从性。结果术前服药起始率:男性组钙剂为27.70%,维生素D为20.27%,双膦酸盐为6.76%;女性组钙剂为46.07%,维生素D为31.46%,双膦酸盐为15.17%;男性组3种药物服药起始率均低于女性组,差异有统计学意义(P0.05)。术后常规抗骨质疏松药物治疗0~6个月,两组患者服药依从性良好的比例较高,男性组中钙剂为79.73%,维生素D为71.62%,双膦酸盐为70.27%;女性组中钙剂为85.96%,维生素D为78.65%,双膦酸盐为76.97%;男性组略低于女性组,但差异无统计学意义(P0.05)。术后7~12个月时两组患者3种服药依从性良好的人数比例均显著减少(P0.05),男性组钙剂为55.40%,维生素D为48.65%,双膦酸盐为41.89%;女性组钙剂为71.91%,维生素D为60.67%,双膦酸盐为57.86%;男性组3种服药依从性良好的比例均低于女性组(P0.05)。结论老年骨质疏松性髋部骨折患者术前抗骨质疏松药物治疗的起始率低,男性患者较女性患者更低;术后抗骨质疏松药物治疗中患者长期的药物依从性较差,男性患者差于女性患者。提示医务人员应该对患者加强抗骨质疏松的健康宣教。     

双膦酸盐治疗股骨非典型性骨折的研究进展

骨质疏松症为一种有较高发病率和死亡率的病症,会导致患者骨折风险增加。双膦酸盐已在许多大型临床试验中被证明可降低骨质疏松性骨折的风险,特别是阿仑膦酸钠已广泛成功地用于骨质疏松症的治疗。双膦酸盐可抑制骨吸收（抑制破骨细胞活性）,同时也可引起骨小梁微损伤的积累或胶原纤维的老化。长期使用双膦酸盐会导致股骨非典型性骨折（AFF）风险增高。本文综述了与双膦酸盐相关AFF的发病机制和管理相关的6个主题,包括双膦酸盐作用机理、双膦酸盐相关AFF的发病机制、AFF的危险因素、双膦酸盐相关AFF的预防、双膦酸盐相关AFF的手术治疗、双膦酸盐相关AFF的医疗管理。     

双膦酸盐类药物在骨折急性期患者中的应用

双膦酸盐类药物（BPs）是目前治疗骨质疏松症的首选药物,可以有效降低椎骨和非椎骨骨折的危险。其中,阿仑膦酸钠（ALN）是应用最多的,它可以通过迅速抑制破骨细胞对骨质的重吸收而防止骨量丢失。而正常的骨折愈合过程包括必要的骨形成和骨重吸收。最近发生骨折的患者是否可以服用这类骨质重吸收抑制剂呢？骨折愈合会不会受到影响,导致骨折延迟愈合或不愈合？笔者就此问题在骨折的愈合过程、双膦酸盐药物的作用机制、双膦酸盐药物对骨折愈合的影响以及骨折后骨量丢失的预防等方面做一个综述。结论骨折急性期患者可以服用推荐剂量的双膦酸盐药物治疗骨质疏松症或预防骨折后的骨量丢失。但是,若骨折急性期患者同时合并有疾病需要较大剂量服用双膦酸盐药物,治疗方案的选择应该以风险-受益比为基础,根据每名患者的具体情况进行治疗。     

使用双膦酸盐类药物的不良反应

回顾了与氨基双膦酸盐相关的不良反应事件。双膦酸盐类药物有口服与静脉注射两种类型。口服双膦酸盐主要用于治疗骨质疏松症,静脉注射的双膦酸盐用于肿瘤和骨质疏松症的治疗。两类双膦酸盐类药物的副作用在许多方面都不同。     

