Epidemiology of vertebral fractures in women

Vertebral fracture prevalence was assessed in an age-stratified random sample of Rochester, Minnesota women aged 50 years and over. Vertebral fractures, including wedge and concavity as well as compression fractures, were common and increased with age. The estimated incidence of new vertebral fractures also rose with age, reaching 29.6 per 1,000 person-years in women aged greater than or equal to 85 years. The prevalence of one or more vertebral fractures also increased with declining bone mass, reaching 42% in women with spinal bone mineral density less than 0.6 g/cm2 by dual photon absorptiometry. Bone mass and age contributed independently to the risk of vertebral fracture, but "age" may reflect other manifestations of osteoporosis.     

Bone loss at the proximal femur and reduced lean mass following liver transplantation: a longitudinal study.

The longevity of recipients of liver transplant may be compromised by spinal osteoporosis and vertebral fractures. However, femoral neck fractures are associated with a higher morbidity and mortality than spine fractures. As there is little information on bone loss at this clinically important site of fracture, the aim of this study was to determine whether accelerated bone loss occurs at the proximal femur following transplantation. Bone mineral density and body composition were measured at the femoral neck, lumbar spine and total body, using dual x-ray absorptiometry in 22 men and 19 women, age 46 +/- 1.4 y (mean +/- SEM) before and at a mean of 19 mo after surgery (range 3-44). Results were expressed in absolute terms (g/cm2) and as a z score. Before transplantation, z scores for bone mineral density were reduced at the femoral neck (-0.47 +/- 0.21 SD), trochanter (-0.56 +/- 0.19 SD), Ward's triangle (-0.35 +/- 0.14 SD), lumbar spine (-0.76 +/- 0.13 SD), and total body (-0.78 +/- 0.15 SD) (all P < 0.01 to < 0.001). Following transplantation, bone mineral density decreased by 8.0 +/- 1.7% at the femoral neck (P < or = 0.01) and by 2.0 +/- 1.2% at the lumbar spine (P < or = 0.05). Total weight increased by 12.2 +/- 2.3%, lean mass decreased by 5.7 +/- 1.4%, while fat mass increased from 24.1 +/- 2.0% to 35.1 +/- 1.8% (all P < or = 0.001). Patients with end-stage liver disease have reduced bone mineral density. Liver transplantation is associated with a rapid decrease in bone mineral density at the proximal femur, further increasing fracture risk and a reduction in lean (muscle) mass, which may also predispose to falls. Prophylactic therapy to prevent further bone loss should be considered in patients after liver transplantation.     

打压植骨人工股骨头置换术治疗高龄不稳定股骨粗隆间骨折

目的 探讨通过打压植骨重建股骨粗隆部结合人工股骨头置换术治疗高龄老人不稳定性股骨粗隆间骨折的疗效.方法 自2005年1月至2008年12月,通过打压植骨重建股骨粗隆部结合人工股骨头置换术治疗高龄老人合并严重骨质疏松的不稳定性股骨粗隆间骨折21例.结果 按Harris评分标准进行功能评定:优14例,良5例,可2例,优良率达90.4%,未出现股骨粗隆骨折不愈合,无感染、脱位、假体松动.结论 通过采用打压植骨技术重建股骨粗隆部结合人工股骨头置换术治疗高龄不稳定性股骨粗隆间骨折是一种较好的方法.

Abstract：

Objective To evaluate the therapeutic effects of the integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty in the treatment of unstable intertrochanteric fractures in aged patients. Methods From January 2006 to December 2008,21 cases unstable intertrohanteric fractures with serious osteoporosis were treated with impaction bone grafting reconstructing the femur trochanter and femoral head arthropalsty. Results Functional assessment based on the Harris score ,great in 14 cases, good in 5 cases, medium in 2 cases. The excellent and good rate was 90. 4%. Conclusion The integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty is convenient to treat unstable intertrochanteric fractures in aged patients.     

