The 10-year probability of a ‘major osteoporotic fracture’ (hip, clinical spine, forearm and humerus) varied markedly in the different countries. As in the case of Pictilisib price hip fracture incidence, there was a greater than 10-fold range in fracture probability. There was some, though not complete, concordance between FRAX-based probabilities and hip fracture incidence reflecting, in part, the effect of the Wortmannin mw heterogeneity of mortality in different regions [3, 14]. Although probability estimates were lower in men than in women, the difference was

modest (lower by 23%) compared to the twofold difference in age-standardised hip fracture risk. The closer approximation between sexes for the probability estimate arises because the risk of hip and other osteoporotic fractures is more or less identical in men and women of the same age and femoral

neck BMD [33–35]. The clinical scenario chosen incorporated a BMD (as well as a prior fragility fracture). The somewhat higher probability estimates in women reflects mainly the lower death risk in women compared with men. There are many well-recognised limitations in this type of analysis, particularly for register studies that include selection bias, the over identification of cases (double counting), inaccurate LY333531 nmr reporting or coding of fractures and errors in the denominator catchment population, particularly in regional rather than national studies. The question arises to what extent might heterogeneity of risk be accounted for by these artefacts. Several considerations suggest that these errors, though significant, have a minor effect in explaining the heterogeneity in a worldwide perspective. For example, a large prospective study undertaken

in 14 regions in six different countries in Europe using standardised methodology demonstrated variability in hip fracture incidence of the same magnitude as that reported in the present study [9]. Analysis of the potential errors of any Fossariinae one estimate was ±10%, which pales into insignificance against the 1,000% differences in fracture risk. This study was a regional study but national register studies in Europe have shown similar findings [31]. Another limitation is the assumption that regional estimates of hip fracture risk are representative of the country in question. In addition to large variations in fracture rates around the world, fracture rates may vary within countries. In addition to ethnic-specific differences [3, 12, 13, 30], up to twofold differences in hip fracture incidence have been reported using common methodology with higher rates in urban communities than rural areas in Argentina [36], Turkey [9], Sweden [37], Norway [38–40], Switzerland [41], Croatia [23] and in USA [42, 43]. The concern is perhaps less where several regional estimates have been used. In the present study, the majority of studies chosen (60%) were national rather than regional estimates.