与双膦酸盐类药物相关的非典型股骨骨折的研究进展

双膦酸盐类药物是治疗骨质疏松症的常用药物之一。它们的应用大大降低了骨质疏松症相关的椎体、非椎体骨折的发生率。然而,近年来美国食品药品监督管理局发布安全警告:长期使用双膦酸盐可能导致下颌骨坏死、心房颤动、非典型股骨骨折等。最近关于长期应用双膦酸盐与非典型骨折的关系越来越受到关注。这些低能量性骨折也称为脆性骨折。其多发生于股骨转子下或股骨干。目前认为双膦酸盐可能通过长期严重地过度抑制骨转换,导致骨重塑受损,骨微损伤累积,骨脆性增加,从而诱发自发性骨折。女性、亚裔、西班牙裔人种、体重指数、长期应用糖皮质激素、长期应用双膦酸盐且无药物假期被认为是非典型股骨骨折的危险因素。美国骨与矿物质研究学会推荐非典型骨折患者应立即停用双膦酸盐类药物,并予以钙剂、维生素D及特立帕肽治疗;对于完全性骨折患者,建议行股骨全长髓内钉内固定以保护整个股骨。总之,与经典的高能量性骨折相比,非典型股骨骨折具有独特的病理生理学特点、临床表现及影像学特征等。这里我们基于近期研究及文献检索做一综述。     

唑来膦酸盐与骨质疏松症

目的 双膦酸盐是目前抗骨质疏松治疗最常用药物.唑来膦酸盐是每年1次静脉注射用双膦酸盐,探讨唑来膦酸盐对骨质疏松的治疗作用及安全性分析.方法 PubMed上检索应用唑来膦酸盐治疗骨质疏松及其他疾病的相关文献并进行分析.结果 HORIZON-PFT 3年研究表明唑来膦酸盐与安慰剂比较,能明显降低椎体、非椎体骨折风险,增加骨密度,降低骨转换标志物水平,增加骨小梁容量.在90 d内行髋部骨折外科治疗的患者中进行的HORIZON-RFT研究发现唑来膦酸盐与安慰剂比较能够明显降低再发骨折风险,降低全因死亡率,增加髋部及股骨颈骨密度.绝经后低骨密度妇女从阿伦膦酸钠改为唑来膦酸盐3个月内平均骨转换标志物水平先下降,后逐渐增至绝经前妇女正常范围,且可维持腰椎骨密度值12个月.另一研究表明与阿伦膦酸钠比较,唑来膦酸盐能更迅速的降低骨吸收标志物,抑制骨吸收.在安全性方面唑来膦酸盐可能的副作用包括急性一过性不良反应,如发热、肌痛、流感样症状,主要为轻到中度,常发生在静脉输注后3 d内,3～7 d左右缓解.研究表明唑来膦酸盐短期内可能引起肾功能的变化,但长期对肾功能未发现明显影响.颌骨骨质疏松性坏死可能与唑来膦酸盐相关,但发生率较低,且多发生在恶性肿瘤如多发性骨髓瘤和转移癌的患者中,尚未证实颌骨骨质疏松性坏死风险增高与用于治疗骨质疏松症批准剂量的唑来膦酸盐有关.其他少见的副作用包括房颤,无症状及一过性低钙血症,尚需要大样本长期研究证实.结论 每年1次唑来膦酸盐是治疗绝经后骨质疏松新的选择.     

从药物假期谈双膦酸盐在老年骨质疏松症患者中的合理应用

骨质疏松症(osteoporosis,OP)是一种以骨量低下、骨微结构破坏,导致骨脆性增加、易发生骨折为特征的全身性疾病。双膦酸盐是目前最常用的抗OP药物,它能有效降低OP患者椎体、非椎体和髋部骨折的风险。但是长期使用双膦酸盐类药物会出现疗效下降,并诱发不典型骨折和下颌骨坏死等严重并发症。目前一般建议连续使用双膦酸盐药物3~5年后,就进入药物假期。在药物假期期间,应注意定期检测骨密度(bone mineral density,BMD)和骨转换标志物(bone turnover markers,BTMs),并根据两者的变化,来决定下一步治疗方案。一般来说,如BTMs水平较低、BMD稳定,则药物假期继续;如BTMs水平增高、BMD下降,应重新接受抗骨吸收治疗;如BTMs水平较低、BMD下降,则应考虑改用特立帕肽成骨治疗。     

