Skip to main content

Advertisement

Log in

Osteoporotic hip fractures in Black South Africans: a regional study

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Osteoporotic hip fractures are thought to be rare in Blacks however, this study from South Africa shows a significant increase in the number of hip fracture in Blacks. With the expected increase in older people, osteoporotic fractures will pose a major health problem and screening guidelines needed to be implemented.

Introduction

Developing countries are predicted to bear the burden of osteoporosis in the coming decades. This study was undertaken to review earlier reports that osteoporotic hip fractures are rare in Black Africans.

Methods

In an observational study, the incidence rates and relative risk ratios (RRR) of osteoporotic hip fractures were calculated in the Black population, aged 60 years and older, residing in the eThekwini region of South Africa. All Black subjects, presenting with a minimal trauma hip fracture to five public hospitals in the region, entered the study. Descriptive statistics were applied to show differences in age and sex.

Results

Eighty-seven subjects were enrolled in the study with a mean age of 76.5 ± 10.5 years and the sex ratio of women to men was 2.5:1. Although men were younger than women, this was not significant (74.2 ± 12.3 vs. 77.4 ± 9.6 years, p = 0.189). The age-adjusted rate was 69.2 per 100,000 p.a. for women and 73.1 per 100,000 p.a. for men. There was a significant increase in the relative risk ratios for hip fractures after the age of 75 years in the total cohort and in women and men. Except for the 65–69-year age group, there was no significant difference in the age-adjusted RRR between women and men.

Conclusion

This study represents the largest number of hip fractures recorded in Black Africans. Although the incidence rate is approximately tenfold higher than previously recorded, it remains amongst the lowest globally. A national registry inclusive of private and public sector is required to establish the true incidence rate of hip fractures in Black Africans.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fuleihan G. The Middle East and Africa Audit (2011) International Osteoporosis Foundation. Available online at https://www.aub.edu.lb/fm/cmop/downloads/ME_audit-e.pdf. Accessed 14 June 2016

  2. Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413. https://doi.org/10.1007/PL00004148

    Article  CAS  PubMed  Google Scholar 

  3. Kanis JA, Oden A, McCloskey EV et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. https://doi.org/10.1007/s00198-012-1964-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Solomon L (1968) Osteoporosis and fracture of the femoral neck in South African Bantu Blacks. J Bone Joint Surg 36(50B):2–1

    Google Scholar 

  5. Solomon L (1979) Bone density in ageing Caucasians and African populations. Lancet 2(8156–8157):1326–1330

    Article  CAS  PubMed  Google Scholar 

  6. Adebajo AO, Cooper C, Evans JG (1991) Fractures of the hip and distal forearm in West Africa and the United Kingdom. Age Ageing 20(6):435–438. https://doi.org/10.1093/ageing/20.6.435

    Article  CAS  PubMed  Google Scholar 

  7. Asprey TJ, Prentice A, Cole TJ et al (1996) Low bone mineral content is common but osteoporotic fractures are rare in elderly rural Gambian women. J Bone Miner Res 11(7):1019–1025

    Article  Google Scholar 

  8. Zebaze RMD, Seeman E (2003) Epidemiology of hip and wrist fractures in Cameroon. Africa Osteoporos Int 14(4):301–305. https://doi.org/10.1007/s00198-002-1356-1

    Article  PubMed  Google Scholar 

  9. Maalouf G, Gannag’e-Yared MH, Ezzedine J et al (2007) Middle East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact 7(2):131–143

    CAS  PubMed  Google Scholar 

  10. El Maghraoui A, Ngbanda AR, Bensaoud N, Bensaoud M, Rezqi A, Tazi MA (2013) Age-adjusted incidence rates of hip fractures between 2006 and 2009 in Rabat. Morocco Osteoporos Int 24(4):1267–1273. https://doi.org/10.1007/s00198-012-2061-3

    Article  PubMed  Google Scholar 

  11. El Maghraoui A, Loumba BA, Jroundi I et al (2005) Epidemiology of hip fractures in 2002 in Rabat. Morocco Osteoporos Int 16(6):597–602. https://doi.org/10.1007/s00198-004-1729-8