膳食钙、磷以及奶制品对绝经后妇女骨密度的影响

目的探讨膳食中钙、磷以及奶制品的摄入量对骨密度及骨盐含量的影响,为研究骨质疏松的预防提供相关线索和依据。方法在广州市越秀区农林街社区发放传单招募调查对象,并采用自编的结构化标准问卷,对320名广州绝经后妇女的膳食习惯进行调查,并测量其全身、股骨全身、股骨颈、股骨干、大粗隆、Ward’s三角以及腰锥1～4的骨密度和骨量,采用多因素逐步回归分析探讨膳食钙、磷及奶制品对骨盐含量及骨密度的影响。结果 320名调查对象平均57.1岁,平均绝经年限7.3年,平均每天摄入钙、磷及奶制品分别为822 mg、949 mg和126 g,平均全身骨密度为1.054 g/cm2,磷与7个部位的骨密度及骨盐含量呈正相关关系（P〈0.05）。随着磷摄入量增加,全身及腰锥1～4骨密度增加,偏回归系数值分别为0.121和0.184 g.（cm2）-1.g-1.d-1。随着奶制品摄入量增加,股骨全身、股骨干骨密度也相应增加,骨密度偏回归系数值分别为0.686、0.841mg.（cm2）-1.g-1.d-1。钙与全身、股骨全身、股骨颈、大粗隆、股骨干和Ward’s三角的BMC具有正相关性,而在钙与BMD关系中,钙只与股骨全身、大粗隆和股骨干呈正相关性,且每日膳食中每增加100 g钙的摄入量,则股骨全身、大粗隆、股骨干的骨密度相应增加5.3、4.8和7.6 g/cm2。结论增加膳食中钙、磷以及奶制品的摄入量有利于绝经后妇女的骨盐含量及骨密度的提高。     

Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age

Hip fractures occur late in life following a substantial reduction in skeletal mass. If risk for such fractures could be predicted early, efforts to prevent excessive bone loss would be more successful and could be directed at the individuals most likely to be affected. With this objective in mind, we devised an approach to estimating the lifetime risk of a proximal femur fracture based on age and on current femoral bone mineral density, using population-based data from ongoing studies of osteoporosis and fractures among Rochester, Minnesota, women. Our calculations indicate that, at any given age, the lifetime risk of a proximal femur fracture rises as current bone density diminishes. At any given level of femoral bone density, lifetime risk rises with younger age and increasing life expectancy. While these trends seem robust, estimates of risk vary substantially with the assumptions that underlie the model. Consequently, these assumptions must be validated before our findings can be applied clinically to predict risk for individual patients.     

Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women.

Body composition (fat and lean compartments) and bone mineral density were measured in 246 healthy premenopausal women, aged 20-40 years, residing in Tecumseh, Michigan. Body composition was measured using four-point bioelectrical impedance and values for fat and lean compartments categorized into tertiles. Additionally, each woman was classified into one of nine different cells based on her location within a 3 x 3 table which reflects the joint distribution of both fat and lean compartments. Bone mineral density of the proximal femur, including the femoral neck and trochanter, was measured using dual photon densitometry. The mean femoral neck bone mineral density values increased significantly and linearly for each tertile of muscle mass (0.90, 0.95, and 1.02 g/cm2, p less than 0.0002). Femoral bone mineral density increased significantly but not linearly as the fat compartment progressed from the lowest to the highest tertile (0.95, 0.93, and 0.99 g/cm2). Bone mineral density of the proximal femur was similar and significantly greater in the high muscle/low fat and high muscle/high fat body composition subgroups compared with bone mineral density in the seven other groups. However, women in the high muscle/low fat subgroup had substantially lower mean weight (67 vs. 91 kg, p less than 0.0001) and mean Quetelet index (22.1 vs. 33.7 kg/m2, p less than 0.0001) than women in the high muscle/high fat subgroup. Bone mineral density values were similar and significantly lower in the following body composition cells: low muscle/low fat, low muscle/medium fat, and low muscle/high fat. Similar findings were observed at the trochanteric site. Low muscle is a risk factor for low bone mineral density in young adult women while higher fat is protective only when associated with substantial muscle.     

