title: Are there still east-to-west differences in the incidence of hip fractures in Germany?
abstract: There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population, and only to a small extent by the regulation of specific medication.
  
  
  BACKGROUND
  The most important complications and the major cost factors of osteoporosis are fractures. In order to develop strategies for fracture prevention, knowledge about different incidence rates and possible causes is necessary.
  
  
  METHODS
  In order to detect persistent differences in the incidence of hip fractures between the former eastern and western states of Germany, structured diagnostic data of patients hospitalized between 2000 and 2011 were used to determine the regional incidence of hip fractures in the individual federal states of Germany. To account for error due to repeated admissions and double registrations, the frequency of fractures was corrected by a factor of 0.89.
  
  
  RESULTS
  Our analysis of the 10-year period from 2000 to 2011 did not confirm the difference between eastern and western Germany reported in the national literature, or the north-south gradient for Germany as reported in several European publications. We found significant differences in the incidence of fractures in adjacent territorial states such as Schleswig-Holstein and Mecklenburg-Western Pomerania or Saxony and Thuringia. Particularly, high incidence rates over the entire period were noted in the city-states of Hamburg, Berlin, and Bremen.
  
  
  CONCLUSIONS
  The reason for such differences is still unclear and, thus, the consequences of urbanization must be considered to explain diverse incidence rates. In general, the investigation of causes should be based on the use of a multivariate model that takes additional factors such as specific drug use, socioeconomic aspects, environmental aspects, education, and health care into account. There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population and only to a small extent by the regulation of specific medication.
authors.affiliation: Medical Office, Großenhainer Strasse 129, 01129, Dresden, Germany, adefer@t-online.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Defèr
authors.forename: Hans-Christof
authors.initials: HC
authors.lastname: Schober
authors.forename: Werner
authors.initials: W
authors.lastname: Möhrke
authors.forename: Klaus
authors.initials: K
authors.lastname: Abendroth
authors.forename: Lorenz C
authors.initials: LC
authors.lastname: Hofbauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries