e. a T-score of −2.5 SD). Probability in different countries is categorised as high (red, >15%), moderate (orange, 10–15%) and low (green, <10%) Fig. 8 Ten-year probability of a major osteoporotic fracture for a woman aged 65 years with a prior fragility fracture (and no other clinical risk factors) Go6983 cell line at the threshold of osteoporosis as judged by BMD at the femoral neck (i.e. a T-score

of −2.5 SD). Probability in different countries is categorised as high (red, >15%), moderate (orange, 10–15%) and low (green, <10%) The general pattern of fracture probability in women was similar to that in men (Fig. 8). Discordances in classification were relatively few. Five countries coded as low risk in men were at intermediate risk for women (Poland, New Zealand, Romania, France and Turkey). Seven countries coded as moderate risk in men were coded at high risk in women (Japan, Belgium, Singapore, Canada, Malta, UK and Slovakia). Discussion The principal finding of the present study is that there is a remarkable variation in the risk of hip fracture worldwide. Age-standardised rates varied approximately 10-fold in both men and women. The difference in incidence between countries was much greater than the differences in incidence between sexes within a country. These findings confirm

conclusions derived from earlier work [5–10, 31] but extend AZD6738 cell line the information base considerably. Whereas a recently published structured review provided information on 32 countries [5], the present systematic review identified 62 countries for which hip fracture rates were available.

Adenosine triphosphate The greater capture of information provides a more detailed map on which to place ecological patterns. In the case of age- and 4SC-202 chemical structure sex-standardised rates for example (see Fig. 5), there appears to be a crescent of high-risk countries beginning in Northern Europe (Iceland, Ireland, Norway and Sweden) that runs through middle Europe (Denmark Belgium, Germany, Switzerland and Austria) and then extends south-eastwards through eastern Europe (Hungary, Czech Republic and Slovakia) and beyond (Oman and Iran). Other high-risk countries (Malta, Argentina and Taiwan) escape this pattern. Hypotheses to explain the heterogeneity in risk will need to take these patterns into account. The present study also reports the heterogeneity in fracture probability for 45 countries and/or ethnic groups with a FRAX model available. Probability is computed from the hazards of death and fracture and differs fundamentally from incidence—a point often unrecognised [32]. FRAX computes probabilities for individuals and not (normally) for a nation so that, for the expression of fracture probability, we chose a clinical scenario of an individual with a prior fragility fracture and a femoral neck T-score for BMD of −2.5 SD. The choice of scenario is somewhat arbitrary but of clinical relevance.