Moderate alcohol consumption and bone density among postmenopausal women

Chronic alcohol abuse is associated with low bone density and high risk of fracture. However, moderate alcohol consumption may help to maintain bone density in postmenopausal women by increasing endogenous estrogens or by promoting secretion of calcitonin. We conducted a prospective study among a sample of 188 white postmenopausal women (ages 50-74) from the Nurses' Health Study who participated in a health examination between 1993 and 1995 that included bone density assessments of the lumbar spine and proximal femur. Long-term alcohol intake was calculated as the average of the 1980 and 1990 measures from a food frequency questionnaire. Women who consumed 75 g or more of alcohol per week had significantly higher bone densities at the lumbar spine compared with non-drinking women (0.951 vs. 0.849 g/cm2, p = 0.002) after adjusting for age, body mass index (kg/m2), age at menopause, use of postmenopausal estrogens, and smoking status. Further adjustment for physical activity and daily intakes of calcium, vitamin D, protein, and caffeine did not alter the results. We also observed a linear increase in spinal bone density over increasing categories of alcohol intake (p = 0.002), suggesting that alcohol intakes of less than 75 g/week may also be of benefit. This positive association was observed among both current users and never users of postmenopausal estrogens. In contrast to the lumbar spine, femoral bone density was not higher among drinkers compared with nondrinkers, although density did increase among drinkers with increasing level of alcohol consumption. Further research is needed to determine whether moderate alcohol consumption can help to protect against spinal fractures in postmenopausal women. This finding must also be evaluated within a larger scope of the risks and benefits of alcohol on heart disease, breast cancer, and hip fractures.     

Height reduction, determined using knee height measurement as a risk factor or predictive sign for osteoporosis in elderly women

OBJECTIVE: We assessed the value of height reduction, calculated using knee height measurement, as a risk factor or predictive sign for osteoporosis in healthy elderly women. METHODS: In 181 healthy women 76 +/- 5 y of age, height, weight, and knee height were evaluated. Femoral and spine bone mineral densities and body compositions were measured using dual-energy X-ray absorptiometry. In 76 young women 27 +/- 4 y of age, a regression equation to predict height, based on knee height, was derived. Using this equation, maximum attained height and height loss were calculated in elderly women, which was correlated to bone mineral density. RESULTS: The equation to predict height was height (cm) = knee height (cm) x 2.22 + 50.54. The calculated height loss in elderly women was -6.1 +/- 3.8 cm or -0.08 +/- 0.05 cm/y of age. Height loss and hip circumference were significant predictors of spine bone mineral density. In the case of femoral bone mineral density, to the same predictors, a negative effect of waist circumference was added. Women in the highest quintile of height reduction (>0.199 cm/y) had an odds ratio of 4.5 (95% confidence interval 1.56-13.3, P < 0.02) for femoral osteoporosis. CONCLUSION: Knee height can be used as an accurate measurement of height loss in the elderly, which is a significant predictor of femur and spine bone mineral densities, in addition to hip circumference.     

Incidence of and Factors for Self-reported Fragility Fractures Among Middle-aged and Elderly Women in Rural Korea: An 11-Year Follow-up Study

Objectives:

This community-based cohort study was performed to investigate the incidence of and factors related to self-reported fragility fractures among middle-aged and elderly women living in rural Korea.

Methods:

The osteoporosis cohort recruited 430 women 40 to 69 years old in 1999, and 396 of these women were followed over 11 years. In 1999, questionnaires from all participants assessed general characteristics, medical history, lifestyle, menstrual and reproductive characteristics, and bone mineral density. In 2010, self-reported fractures and the date, site, and cause of these fractures were recorded. Cox proportional hazards models were used to calculate hazard ratios (HRs).

Results:

Seventy-six participants among 3949.7 person-years experienced fragility fractures during the 11-year follow-up. The incidence of fragility fractures was 1924.2 per 100 000 person-years (95% confidence interval [CI], 1491.6 to 2356.8). In the multivariate model, low body mass index (HR, 2.66; 95% CI, 1.13 to 6.24), a parental history of osteoporosis (HR, 2.03; 95% CI, 1.18 to 3.49), and postmenopausal status (HR, 3.50; 95% CI, 1.05 to 11.67) were significantly related to fragility fracture.

Conclusions:

Fracture prevention programs are needed among postmenopausal, rural, Korean women with a low body mass index and parental history of osteoporosis Korea.     

