Bone Vol. 24, No.
3
Changing Incidence of Hip, Distal Radius, and Proximal
Humerus Fractures in Tottori Prefecture, Japan
H. HAGINO,1 K. YAMAMOTO,1 H. OHSHIRO,2 T. NAKAMURA,1 H. KISHIMOTO,1 and T. NOSE2
Departments of 1 Orthopedic Surgery and 2 Public Health, Tottori University, Yonago, Japan
A survey of all fractures in patients >35 years of age for hip,
distal radius, and proximal humerus was performed in Tot-
tori Prefecture, Japan. Hip fracture survey was done for the
years 1986 –1988, and also 1992–1994. A distal radius and
proximal humerus fracture survey was done for the years
1986 –1988, 1992, and 1995. The age- and gender-specific
incidence rates of these three types of fracture among Japa-
nese were substantially lower than those of whites living in
North America or northern Europe. The age-adjusted inci-
dence rates of hip fracture (per 100,000 person-years) were
40.7 and 114.1 in 1986 and 57.1 and 145.2 in 1994 for men
and women, respectively, showing a significant increase with
time for women. Upon examination of individual fracture
types, there was no significant increase in cervical fractures,
whereas a significant increase was observed in trochanteric
fractures for women. The age-adjusted incidence rates of
distal radius fractures for women were 164.9 in 1986 and
211.4 in 1995, showing a significant increase with time;
however, no increase was observed among men. Incidence of
proximal humerus fractures was 10.3 and 42.0 in 1986 and
17.1 and 47.9 in 1995 for men and women, respectively, and
these increases were significant for both genders. (Bone 24:
265–270; 1999) © 1999 by Elsevier Science Inc. All rights
reserved.
Key Words: Epidemiology; Hip fractures; Distal radius frac-
tures; Proximal humerus fractures; Incidence.
Introduction
The rapid increase in number of osteoporotic patients and
osteoporosis-related fractures presents a major health care
problem in many developed countries. Distal radius and prox-
imal humerus fractures, as well as hip fractures, are common
among elderly populations, being associated with osteoporo-
sis.39 We previously reported a study on the incidence rates of
hip and distal radius fracture in Tottori Prefecture, showing
that these rates were lower than in whites living in North
America or northern Europe.12,25
An increase in the age-specific incidence rates of hip fractures
has been reported during the last decade in many coun-
tries.6,20,28,31 In Asian countries, several studies concerning re-
Address for correspondence and reprints: Hiroshi Hagino, M.D., De-
partment of Orthopedic Surgery, Faculty of Medicine, Tottori University,
Yonago, Tottori 683-8504, Japan. E-mail: hagino@grape.med.tottori-
u.ac.jp
© 1999 by Elsevier Science Inc.
All rights reserved.
March 1999:265–270
cent trends in hip fracture have been performed, all showing an
increased incidence.14,21,29 Only a few surveys have examined
the changing incidence of distal radius and proximal humerus
fracture in European countries,4,5,15,20 and no results are avail-
able on the trends of incidence of these two types of fracture in
Asian countries.
Because the growth of the elderly population will be more
marked in Asia than in Europe and North America, large in-
creases in osteoporosis-related fractures are predicted in this
region.16 If such an increase in incidence of these fractures is
observed, we may expect the trend to continue and we will need
to plan accordingly.
The purposes of this investigation were to present the inci-
dence of hip and distal radius fractures during an extended
observation period, to clarify the incidence of proximal humerus
fractures, and to evaluate the recent trends in incidence of all
three types of fracture.
Patients and Methods
Data Collection
Tottori Prefecture is located in midwestern Japan. Its population
was 616,399 in 1986 and 614,929 in 1995. The percentage of the
total population aged $65 years was 14.1% in 1986 and 19.3%
in 1995.
A tally of all fractures in patients $35 years during 1986 –
1988 and 1992–1994 for hip, and 1986 –1988, 1992, and 1995
for distal radius and proximal humerus was conducted in all
hospitals and clinics in Tottori Prefecture. Some of these data
(1986 –1988 for hip fractures and 1986 –1987 for distal radius
fractures) have been reported previously,12,25 but the results were
reanalyzed for this study.
In this prefecture, there were 23, 23, 23, 27, 27, 27, and 27
hospitals that had a department of orthopedic surgery or general
surgery and 121, 121, 121, 124, 126, 126, and 126 clinics
operated by orthopedic surgeons or general surgeons that might
possibly treat patients with fractures, in 1986, 1987, 1988, 1992,
1993, 1994, and 1995, respectively. Patients presenting fractures
at all these hospitals, all mental hospitals, and all these clinics
were the subject of this survey.
Registration was performed each year by the doctors from
each hospital or clinic according to their hospital records. Com-
pletion of registration was confirmed by interviewing doctors or
making telephone calls. If the registration form could not be
completely filled by the staff of the hospitals or clinics, investi-
gators were sent from Tottori University to ascertain registrations
by reviewing the charts for fracture patients. All relevant cases in
the prefecture could thus be covered. Registration information
265 8756-3282/99/$20.00
PII S8756-3282(98)00175-6
266 H. Hagino et al. Bone Vol. 24, No. 3
Changing incidence of fractures in Tottori, Japan March 1999:265–270