    Article  PubMed  Google Scholar 

  12. Jervas E, Onwukamuche CK, Anyanwu GE, Ugochukwu AI (2011) Incidence of fall related hip fractures among the elderly persons in Owerri, Nigeria. Asian J Med Sci 3(3):110–114

    Google Scholar 

  13. Basu D (2010) Determination of bone mass and prevalence of vertebral deformities in postmenopausal black women in South Africa. PhD dissertation, University of the Witwatersrand, South Africa. University of the Witwatersrand, South Africa

  14. Conradie M, Conradie MM, Kidd M, Hough S (2014) Bone density in black and white South African women: contribution of ethnicity, body weight and lifestyle. Arch Osteoporos 9(1):193. https://doi.org/10.1007/s11657-014-0193-0

    Article  PubMed  Google Scholar 

  15. Conradie M (2008) A comparative study of known determinants of bone strength in black and white South African females, in Division of Endocrinology and Metabolism, PhD dissertation, Tygerberg Academic Hospital. University of Stellenbosch

  16. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fractures in white women. Study of osteoporotic fractures research group. N Engl J Med 332(12):767–773. https://doi.org/10.1056/NEJM199503233321202

    Article  CAS  PubMed  Google Scholar 

  17. Statistics South Africa, General Household Survey 2007–2008. Available online at www.gov.za/documents/download.php. Accessed 10 May 2017

  18. Statistics South Africa (2008) Available online at https://statssa.gov/za/publications/P03011/p03011007.pdf, 2008. Accessed 10 May 2017

  19. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289. https://doi.org/10.1007/BF01623184

    Article  CAS  PubMed  Google Scholar 

  20. World Health statistics, Life expectancy at birth (years) 2000–2015, Global health Organization. Available online at www.who.int/gho/mortality_burden_disease/life_tables/en. Accessed 10 May 2017

  21. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2010 Revision. 2012: New York Available online at https://esa.un.org/unpd/wpp/publications/Files/WPP2012_HIGHLIGHTS.pdf. Accessed at 17 June 2016

  22. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M (1996) Epidemiology of hip fractures. Bone 18(1):S57–S63. https://doi.org/10.1016/8756-3282(95)00381-9

    Article  Google Scholar 

  23. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(2):S3–S7. https://doi.org/10.1007/s00198-004-1702-6

    Article  PubMed  Google Scholar 

  24. Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C (2013) Incidence of hip fracture in Rohtak district. North India Arch Osteoporos 8(1–2):135. https://doi.org/10.1007/s11657-013-0135-2

    Article  CAS  PubMed  Google Scholar 

  25. Clark P, Lavielle P, Franco-Marina F et al (2005) Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study. Osteoporos Int 12:2025–2203

    Article  Google Scholar 

  26. Hannan MT, Felson DT, Dawson-Hughes B et al (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis study. JBMR 15(4):710–720

    Article  CAS  Google Scholar 

  27. Cooper C, Melton LJ 3rd (1992) Epidemiology of osteoporosis. Trends Endocrinol Metab 3(6):224–229. https://doi.org/10.1016/1043-2760(92)90032-V

    Article  CAS  PubMed  Google Scholar 

  28. Sterling RS (2011) Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clin Orthop Relat Res 469(7):1913–1918. https://doi.org/10.1007/s11999-010-1736-3

    Article  PubMed  Google Scholar 

  29. William G, Hawkes WG, Wehren L et al (2006) Gender differences in functioning after hip fracture. J Gerontol A Biol Sci Med Sci 61(5):495–499

    Article  Google Scholar 

  30. Becker C, Crow S, Toman J, Lipton C, McMahon DJ, Macaulay W, Siris E (2006) Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17(3):410–416. https://doi.org/10.1007/s00198-005-0001-1

    Article  PubMed  Google Scholar 

  31. Löfman O, Berglund K, Larsson L, Toss G (2002) Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int 13(1):18–25. https://doi.org/10.1007/s198-002-8333-x

    Article  PubMed  Google Scholar 

  32. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. https://doi.org/10.1007/s00198-006-0172-4