中老年男性雄激素部分缺乏综合征患者的骨密度改变及其影响因素的研究

目的 探讨中老年男性雄激素部分缺乏综合征（partial androgen deficiency in the aging male,PADAM）患者的骨密度（bone mineral density,BMD）特点及其影响因素.方法 采用双能X线骨密度仪（dual energy X-ray absorptiometry,DEXA）测定186例中老年PADAM患者和125例年龄、体重指数（body mass index,BMI）相匹配的健康中老年人的腰椎及股骨颈骨密度,收集相关生化、性激素及骨代谢指标,并对其与年龄、身高、体重、BMI、性激素水平及部分骨代谢指标进行多元逐步回归分析.结果 （1）PADAM组患者腰椎BMD与健康对照组差异无统计学意义（P＞0.05）,但股骨颈各部位BMD均较健康对照组明显降低[Neck：（0.831±0.136）g/cm2 vs（0.954±0.143）g/cm2,Ward＇s：（0.712±0.127）g/cm2 vs（0.811±0.149）g/cm2,Troch：（0.697±0.124）g/cm2 vs（0.764±0.131）g/cm2,P＜0.05）].（2）PADAM组及健康对照组骨量减少的发生率分别为48.9%、36%,骨质疏松的发生率分别为33.3%、20.8%.（3）PADAM患者腰椎BMD与BMI呈正相关;而股骨颈各部位BMD均与年龄呈负相关,与BMI、雄激素水平呈正相关（P＜0.05）.结论 PADAM患者股骨颈各部位骨密度明显降低.高龄、低体重指数和低雄激素水平为PADAM患者BMD降低的危险因素.     

Effect of alcohol intake on bone mineral density in elderly women: The EPIDOS Study. Epidémiologie de l'Ostéoporose

To study potential associations between alcohol consumption and bone mineral density in women aged 75 years or older, the authors analyzed 7,598 ambulatory women (mean age, 79.9 years; standard deviation, 3.8 years) recruited at five centers in France between 1992 and 1994. The current alcohol intake was assessed using a self-questionnaire. Bone mineral density was measured by dual-photon X-ray absorptiometry of the proximal femur and total body and adjusted for age, weight, and height (Z score). Compared with nonusers, women who drank 11-29 g of alcohol per day (g/day) had higher bone mineral density values at the trochanteric site (p = 0.0017). Neither 1-10 g/day nor >30 g/day users had increased bone mineral density levels. These results were unrelated to estrogen replacement therapy use, dietary calcium intake, current smoking status, usual physical activity, educational attainment, household monthly income, and general health status. Alcohol intake was not associated with bone mineral density at the femoral neck. Total body bone mineral density was lower in subjects with alcohol intakes >30 g/day (p = 0.047). Our data suggest that moderate drinking (e.g., 1-3 glasses of wine per day) is associated with an increase in trochanteric bone mineral density in elderly ambulatory women. However, higher intakes may have detrimental effects on bone mass.     

Long-term depot-medroxyprogesterone acetate and bone mineral density.

The association between long-term use of depot-medroxyprogesterone acetate (DMPA) and bone mineral density (BMD) has been controversial, as seen in three case-control studies in New Zealand, Thailand, and the United Kingdom. In the present case-controlled study of BMD, a group of 67 Chinese women who had used DMPA from 5-15 years was compared with 218 women of the same age range who had not used any steroidal hormones. DMPA users were found to have a significantly lower BMD at lumbar vertebra (L2-4) (0.93 g/cm2), neck of femur (0.69 g/cm2), trochanter (0.59 g/cm2), and Ward's triangle (0.58 g/cm2), as compared with the control group, whose corresponding BMD values were 1.03 g/cm2, 0.83 g/cm2, 0.71 g/cm2, and 0.78 g/cm2, respectively (p < 0.001). The average percentage of bone loss per year was estimated to be 1.1% in L2-4, 2.3% in neck of femur, 2.4% in trochanter, and 3.5% in Ward's triangle. The percentage of bone loss in L2-4 was found to be more pronounced with age. This study provided information that the use of DMPA in a Chinese group for > 5 years in associated with bone loss, and a prospective study is needed to confirm these data, which are different from two case-control studies.     

维生素K和钙对去卵巢大鼠骨质疏松的影响

切除雌鼠双侧卵巢以造成骨快速丢失作为模拟女性绝经后骨质疏松症的动物模型,从骨计量学、骨生物力学等方面综合观察单纯补充维生素Ｋ（９０ｍ ｇ／ｋｇ）、钙（５ｇ／ｋｇ）及两者联合作用６个月对骨丢失的影响。结果发现：与正常对照组（Ａ）大鼠相比,模型对照组（Ｂ）大鼠骨量显著减少,骨脆性增加。与模型对照组相比,单纯补充维生素Ｋ组（Ｄ） 股骨中点骨密度值显著提高,股骨干骺端及腰椎骨密度、股骨近侧端矿物质含量都有增高趋势,表明补充维生素Ｋ 可在一定程度上减少骨丢失;同时补充维生素Ｋ及钙组（Ｅ）股骨的最大挠度与最大应变值,与模型对照组相比也有增高趋势,表明补充维生素Ｋ可提高骨的柔韧性,改善股骨的力学性能。综合骨计量学与骨力学观察结果,发现各种实验措施对密质骨的效果皆优于松质骨,并且维生素Ｋ与钙的联合作用效果优于单纯补充维生素Ｋ 或钙。本实验结果提示：绝经后妇女,作为骨质疏松危险人群,增加膳食维生素Ｋ 与钙的摄入是有帮助的     

