November 8. 2010 12:13

Interesting data with only a tangential mention of nourishment as a reason stated or hypothesized for the improvement.  The presumption under the radar is because of improved nutrition but might it be for increased weight bearing exercise in the more senior populations. Might it just be more people are drinking orange juice with calcium in it?

The posit that the most important "take-away" is that this trend was going on prior to or in spite of medications is not particularly interesting to me. The 'reason' for the trend would have been or even a supported theory would have been.

Another theory could be global warming.  Warmer temperatures means less snow and ice on your sidewalks resulting in fewer slips and falls resulting in hip fractures.  Just a theory but it has as much logic as anything else. While, if I were betting, I would presume the improvement trend would primarily be due to diet I don't see that argument here. What has happened in the diet of U.S. and Canadian citizens in the last twenty years that would result in the difference?

EJ Levy

November 8. 2010 12:46

Dear EJ,
there are probably a great many factors contributing to the decline, but the fad for adding calcium to sundry food products isn't likely to be one of them. Dr. Brown has noted in an earlier blog post that studies have shown that high calcium intake doesn't lower hip fracture risk -- in fact, it raises the risk! (see www.betterbones.com/blog/post/High-calcium-intake-does-not-prevent-bone-fractures.aspx).

We'd also hesitate to attribute the decline in hip fractures to climate change because while ice and snow may contribute to some falls, a great many people fall in situations where ice and snow aren't a factor. A wrinkled area rug or a wet bathroom floor are as likely, or more likely, to lead to falls (please see Susan's articles on fall prevention and impaired balance here www.betterbones.com/bonefracture/fractureprevention.aspx and here: www.betterbones.com/bonefracture/healthandsafety.aspx). Moreover, global climate change doesn't necessarily mean less opportunity for people to slip on ice -- depending on where you live, it might actually increase the exposure to slick conditions by promoting a melt-freeze cycle that means there's more slippery, hard ice and less deep snow (which actually cushions falls) for at-risk individuals to cope with.

The "why" behind the decrease is of interest to us as well, but so far there hasn't been much information about where the change comes from.

Managing Editor

November 8. 2010 13:51

You write:
"and scientists agree that this decline in fracture incidence is not due to use of osteoporosis medications."

Which scientists? What sources do you use for this bold-face, sweeping statement?

I'm not saying it's wrong, but I looked at the abstracts and did not see that conclusion, which would be extremely significant if it were scientifically verified. With all the misleading information put out by both pharmaceutical companies, and every alternative healer trying to sell their bone-building products, one has to be very careful these claims if one is to remain a credible source of information.

Please accept this as a suggestion rather than a criticism.

GB

November 8. 2010 21:16

GB put it into words better than I could have. It would be great to learn more about the sources for your bolded statement.

Sabine

November 10. 2010 10:57

Dear GB and Sabine, Thanks for your question on sources of the declining fracture rate statistics. First, let me say this trend was discussed by noted osteoporosis epidemiologist, Dr. Robert Melton, some time ago.  The major trend toward decline began long before the advent of bone drugs (see my previous blog www.betterbones.com/blog/post/US-hip-fracture-rates-on-the-decline.aspx).
In one of the articles I site above Dr. Leslie states that standardized  hip fractures rates have steadily declined in Canada since 1983 and that,"The decline began before the widespread availability of bone density testing for pharmacological treatments for osteoporosis..."  The Gehlbach study, also reported above, looks at more recent changes in fracture rates and suggesting that some might think the changes are due to bone drugs. They point out, however, that there were not enough people actually using the dugs to make their use the major thrust behind the decline.  Actually researchers in many parts of the world are scratching their heads trying to understand why hip fractures rates are declining in many highly industrialized areas.  Danish researchers addressed the question head on in an 2009 publication entitled, "Declining incidence of hip fractures and the extend of use of anti-osteoporosis therapy in Denmark 1997-2006".  Their conclusion was that, "The decrease in hip fractures is much too large to be explained by the extent of anti-osteoporotic medication."  Further, they also note (as others have when referring to other countries)that "...the decease in fracture rates also applied to men, despite much lower treatment rates."  Abrhamsen,B.and P.Vestergaard, Osteo. Internat. May 13, 2009, 10.1007/s00198-009-0957-3

Susan Brown