For Argentina, China, Iran, Malaysia, Morocco, Norway, Poland, Sweden, Thailand and the UK, we used a single regional estimate but in each instance a review of alternate sources showed that the estimate we chose did not substantially differ from alternate estimates. Sources of information are given in Table 3 of the Appendix. Data analysis Incidence (rates/100,000) was assembled by age and by sex. Where possible, 5-year age categories were used. Where
5-year age intervals were not available, 10-year intervals were used (intervals of greater than 10 years were an exclusion criterion). For each country, age- and sex-specific rates were used to compute age-adjusted incidence of hip fracture in men, women and men and women combined adjusted to the world population. UN data were used for population demography in 5-year groups for the year 2010 [29]. In the case find more of Singapore
and USA, hip fracture rates were available by ethnic origin. For the purposes of this study, population-weighted means were used and applied to the total population on the recommendation of the Working Group of the IOF Committee of Scientific Advisors. For Israel, incidence was available by race in a single study and a population-weighted mean was used [30]. A total of 72 studies from 63 countries were selected for the calculation of standardised incidence. Details of each study are given in Table 3 of the Appendix. Probability estimates For those countries where a FRAX model was available, we computed the 10-year probability selleck compound Casein kinase 1 of a major Selleck GSK2245840 osteoporotic fracture (hip, clinical vertebral, forearm or humeral fracture) using version 3.5 of FRAX (http://www.shef.ac.uk/FRAX/). Since FRAX provides individual rather than population-based probabilities, we chose the clinical scenario of an individual aged 65 years with a prior fragility fracture (and no other clinical risk factors) at the threshold of osteoporosis as judged by BMD at the femoral neck (i.e. a T-score of −2.5 SD). The body mass index was set at 24 kg/m2. Estimates were made for men and women. Note that the T-score in men is calculated using the same reference range as
that used in women. As of November 2011, 45 FRAX calculators were available for the 40 countries listed in Table 1. Note that five models (flagged in Table 1) were not yet published at the cut-off date but were released online at the beginning of 2012. One of these was a surrogate model (Sri Lanka) derived from the fracture hazard of expatriate Indians living in Singapore and the death hazard for Sri Lanka. The models for Belgium, Czech Republic, Lebanon and Italy were updated with improved or more recent epidemiology and were also released online at the start of 2012. For USA and Singapore, fracture probabilities were available by ethnic origin. For the purposes of this study, means were used weighted by population size in addition to ethnic-specific probabilities.