Table 1. Age- and gender-specific incidence of hip fractures in Tottori Prefecture, Japan

Age 1986 1987 1988 1992 1993 1994

group
(yr) Men Women Men Women Men Women Men Women Men Women Men Women

35–39 7 (2) 0 (0) 4 (1) 0 (0) 8 (2) 0 (0) 0 (0) 5 (1) 0 (0) 0 (0) 5 (1) 0 (0)
40–44 5 (1) 0 (0) 15 (3) 0 (0) 18 (4) 5 (1) 19 (5) 0 (0) 0 (0) 0 (0) 8 (2) 9 (2)
45–49 5 (1) 0 (0) 0 (0) 0 (0) 11 (2) 10 (2) 15 (3) 5 (1) 5 (1) 5 (1) 9 (2) 9 (2)
50–54 30 (6) 18 (4) 10 (2) 5 (1) 16 (3) 19 (4) 6 (1) 26 (5) 17 (3) 5 (1) 21 (4) 0 (0)
55–59 30 (6) 26 (6) 20 (4) 18 (4) 30 (6) 27 (6) 37 (7) 28 (6) 38 (7) 33 (7) 17 (3) 50 (10)
60–64 18 (3) 48 (10) 40 (7) 61 (13) 49 (9) 46 (10) 52 (10) 68 (15) 36 (7) 45 (10) 63 (12) 41 (9)
65–69 62 (7) 95 (16) 17 (2) 63 (11) 76 (9) 72 (13) 93 (15) 135 (28) 77 (13) 100 (21) 63 (11) 89 (19)
70–74 102 (10) 199 (28) 151 (15) 182 (26) 141 (14) 192 (28) 89 (9) 201 (33) 107 (11) 135 (23) 107 (12) 255 (46)
75–79 169 (12) 486 (54) 152 (11) 483 (56) 203 (15) 454 (54) 251 (20) 482 (62) 212 (17) 479 (63) 244 (19) 479 (63)
80–84 106 (4) 571 (37) 307 (12) 751 (51) 245 (10) 947 (68) 326 (16) 1071 (99) 199 (10) 927 (89) 443 (23) 804 (80)
85– 537 (11) 1171 (54) 630 (14) 1071 (54) 700 (16) 1558 (83) 711 (19) 1707 (109) 561 (16) 1508 (104) 695 (21) 1875 (139)
Total (63) (209) (71) (216) (90) (269) (105) (359) (85) (319) (110) (370)

Data are the age- and gender-specific incidence rates per 100,000 person-years. Number of patients with fracture are given in parentheses.