    Article  CAS  PubMed  Google Scholar 

  33. South African History Online. Pass laws in South Africa 1800–1994. (2000) Available online at: www.sahistory.org.za › History of Women's struggle in South Africa. Accessed at 17 June 2016

  34. Peer N, Lombard C, Steyn K, Levitt N (2014) Rising alcohol consumption and a high prevalence of problem drinking in black men and women in Cape Town: the CRIBSA study. J Epidemiol Community Health 68(5):446–452. https://doi.org/10.1136/jech-2013-202985

    Article  PubMed  Google Scholar 

  35. Lau EM, Lee JK, Suriwong P et al (2001) The incidence of hip fractures in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12(3):239–243. https://doi.org/10.1007/s001980170135

    Article  CAS  PubMed  Google Scholar 

  36. Jha RM, Mithai A, Malhotra N, Brown EM (2010) Pilot case-control investigation of risk factors for hip fractures in the urban Indian population. BMC Musculoskelet Disord 11:49. https://doi.org/10.1186/1471-2474-11-49

  37. Arakaki H, Owan I, Kudoh H, Horizono H, Arakaki K, Ikema Y, Shinjo H, Hayashi K, Kanaya F (2011) Epidemiology of hip fractures in Okinawa, Japan. J Bone Miner Metab 29(3):309–314. https://doi.org/10.1007/s00774-010-0218-8

    Article  PubMed  Google Scholar 

  38. Filip RS, Zagorski J (2005) Osteoporosis risk factors in rural and urban women from the Lublin region of Poland. Ann Agric Environ Med 12(1):21–26

    PubMed  Google Scholar 

  39. Finsen V, Benum P (1987) Changing incidence of hip fracture in rural and urban areas of central Norway. Clin Orthop Relat Res 218:104–110

    Google Scholar 

  40. Madhok R, Melton LJ, Atkinson EJ, O'Fallon WM, Lewallen DG (1993) Urban vs rural increase in hip fracture incidence: age and sex of 901 cases 1980-89 in Olmsted County, USA. Acta Orthop Scand 64(5):543–548. https://doi.org/10.3109/17453679308993689

    Article  CAS  PubMed  Google Scholar 

  41. Jonsson B, Gardsell P, Johnell O et al (1992) Differences in fracture pattern between an urban and a rural population of comparative population-based study in southern Sweden. Osteoporos Int 2(6):269–273. https://doi.org/10.1007/BF01623181

    Article  CAS  PubMed  Google Scholar 

  42. Chevalley T, Herrmann FR, Delmi M et al (2002) Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int 13(2):113–118. https://doi.org/10.1007/s001980200002

    Article  CAS  PubMed  Google Scholar 

  43. Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna FS, Wluka AE (2009) The association between urban or rural locality and hip fracture in community-based adults: a systematic review. J Epidemiol Community Health 64(8):656–665. https://doi.org/10.1136/jech.2008.085738

    Article  PubMed  Google Scholar 

  44. Statistics South Africa. General household survey in P0318 General household survey (2014) Pretoria. Available at https://www.datafirst.uct.ac.za/dataportal/index.php/catalog/526/download/7309. Accessed 19 May 2016

  45. Hough FS, Ascott-Evans BH, Brown SL et al (2010) NOFSA guideline for the diagnosis and management of osteoporosis. JEMDSA 15(3):Supple 2

    Google Scholar 

Download references

Funding

This study was funded by an unrestricted educational grant from Servier® and the University of Kwa-Zulu Natal.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Paruk.

Ethics declarations

Ethical approval for the study was granted by the Biomedical Research Ethics Committee of University of KwaZulu-Natal (KZN), and study approval was obtained from the KZN Provincial Department of Health and from all the hospitals involved in the study. The study was conducted according to the ethical guidelines and principles of the International Declaration of Helsinki and South African Guidelines for Good Clinical Practice.

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paruk, F., Matthews, G. & Cassim, B. Osteoporotic hip fractures in Black South Africans: a regional study. Arch Osteoporos 12, 107 (2017). https://doi.org/10.1007/s11657-017-0409-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-017-0409-1

Keywords

Navigation