Osteoporosis and African American women

The incidence of osteoporosis and related fractures in African American women is half that of Caucasian women. African American women who sustain osteoporosis-related fractures have increased disability and decreased survival. Given the exponential increase in hip fracture rate among African American women over the age of 70 years, the risk of osteoporosis among this population may be underestimated. This review focuses on racial differences in women's bone mineral density (BMD) and bone metabolism and on various explanations for these observed differences. Environmental risk factors for osteoporosis and related fractures among African American women and modalities for prevention and treatment of osteoporosis are discussed. African American women begin menopause with higher BMD and have lower rates of women's bone loss after menopause, which account for their decreased incidence of osteoporosis and related fractures. The risk factors for osteoporosis among African American women are similar to those found in Caucasian women. Lifestyle interventions, such as calcium and vitamin D supplementation, smoking cessation, and increased physical activity, should be encouraged to enhance peak bone mass and to decrease bone loss. These interventions and other treatment modalities, such as hormone replacement therapy, bisphosphonates, and selective estrogen receptor modulators, should be studied further in African American women.     

Menatetrenone (vitamin K2) and bone quality in the treatment of postmenopausal osteoporosis

Menatetrenone (vitamin K2) reduces the incidence of vertebral fractures but has only modest effects on bone mineral density (BMD) in postmenopausal women with osteoporosis. Combined treatment with bisphosphonates and menatetrenone may be more effective than treatment with bisphosphonates alone in preventing vertebral fractures, despite the lack of an additive effect of menatetrenone on the BMD increase by bisphosphonates. Menatetrenone improves bone architecture in ovariectomized rats, and the mineral/ matrix ratio of the bone in terms of matrix volume and bone strength (without increasing bone mass) in rats with magnesium deficiency. Thus, available evidence supports an effect of menatetrenone on bone quality during osteoporosis treatment.     

唑来膦酸对骨质疏松性股骨粗隆间骨折的临床疗效观察

目的：观察应用唑来膦酸对老年骨质疏松性股骨粗隆间骨折临床疗效的影响。方法：将本院2012年1月-2014年1月采用闭合复位髓内钉固定术治疗的64例骨质疏松性粗隆间骨折患者按照随机数字表法分为治疗组34例和对照组30例。其中治疗组应用唑来膦酸进行治疗,对照组未应用唑来膦酸进行治疗。观察比较两组患者术前及术后1年的骨密度值、Harris髋关节功能评分、骨折愈合时间和再次骨折发生率。结果：治疗组的骨折愈合时间和Harris评分分别为（12.14±1.38）周、（89.42±4.82）分;对照组分别为（13.86±1.76）周、（88.54±4.54）分,两组比较差异均无统计学意义（P〉0.05）。术后1年治疗组骨密度平均为（0.728±0.134）g/cm2明显高于对照组的（0.542±0.138）g/cm2,且治疗组术后1年与术前骨密度比较差异有统计学意义（P〈0.05）,对照组术后1年与术前骨密度比较差异无统计学意义（P〉0.05）。治疗组再次骨折发生率5.8%明显低于对照组的20.0%,比较差异有统计学意义（P〈0.05）。结论：老年骨质疏松性股骨粗隆间骨折内固定术后应用唑来膦酸能明显升高患者骨密度,预防患者再次骨折的发生,值得临床推广。     