included name, gender, age, place of residence, date of fracture,
type of fracture (for hip fractures), and treatment. Patients resid-
ing in other prefectures were excluded. Duplication of cases was
checked for by patient name and address.
Calculation of Incidence
The patients were divided into groups according to age, which
was subdivided into 5 year increments, gender, and fracture type.
The age- and gender-specific incidence rates (per 100,000 per-
son-years) were calculated based on the population of Tottori
Prefecture in each year. A national census was undertaken in
Japan on October 1, 1985, and again in 1990 and 1995. The age-
and gender-specific population for each survey year was esti-
mated by the Bureau of Statistics of the Tottori Prefecture
Government Office according to its resident registration records.
Hip fracture patients $85 years were subdivided into groups
(85– 89, 90 –94, and .94 years), and age- and gender-specific
incidence rates (per 100,000 person-years) during 1986 –1988
and 1992–1994 were calculated to determine the recent trend in
incidence among the aged population.
To compare the incidence in Tottori Prefecture with the data
from other geographic areas, the incidence rates, adjusted to the
population structure of 1995 in the whole of Japan, were calcu-
lated from the age- and gender-specific incidence rates reported
previously.
Hip Fracture
Number of patients. The survey found 2266 new hip fractures in
the total survey years (Table 1). The number of women patients
was more than three times the number of men. The right hip was
fractured in 1120 patients and left hip in 1146 patients. The total
number of fractured patients in each month during the observa-
tion period was highest in October (n 5 218) and lowest in July
(n 5 149), showing no seasonal trends (Figure 1).
Dividing by fracture types, 1336 were trochanteric fractures
and 896 were cervical fractures. There were 34 unclassified
fractures during the survey period.
Incidence. The age- and gender-specific incidence rates for
both genders increased exponentially with age after 70 years of
age (Table 1). Those for men were one third to one half of those
for women. The incidence between 1986 and 1994 increased
among patients $80 years for both genders. The incidence rates
in each year, age adjusted to the population structure of 1986,
showed a significant increase with time for women (Table 2).
The rate of increase in men between 1986 and 1994 was actually

Statistical Methods

A test of trends of proportions in quantitatively ordered samples

was used to analyze the changes of incidence.10 The incidence
rates, age-adjusted to the population structure of 1986 in Tottori
Prefecture ($35 years), were calculated from the age- and
gender-specific incidence rates in each observation year. The
overall chi-square values and slope were examined. The monthly
variation in the number of patients was tested by Friedman’s test.
p , 0.05 was considered significant.

Results

The registration covered 98% of all hospitals and clinics in 1986

and 100% in all other survey years. In one hospital and one clinic
registration was not performed in 1986; however, because frac- Figure 1. Monthly variation of patients with limb fractures. Each bar
tured patients were not usually treated in this hospital and clinic, indicates the total number of patients fractured in each month during the
this survey covered all patients with the subject fractures. survey period.
Bone Vol. 24, No. 3 H. Hagino et al. 267
March 1999:265–270 Changing incidence of fractures in Tottori, Japan

Table 2. Test of trends in incidence of fracture in Tottori Prefecture

Hip
All Cervical Trochanteric Distal radius Proximal humerus
Observation
(year) Men Women Men Women Men Women Men Women Men Women

1986 40.7 114.1 14.2 47.5 25.2 65.0 73.7 164.9 10.3 42.0
1987 44.3 112.3 16.2 47.2 28.0 63.6 46.3 152.4 13.3 31.7
1988 55.0 134.0 20.9 56.0 32.9 73.1 50.3 146.6 9.6 42.3
1992 56.4 153.5 22.6 62.7 33.3 87.3 57.1 184.0 25.4 52.9
1993 45.9 129.8 14.3 55.1 31.1 74.4
1994 57.1 145.2 21.0 59.7 36.1 85.2
1995 56.1 211.4 17.1 47.9

Overall x2
7.8 18.8 5.9 6.7 3.8 12.0 11.9 29.6 17.0 10.6
p n.s.a ,0.005 n.s. n.s. n.s. ,0.05 ,0.05 ,0.005 ,0.005 ,0.05
x2 slope — 11.2 — — — 8.5 0.3 24.0 7.8 5.2
p ,0.005 ,0.005 n.s. ,0.005 ,0.01 ,0.05

Data are incidences (per 100,000 person-years) age adjusted to the 1986 population of in Tottori Prefecture ($35 years) (population ages 35 and over
was 154,774 for men and 183,157 for women in 1986). Chi-square values (overall and slope) were examined by test of trends of proportions in
quantitatively ordered samples.
a
Not significant.