双膦酸盐的今昔与思考

双膦酸盐(bisphosphonates,BPs)是近30年来研发的抗代谢性骨病的一类新药,能特异地与骨质中的羟磷灰石结合,抑制破骨细胞活性,从而抑制骨吸收。根据双膦酸盐类药物化学结构的变化,药物活性的改变,其抗骨吸收作用也不断增强,成为调节骨代谢、改善骨质疏松症状、降低骨折风险的一线抗骨质疏松药物。本文综述了双膦酸盐的发展史,第一代、第二代、第三代双膦酸盐的化学结构,第三代双膦酸盐抗骨吸收研究作用及临床实践中如何正确使用双膦酸盐,旨在为规范治疗骨质疏松提供科学的理论依据。     

绝经后骨质疏松症的治疗进展

骨质疏松症是一个与老龄化进程息息相关的全球性健康问题，骨质疏松症患者不仅经常被漏诊，而且常常不能得到及时治疗。正因为如此，骨质疏松症直接导致了高发病率、高死亡率以及生活质量的下降。雌激素缺乏是绝经后骨量丢失的一个主要影响因素，50岁女性其一生中发生骨折风险的概率大约是50 %，对骨质疏松症进行针对性的治疗可以预防这些骨折的发生。除此之外，非药物性的治疗还包括健康饮食、防止跌倒以及适当的体育锻炼；药物治疗主要包括钙剂、维生素D以及抗骨吸收药物（选择性雌激素受体调节剂、激素替代治疗、双膦酸盐类药物、狄迪诺塞麦）、骨形成药物（特立帕肽）和混合型制剂（雷尼酸锶）在内的骨活性药物。双膦酸盐类药物（阿仑膦酸钠、利塞膦酸钠、伊班膦酸钠和唑来膦酸钠）是目前骨质疏松症治疗中最常应用的抗骨吸收药物，但由于其依从性、耐受性较差，加之不良反应的影响，会限制其从抗骨吸收治疗中的获益。目前已在研发针对骨细胞信号传导研究基础上的一些新药，并且正在进行疗效评估的临床试验。     

老年人髋部骨折156例临床治疗分析

目的 报告老年人髋部骨折的临床治疗方法，分析老年髋部骨折特点及诊治注意事项。方法 自1997年1月－1999年12月共治疗60岁以上（60－93岁）髋部骨折156例。男性55例，平均年龄71．8岁；女性101例，平均年龄73．1岁。骨折类型：股骨颈骨折94例，男性20例，女性74例；股骨粗隆间骨折62例，男性35例，女性27例。本组接受非手术治疗41例；手术治疗115例，其中行各种内固定手术45例，人工股骨头置换68例，股骨头颈切除2例。部分病例同时给予骨质疏松药物治疗。结果 获得随访110例。随访时间0．5－3．5年。术后下肢静脉栓塞2例，股骨头缺血坏死2例，内固定物松动，滑脱2例，断裂1例，人工股骨头下沉致疼痛4例，术后近期死亡2例（死于心肌梗塞及呼吸道感染），97例（88．2％）恢复行走功能。结论 （1）老年人髋部骨折以女性多见，占64．7％；男性少见，占35．3％。这与女性绝经后骨折疏松症的发生密切相关。而老年股骨颈骨折多见于女性，股骨粗隆间骨折则多见于男性。70岁以后，老年髋部骨折发生率明显上升。这与老年性骨质疏松症的发生明显相关。说明随着年龄的增加，骨折的发生率明显增高，骨折危险性增加。（2）老年人髋部骨折属于骨质疏松性骨折，股骨粗隆间骨折一般都有明确外伤史；而股骨颈骨折常由轻微外力（扭转）所致，因此在诊断时须防止漏诊或误诊，影响治疗效果。（3）老年人多伴有心血管系统或呼吸系统疾病，骨折后长期卧床具致使的威胁，因此在治疗上如无禁忌应争取早期手术，早期下床活动。（4）在治疗骨折的同时，应注意对骨质疏松症的治疗，这对减轻全身骨痛，促进骨折愈合，防止再骨折均有重要意义。     

Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials.

