Hip fractures: Predictors, incidence and survival

NOREPOS: The Norwegian Epidemiologic Osteoporosis Studies


The overall research question posed is why Norway has among the highest incidences of hip fractures in the world. To contribute to the answer we will:
1) assess the incidence of, and mortality after, hip fracture in the Norwegian population 1994-2007 with special focus on geographic differences, seasonal variations, socioeconomic differences and time trends;
2) assess whether drinking water is related to osteoporosis and hip fracture. Specific factors in drinking water include a) calcium, magnesium, water hardness, acidity, and alkalinity; b) aluminium, cadmium, lead, and fluoride; and c) content of E.coli and coli form bacteria (as approximations of inflammation);
3) prospectively investigate the impact of the combination of vitamins D and A status on the risk of hip fracture in a population-based multi-centre cohort of men and women residing in different districts of Norway, with special emphasis on exploring any possible interaction between the two vitamins.


Although Norway has among the highest incidences of hip fractures in the world, the true figures are not known, nor are the causes. Osteoporotic fractures bring about much pain, suffering and reduced quality of life for the patients, and the economic consequences are very high. A linkage will be established with hip fractures, deaths, socioeconomic factors and water quality from the whole Norwegian population 1994-2007. The linkage will also include COhort NORway, with information about risk factors (including stored biologic samples) from >181,000 participants, and >47,000 bone mineral density measures (NOREPOS), some of the largest cohort studies in the world.
Our first and fundamental objective is to describe the incidence and mortality of hip fractures 1994-2007.
Thereafter, we seek to explain some of the variation in hip fracture risk by environmental and lifestyle factors. There are indications that water quality, through its variable content of minerals and bacteria, could affect the risk for hip fracture. The investigation of this novel hypothesis is made possible through data from the Norwegian Registry of Waterworks. Second, there are indications that vitamin A (whose intake in Norway is generally high) affects the relation between vitamin D and skeletal health negatively. A nested case-control study using stored sera will examine whether a high intake of Vitamin A increases the risk of fractures. No previous studies, and no other research groups, have had the opportunity to investigate important and novel public health determinants of hip fractures on such a large scale. The linkages between exposure and outcome data give us an international advantage. Results will give directions for future research and for preventive strategies. The research will be conducted by NOREPOS, a ten-year old unique interdisciplinary research network including all the university medical faculties in the country, in addition to the Norwegian Institute of Public Health.

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