greater than that in women; however, this was not statistically
significant because of the smaller number of cases in men.
The age- and gender-specific incidence rates of trochanteric
fractures $85 years of age in both genders were about twice that
of cervical fractures and increased between the survey periods of
1986 –1988 and 1992–1994 among women (Figure 2). The
incidence rates in each year showed no significant increase in
cervical fractures between 1986 and 1994, whereas a significant
increase was observed in trochanteric fractures for women (Table
2).
The mean age- and gender-specific incidence rates at $85
years among women were 1179.2, 1448.8, and 1895.0 per
100,000 person-years in 1986 –1988, and 1632.8, 1771.7, and
2160.1 in 1992–1994 in the age groups 85– 89, 90 –94, and $95
years, respectively. Rates among men were 551.5, 768.6, and
1612.9 in 1986 –1988, and 572.6, 831.7, and 1197.9 in 1992–
1994 in the age groups 85– 89, 90 –94, and $95 years,
respectively.
Distal Radius Fractures
Number of patients. Two thousand one hundred forty-five new
distal radius fractures were registered in the total survey years
(Table 3). The numbers of women patients were 2.6 – 4.8 times
those for men. Nine hundred forty-two fractures occurred on the
right side and 1203 on the left side. The total number of patients
in each month was the highest in December (n 5 216) and lowest
in April (n 5 148); however, the seasonal trend was not statis-
tically significant (Figure 1).
Incidence. The age- and gender-specific incidence rates for
age 35– 44 years were higher in men than in women, and those
at $55 years were lower than in women. The incidence for
women increased after 50 years of age and leveled off after 70
years of age, despite the lack of rise in incidence related to age
for men (Table 3). The incidence rates in each year showed a
significant increase with time for women (Table 2).
Proximal Humerus Fractures
Number of patients. Five hundred seventy-nine new proximal
humerus fractures were registered in the total survey years
(Table 4). The numbers of female patients were 2.5–5.2 times
those of men. Two hundred sixty-three fractures occurred on the
right side and 316 on the left. The total number of fractures in

Figure 2. Age- and gender-specific incidence rates of cervical and trochanteric fractures. The age- and gender-specific incidence rates of trochanteric
fractures $85 years of age were about twice that of cervical fractures in both genders, and increased between the survey periods of 1986 –1988 and
1992–1994 among women.
268 H. Hagino et al. Bone Vol. 24, No. 3
Changing incidence of fractures in Tottori, Japan March 1999:265–270

Table 3. Age- and gender-specific incidence of distal radius fractures in Tottori Prefecture, Japan

1986 1987 1988 1992 1995

Age group
(yr) Men Women Men Women Men Women Men Women Men Women

35–39 44 (12) 27 (7) 34 (9) 23 (6) 56 (14) 29 (7) 43 (9) 5 (1) 41 (8) 10 (2)
40–44 86 (16) 16 (3) 60 (12) 31 (6) 27 (6) 14 (3) 49 (13) 16 (4) 26 (6) 45 (10)
45–49 60 (11) 71 (14) 38 (7) 87 (17) 49 (9) 51 (10) 41 (8) 73 (14) 48 (12) 29 (7)
50–54 114 (23) 104 (23) 51 (10) 115 (25) 42 (8) 179 (38) 45 (8) 119 (23) 69 (13) 179 (35)
55–59 59 (12) 238 (54) 44 (9) 240 (54) 69 (14) 192 (43) 68 (13) 220 (47) 75 (13) 318 (62)
60–64 80 (13) 279 (58) 63 (11) 220 (47) 33 (6) 212 (46) 94 (18) 271 (60) 43 (8) 332 (72)
65–69 80 (9) 279 (47) 78 (9) 240 (42) 34 (4) 211 (38) 75 (12) 299 (62) 57 (10) 340 (73)
70–74 92 (9) 220 (31) 30 (3) 154 (22) 60 (6) 254 (37) 99 (10) 407 (67) 57 (7) 364 (68)
75–79 99 (7) 333 (37) 41 (3) 276 (32) 95 (7) 235 (28) 13 (1) 365 (47) 138 (11) 334 (46)
80–84 53 (2) 293 (19) 0 (0) 280 (19) 73 (3) 264 (19) 41 (2) 368 (34) 57 (3) 380 (39)
85– 0 (0) 195 (9) 0 (0) 298 (15) 87 (2) 150 (8) 75 (2) 298 (19) 93 (3) 421 (33)

Total (114) (302) (73) (285) (79) (277) (96) (378) (94) (447)

Data are the age- and gender-specific incidence rates per 100,000 person-years. Number of patients with fracture are given in parentheses.