Long-term fracture risk among infertile women: a population-based cohort study

Nulliparity has been linked to bone loss and fractures, but the contribution of infertility is unclear. The purpose of this study was to assess the long-term risk of fractures among infertile women. In a population-based retrospective cohort study, all 658 Olmsted County, Minnesota, women with infertility (failure to conceive after 1 year despite intercourse without contraception) first diagnosed at Mayo Clinic in 1935-1964 were followed for fractures. Risk was assessed by comparing new fractures of each type to the number expected from sex-specific and age-specific fracture rates in the general population (standardized incidence ratios [SIR]). During 18,130 person-years of follow-up, 184 women experienced at least one fracture when 291 would have been expected on the basis of fracture incidence rates in the general population (SIR 0.6, 95% CI 0.5-0.7). There was no increase in proximal femur fractures (SIR 1.0, 95% CI 0.6-1.6) and a statistically significant decrease in the risk of distal forearm fractures (SIR 0.7, 95% CI 0.5-0.97), two of the three sites traditionally associated with osteoporosis. By contrast, there was a significant increase in subsequent vertebral fractures (SIR 1.9, 95% CI 1.4-2.4) that was consistent across divergent causes of infertility and reported menstrual patterns. Although an apparent increase in the risk of vertebral fractures requires further investigation, we saw no indication of an increase in limb fractures, suggesting that infertility does not have long-term adverse skeletal effects like those reported for athletes and dieters with irregular menses.     

Effectiveness of screening for osteoporosis by bone density measurement for the prevention of fractures: a review of the evidence

To review evidence on the benefits of screening women and men for osteoporosis, a Pub Med search was performed in English papers published between 1990 and 2002. We used data from a cohort study to estimate risk of fracture from bone mineral density. Bone mineral density measured by dual X-ray absorptiometry (DXA) can predict bone fracture among elderly women, peri- and early post-menopausal women, and elderly men. It is recommended that all white women older than 65 years be screened routinely for osteoporosis. We suggest that Japanese elderly women should receive BMD measurements as a screening, but we have still issues to be solved including age from when the screening should be started, methods, and how to treat the women found to have osteoporosis at the screening. For peri- and postmenopausal women and elderly men, it might be beneficial to measure BMD as a screening and start treatment for those patients found to have osteoporosis. However, incidence of fractures for these people is lower than that for elderly women. One bone mass measurement can predict bone fracture risk for as long as over 10 years or more, but predictive ability of BMD decreases with time. Therefore, cost effectiveness needs to be reviewed to determine the benefits of screening among peri-menopausal women and men. Although bone assessment by quantitative ultra sound (QUS) method by ultrasound can also predict future fractures, only a relatively small number of longitudinal studies have been conducted in the Western countries, and there is no established evidence by means of longitudinal studies among Japanese. It is necessary in Japan to seek such evidence, however, since this method is widely used for an osteoporosis examinations.     

探讨Z值诊断股骨近端骨质疏松的意义

目的探讨应用Z值（Z-score）诊断绝经前妇女和小于50岁男性股骨近端骨质疏松症（Osteoporosis,OP）的意义。方法在北京城区2744例正常人群中选择受检者,以股骨近端为测量点进行骨密度（Bone mineral density,BMD）测量观察在受试者中应用Z值对OP的诊断意义并与T值诊断OP的患病率比较。结果受试者应用Z值诊断OP患病率较应用T值诊断明显降低,但男性在50岁以后出现患病率加速趋势。结论应用Z值诊断绝经前妇女和小于50岁男性股骨近端OP可以避免过早的诊断OP,但其与骨折风险的相关性将有待于进一步研究。     

Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965-1983

Time trends from 1965 through 1983 for age-specific and age-standardized rates of first hospital admission for a proximal femur fracture were studied in the Uppsala Health Care Region, Sweden, using a centralized register for inpatient care. During the 19-year study period, 29,277 hospital admissions for a first hip fracture were recorded in this population of about 1.5 million persons. The total number of first hip fracture admissions per year increased for both sexes. Age-standardized admission rates for both cervical and trochanteric fractures increased in men (average change per year of 1.8% and 2.6%, respectively) in contrast to the decreased admission rate for cervical fractures (-1.6% per year) and a stable rate for trochanteric fractures (0.4% per year) in women. The cumulative rate of cervical or trochanteric fracture at ages 30-79 years increased 46% in men (from 42/1,000 population in 1965 to 61.5/1,000 population in 1983) in contrast to a 24% decrease in women (from 134/1,000 population in 1965 to 101.5/1,000 population in 1983). The female:male ratio of age-standardized incidence rates decreased for both types of fracture during the study period. This finding of stable or decreasing rates of hip fracture in women contrasts with the findings of most previous studies.