Hip fractures: a worldwide problem today and tomorrow.

Hip fractures lead to excess deaths and substantial disability. Most are related both to falls and to osteoporosis, which affects one in four post-menopausal white women, but a lesser number of men or women of other races. Consequently, about half of the 1.66 million hip fractures worldwide in 1990 occurred in Europe and North America. Even within these regions, however, there is substantial variation in hip fracture incidence rates, which suggests the existence of important environmental factors that could be manipulated to reduce hip fracture occurrence. This is important because in the United States alone, a quarter of a million hip fractures annually cost over $8 billion, mostly for acute medical care and nursing home services. Future costs will be even greater because populations are ageing rapidly around the world and because hip fracture incidence rates are rising in some regions. The number of elderly is increasing most rapidly in Asia, Latin America, the Middle East, and Africa, and these regions will account for over 70% of the 6.26 million hip fractures expected in the year 2050. Because fracture treatment is expensive, and rehabilitation not always successful, effective prophylaxis offers the only hope of alleviating the enormous social burden of hip fractures.