each month was highest in October (n 5 62) and lowest in June
(n 5 35), showing no seasonal trends (Figure 1).
Incidence. The age- and gender-specific incidence rates for
women increased linearly with age after 50 years of age (Table
4). Those for men peaked at $75 years of age; however, no
obvious correlation with age was observed because of the small
number of patients. The incidence rates in each year showed a
significant increase with time for both genders (Table 2).
Comparison With Other Geographic Areas
Compared with data previously reported from other geographic
areas, the incidence of hip fractures in Japan in 1992–1994 is
apparently lower than for whites living in northern Europe or
North America, for both genders (Table 5). However, the inci-
dence among whites in southern Europe is similar to that among
Japanese. The incidence rates for both distal radius and proximal
humerus in 1992 and 1995 were also lower than among whites in
northern Europe or North America.
Discussion
Because Tottori Prefecture faces the Sea of Japan and is sur-
rounded by mountains, all patients with fractures must be treated
at a hospital or a clinic within this prefecture. Its population is not
large, but is homogeneous, making this area of Japan appropriate
for an epidemiological study of osteoporotic fractures. Japanese
citizens are legally obliged to belong to one of several govern-
ment-subsidized health insurance programs. Thus, every patient
with an osteoporotic fracture is treated in either a hospital or a
clinic. These circumstances contribute to the validity of
the survey.
There have been several reports concerning the incidence of
hip fracture within Japan.9,29,36 These incidence rates were
similar to our results, assuming that the incidence of the other
two peripheral fractures in this study adequately represent the
Japanese population.
The incidence of hip fracture among Asian populations is
reported to be lower than for whites living in North America or
northern Europe.14,21,37 The present study provides additional
information that the incidence rates of distal radius and proximal
humerus fracture are lower in Japanese than in European or
North American whites; however, the patterns of increase in
incidence with age are similar in Japanese and whites. In con-
trast, the prevalence of vertebral fractures is reported to be higher
or the same in Japan as in the USA.35,41 These divergent findings
suggest that different risk factors probably influence peripheral
and vertebral fractures to some extent.34
Bone mineral density among Japanese is similar or lower than
in whites after adjusting for body size.17,27 Therefore, the dif-
ference in bone mass provides no explanation of the difference in

Table 4. Age- and gender-specific incidence of proximal humerus fractures in Tottori Prefecture, Japan

1986 1987 1988 1992 1995

Age group
(yr) Men Women Men Women Men Women Men Women Men Women

35–39 7 (2) 4 (1) 8 (2) 4 (1) 0 (0) 4 (1) 14 (3) 0 (0) 5 (1) 0 (0)
40–44 0 (0) 16 (3) 15 (3) 5 (1) 14 (3) 9 (2) 23 (6) 4 (1) 13 (3) 5 (1)
45–49 22 (4) 10 (2) 16 (3) 0 (0) 0 (0) 0 (0) 0 (0) 21 (4) 12 (3) 12 (3)
50–54 0 (0) 18 (4) 5 (1) 18 (4) 0 (0) 0 (0) 17 (3) 21 (4) 11 (2) 15 (3)
55–59 0 (0) 40 (9) 15 (3) 22 (5) 20 (4) 31 (7) 16 (3) 42 (9) 17 (3) 15 (3)
60–64 18 (3) 58 (12) 0 (0) 28 (6) 22 (4) 18 (4) 21 (4) 50 (11) 11 (2) 42 (9)
65–69 18 (2) 24 (4) 0 (0) 23 (4) 17 (2) 66 (12) 50 (8) 82 (17) 23 (4) 65 (14)
70–74 10 (1) 71 (10) 10 (1) 84 (12) 10 (1) 82 (12) 59 (6) 115 (19) 24 (3) 102 (19)
75–79 42 (3) 117 (13) 69 (5) 78 (9) 0 (0) 202 (24) 63 (5) 140 (18) 50 (4) 167 (23)
80–84 0 (0) 170 (11) 26 (1) 118 (8) 49 (2) 167 (12) 122 (6) 205 (19) 19 (1) 205 (21)
85– 49 (1) 173 (8) 90 (2) 179 (9) 0 (0) 169 (9) 37 (1) 188 (12) 186 (6) 255 (20)

Total (16) (77) (21) (59) (16) (83) (45) (114) (32) (116)

Data are the age- and gender-specific incidence rates per 100,000 person-years. Number of patients with fracture are given in parentheses.
Bone Vol. 24, No. 3 H. Hagino et al. 269
March 1999:265–270 Changing incidence of fractures in Tottori, Japan

Table 5. Comparison of fracture incidence in Tottori Prefecture with other geographic areas