In postmenopausal women, the efficacy of bisphosphonates on hip fracture risk is not clear. This Bayesian meta-analysis quantitatively reviewed data from 12 randomized clinical trials with 18,667 patients and found that bisphosphonate treatment was associated with a reduced risk for hip fracture by 42%. INTRODUCTION: The efficacy of antiresorptive bisphosphonates therapy on reducing hip fracture is not clear, because evidence from randomized clinical trials (RCTs) is inconclusive. This study was undertaken to quantitatively assess the effect of bisphosphonates on hip fracture using literature review and meta-analysis. MATERIALS AND METHODS: Bayesian methods of meta-analysis were applied to synthesize data from 12 RCTs available between 1990 and 2004. The trials involved 18,667 postmenopausal women with low BMD or osteoporosis who have been followed or treated for between 1 and 4 years. The medications used were etidronate (two trials) alendronate (six trials), risedronate (three trials), and clodronate (one trial). The primary endpoint was the incidence of hip fracture. RESULTS: When data from all 12 studies were pooled, treatment with bisphosphonates was associated with a reduced risk for hip fracture by 42% (relative risk [RR], 0.58; 95% credible interval [CrI], 0.42-0.80). The absolute rate reduction was 52 hip fractures per 10,000 women (95% CrI, 4-110) for a period of 3-year treatment. The probability that bisphosphonates are better than placebo (in reducing hip fracture risk by at least 30%) was 0.90. CONCLUSIONS: In postmenopausal women with osteoporosis or low BMD, bisphosphonate treatment is associated with reduced risk of hip fracture.     

老年髋部骨折224例临床分析

目的：分析老年髋部骨折的临床流行病学特征,为老年髋部骨折的预防及治疗提供理论依据。方法：回顾性分析224例老年髋部骨折住院患者性别、年龄、骨折部位、致伤原因、伴发病及治疗费用。结果：老年髋部骨折的发病率女性高于男性,以70～79岁年龄段发病率较高,股骨颈骨折与股骨粗隆间骨折发病率相当,骨折多由自行摔伤或轻微碰撞跌伤所致,老年髋部骨折患者伴发病较高,且住院治疗费用呈上升趋势。结论：老年女性容易发生髋部骨折,其外因是跌倒,内因是骨质疏松,预防跌倒及防治骨质疏松至关重要,且需要费用低廉的临床治疗方法。     

Elderly patients with two episodes of fragility hip fractures form a special subgroup

PURPOSE. To identify the demographic features of patients aged 65 years or older admitted with 2 episodes of fragility hip fractures. METHODS. From July 2003 to December 2004 inclusive, 50 consecutive elderly patients underwent surgery for a second episode of hip fracture. Patients in a very poor physical condition and therefore unfit for surgery were excluded. Risk factors of fractures in both episodes and whether risk factors were corrected after the first episode were analysed. Detailed radiological assessment and charting of elderly mobility scores and Barthel index were completed and the one-year mortality rate documented. The rehabilitation periods for the 2 episodes of hip fracture were compared. RESULTS. Most patients were female and had trochanteric fractures. In patients aged 65 to 75 years, the incidence of femoral neck fracture occurred as often as trochanteric fracture; while trochanteric fracture was predominant in older patients. Subclinical osteomalacia and undiagnosed hyperthyroidism was found in 3 of the 7 younger patients. Only 30% of them were on treatment for osteoporosis after the first fracture, which underlines the importance of osteoporosis treatment in these patients. CONCLUSION. Elderly patients with 2 episodes of fragility hip fractures form a special subgroup among geriatric hip fracture patients. Fall prevention programmes and treatment for osteoporosis are recommended.     

