International variations in hip fracture risk have displayed a north–south gradient [6] which has been linked to the importance of sunlight exposure [22]. A study using national data from France showed substantial GS-7977 in vitro heterogeneity of hip fracture risk within the country, with higher hip fracture risk in the Southern France [23]. Other studies reporting regional differences in hip fracture rates within countries explain the differences by an urban–rural gradient [24]. In a study from Australia, the age-adjusted

incidence of hip fracture was 32% Fosbretabulin mw lower in rural compared to urban residents aged 60 years and above, 26% lower in women [25]. In comparison, the age-adjusted rates in women aged 65 years and above were 21% lower in Harstad than in the more urbanized capitol Oslo [8]. Unfortunately, with the registry data available, we do not have explanation for the indicated urban–rural difference, but another Norwegian study reported higher bone mineral density levels in rural versus urban dwellers at the hip [26], one factor which may explain differences in fracture risk. In a study by Ringsberg et al. [27], urban subjects had significantly poorer balance

compared with their rural counterparts, a difference which increased with increasing age, affected gait performance and buy GDC 0032 risk of falls. With an extensive prevention program running in Harstad between 1988 and 1993 [18, 19] and part of this program still integrated in the community health service, this may also explain the differences in fracture rates between Harstad and Oslo. It could furthermore be expected Bumetanide that the extensive prevention program might have resulted in lower fracture rates especially in the first years after 1994. However, comparison of the two periods, 1994–1996 and 2006–2008, indicated no significant change in the age-adjusted incidence rates in any of the sexes during the time of the study. Interestingly, this stability of age-adjusted incidence rates is in accordance

with data from Oslo [8] and reports from several other countries including Finland, Denmark, Norway, Switzerland, Canada, US and Australia [10, 12–15, 28]. There are studies reporting increasing numbers of hip fracture rates in women and men in Germany and Austria [29, 30], in men in Switzerland [28], in the oldest age groups in Swedish [31] and Swiss [32] women. Conflicting results are also reported within countries where, for example, a recent paper from the Australian Capital Territory reported significant declining hip fracture rates after 2001 in women [13], while other data from Australia indicate no change in incidence [33]. The Australian report suggests that the declining hip fracture rates may be explained by increased use of anti-osteoporotic treatments [13].