Hip Distal forearm Proximal humerus

Geographic area (country) Men Women Men Women Men Women

Rochester, MN (USA) 147 33536 89 43830 54 16133

Stockholm (Sweden) 155 37913 148 67138
Malmö (Sweden) 173 40511 166 7664 91 2215
Dundee and Oxford (UK) 97 2736 73 33018 36 6318
Picardy (France) 68 1613
Siena (Italy) 28 1287
Hong Kong (China) 52 13614
Kuala Lumpur (Malaysia) 48 7221
Honam (Korea) 28 2537
Idaban (Nigeria) 1 11 2 21

Tottori (Japan) 54 155a 57 196b 21 52b

Data are incidences (per 100,000 person-years) adjusted to the population structure of 1995 in all of Japan ($35
years).
a
Average incidence in 1992–1994.
b
Years 1992 and 1995 applied.

incidence of limb fracture between Japanese and white subjects.
Although it remains uncertain why the incidence rates of limb
fractures in Japan are lower than for whites, there are several
hypotheses. The shorter hip axis length among Japanese might
explain the lower hip fracture risk;8,26 however, this holds true
only for hip fractures. The fact that the prevalence of falls among
Japanese is only a half that of whites offers a possible explana-
tion for the difference in incidence of these fractures.2 Recently,
it was reported that some traditional Japanese lifestyle charac-
teristics help to prevent hip fractures.40
Several studies have demonstrated seasonality in hip frac-
tures,19 whereas others contradict this assumption.32 In contrast,
seasonal variation in forearm fractures is supported by many
survey findings showing that freezing temperatures are associ-
ated with increased incidence.24,38 Tottori Prefecture experiences
snow in winter, and a slight increase in the number of patients
with distal radius fractures was observed in December, January,
and February, although this was not statistically significant.
We found that the increase with time in the incidence of hip
fractures was pronounced among the population members aged
$80 years. Although the population of older people is increasing
with time, the incidence in women $85 years of age showed an
observable increase with time for each age group, which indi-
cates that the observed increase in incidence is not due to the
growing elderly population.
The increase in age-specific incidence of hip fractures is a recent
worldwide trend, encompassing Asian countries,6,11,14,20,21,31 but
not the USA.23 Several studies have demonstrated that the increase
in incidence is greater for trochanteric fractures than for cervical
fractures,16,31 which is consistent with our observations. That tro-
chanteric fractures have a closer relationship with bone fragility than
do cervical fractures probably affected the trend.22 Bengnér and
Johnell4 compared the incidence of forearm fractures in Malmö,
Sweden, during 1980 –1981 with that in 1953–1957, concluding that
age-specific incidence had almost doubled. In contrast, Laurizen et
al.20 observed no significant changes in incidence of radial fractures
in Denmark. Concerning proximal humeral fractures, a few studies
have demonstrated an increase in age-specific incidence,5,16 but
another study showed no increase.20
The increase in risk factors of fractures, including decrease in
physical activity, is a possible explanation for the increase in
fracture incidence among Japanese. One important point in
explaining the increase in age-specific incidence is Japan’s
growing population of less healthy seniors. The lifespan of
Japanese men and women rose to 76.0 and 82.1, respectively, in
1990, which is the longest in the world. There might be a greater
proportion of seniors with poor health because of other treatment
conditions, with the result that people are living longer during a
time when their bones are considerably weakened.
Our study has several limitations. Data collection was per-
formed based on hospital records and the method of registration
was consistent during the observation period; however, there
may have been some reporting bias. The maximum difference in
observation period covers only a 10-year period, and the total
survey years are 6 years for hip fractures and 5 years for the other
two fracture types. A study of longer duration will be needed to
confirm the trends in incidence of these fractures.
Assuming no change in age- and gender-specific incidence,
the number of hip fractures in Japan has been projected to be
close to 180,000 in 2025, 2.5 times that in 1994, due to the
growing elderly population. The number of distal radius and
proximal humerus fractures has been estimated to be 124,000 and
45,000 in 2025, respectively. However, if incidence continues to
increase at the same rate as that observed over the 10 years
studied here, the number of patients may be double the afore-
mentioned estimates by 2025. Every effort must be made to
prevent these osteoporosis-related fractures.
We conclude that the incidence rates of hip, distal radius, and
proximal humerus fractures among Japanese are lower than those
among whites living in North America or northern Europe. An
increase in the incidence rates of these fractures is the trend in
Japan.
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Date Received: June 29, 1998
Date Revised: October 19, 1998
Date Accepted: November 11, 1998