Hip fracture in women. Incidence, in-hospital mortality, and five-year survival probabilities in members of a prepaid health plan

The problem of hip fracture is especially serious for women, who live longer than men and who have a higher risk of the condition. Data on women older than 49 years enrolled in a prepaid medical care program were analyzed to determine the incidence of hospitalization for hip fracture, in-hospital death rate, and five-year probability of survival after hip fracture. The cumulative lifetime probability of hip fracture for women alive at age 50 years was calculated, taking into account current estimates of survival in women. As in other studies, the incidence of hip fracture increased exponentially with age. In-hospital death rate after hip fracture was low in this population (3.7%). Survival after hip fracture was correlated with age at hospitalization. About 12% of women alive at age 50 years will be hospitalized for a hip fracture at least once before they die. In this population, the incidence of hospitalization, in-hospital death rate, and lifetime probability of hip fracture were lower than in some other reports.     

多学科协作构建老年髋部骨折"绿色通道"

目的评价新型冠状病毒肺炎疫情前后多学科协作模式治疗老年髋部骨折的效果，探索常态化疫情防控形势下进一步完善临床诊疗路径的突破点。 方法回顾性收集自2019年1月至2020年12月间北京积水潭医院老年创伤骨科以多学科协作模式治疗的老年髋部骨折患者的相关信息进行分析比较，包括年龄、性别、骨折类型、美国麻醉医师协会（ASA）评分、手术治疗率、受伤至急诊时间、急诊至入院时间、入院至手术时间、入院48 h内手术率、住院时间、围手术期并发症发生率及院内死亡率等。 结果本研究共纳入老年髋部骨折患者2 275例，平均年龄79.7岁（65~105岁）；男性663例（29.1%），女性1 612例（70.9%）；股骨颈骨折1 219例（53.6%），股骨粗隆间骨折1 016例（44.7%），股骨粗隆下骨折40例（1.8%）；ASA评分高分级占比49.6%；手术治疗率为97.7%；院内死亡率为0.2%（4例）。相较于2019年，2020年所收治患者受伤至急诊平均时间明显延长（1.7 d VS. 3.4 d，P=0.000），急诊至入院平均时间无明显变化（23.4 h VS. 24.0 h，P=0.109），入院至手术平均时间略有增长（30.7 h VS. 38.3 h，P=0.000），入院48 h内手术率有所下降（82.1% VS. 72.4%，P=0.000），平均住院时间略有延长（4.1 d VS. 4.3 d，P=0.005）；围手术期并发症发生率明显增加（16.9% VS. 22.5%，P=0.001），主要体现在压疮、肺部感染及泌尿系感染的发生率明显上升。 结论基于多学科协作的老年髋部骨折"绿色通道"诊疗模式院内死亡率极低；有效地缩短术前等待时间，可能降低围手术期并发症发生率。     

我国中老年脆性髋部骨折及桡骨远端骨折骨质疏松诊断标准与WHO诊断标准的比较分析

目的评估我国中老年髋部骨折及桡骨远端骨折骨质疏松诊断标准与世界卫生组织(World Health Organization,WHO)诊断标准的不同所产生的骨质疏松人群的数量差异,更加精确地指导临床对适宜骨质疏松人群的筛查及治疗。方法收集2016年8月至2018年2月我院骨科年龄在60～80岁的脆性髋部骨折女性患者110例及桡骨远端骨折女性患者100例及与年龄相仿的正常人女性312名,使用双能X线骨密度仪测量腰1～4、股骨颈、股骨大粗隆骨密度,分别计算骨质疏松率;再按照我国骨质疏松诊断标准及WHO诊断标准进行比较分析。结果脆性髋部骨折女性患者腰1～4、股骨颈、股骨大粗隆骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。脆性桡骨远端骨折女性患者腰1～4、股骨颈骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。股骨大粗隆骨密度低于对照组,骨质疏松率高于对照组,但差异不具有统计学意义(P0.05)。按照我国骨质疏松诊断标准与WHO诊断标准进行比较,我国脆性髋部骨折及桡骨远端骨折骨质疏松人数多于WHO骨质疏松人数,差异具有统计学意义(P0.05)。结论据本文分析,我国脆性髋部骨折及桡骨远端骨折骨质疏松率明显高于正常人,我国骨质疏松诊断标准扩大了骨质疏松人数。呼吁更多研究评估我国骨质疏松骨折,特别是脆性桡骨远端骨折的诊断及治疗,适时调整我国骨质疏松诊断标准。     

老年髋部骨折的手术治疗

目的 报告老年人髋部骨折临床治疗效果,分析老年人髋部骨折特点及诊治注意事项。方法 对55岁以上老年髋部骨折193例的临床资料进行总结分析。结果 随访135例,时间6～22个月。术后下肢静脉栓塞2例,股骨头缺血性坏死1例,内固定物松动1例,116例(85.9％)恢复行走功能。结论 老年人髋部骨折以女性多见,65岁以后,老年髋部骨折发生率明显上升。说明随着年龄的增加,骨折的发生率明显增高,骨折危险性增加。老年人髋部骨折属于骨质疏松性骨折,一般都有明显外伤史。老年人多伴有心血管系统或呼吸系统疾病,骨折后长期卧床具有致命的危险,因此若无禁忌证应争取早期手术。在治疗骨折的同时,应注意对骨质疏松症的治疗。应重视骨折后下肢深静脉血栓形成的预防。     

Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study.

In this prospective 12-year study in men and women 60 years of age and older, there was a 4-6% per year reduction in the incidence rate of overall osteoporotic fractures, but the study was unable to exclude any change in the hip fracture incidence rate. Approximately one-half of hip fractures occurred before 80 years in men and two-thirds before 85 years in women. The age distribution of hip fractures underlines the need for earlier intervention in osteoporosis. INTRODUCTION: Although hip fracture is the major osteoporotic fracture in terms of health outcomes, quality of life, and costs, there is a paucity of long-term data on secular changes in men and women within a defined community. This long-term prospective population-based study over 12 years from 1989 to 2000 specifically examined the age distribution and secular changes in the incidence rates of hip and other osteoporotic fractures in men and women 60 years of age and older in a predominantly white population in Dubbo, Australia. MATERIALS AND METHODS: Hip and all other clinical fractures were ascertained by reviewing all radiography reports from the two area radiology services, ensuring complete ascertainment of all clinical osteoporotic fractures. RESULTS AND CONCLUSION: Among the 1055 symptomatic atraumatic fractures (after excluding pathological fractures), there was a significant reduction in the overall fracture incidence rate in women (4% per year; p = 0.0003) and men (6% per year; p = 0.0004) over the 12 years. There were 229 hip fractures (175 in women and 54 in men) within 39,357 person-years of observation. The overall rate +/- SE of hip fracture was 759 +/- 57 per 100,000 person-years in women and 329 +/- 45 per 100,000 person-years in men, with an exponential increase with age. With advancing age, the incidence rate of hip fractures in men approached that in women; the female:male ratio fell from 4.5 (95% CI: 1.3-15.7) to 1.5 (0.9-2.5) and 1.9 (1.2-2.8) in the 60-69, 70-79, and 80+ year age groups, respectively. In women, the absolute number of fractures and incidence rate continuously increased with age; however, in men, the absolute number of hip fractures peaked at 80-84 years of age and then decreased. Most importantly, despite the continuing increase with age, almost one-half (48%) of the hip fractures occurred before the age of 80 years in men, and 66% of hip fractures occurred before the age of 85 years in women. The overall hip fracture incidence is comparable with other white (except Sweden) and Asian groups as well as two other Australian studies. This study could not exclude a change in hip fracture incidence rate, even in those 80 years of age and over among whom the incidence of hip fractures was the highest. The incidence data highlight the fact that a large proportion of hip fractures occurs in those under 80 years of age, particularly in men. This age distribution underlines the need for earlier intervention in osteoporosis in women and particularly in men to achieve the most cost-effective outcomes.