



@article {3263,
	title = {Age-period-cohort effects in the incidence of hip fractures: Political and economic events are coincident with changes in risk},
	journal = {Osteoporosis International},
	volume = {25},
	year = {2014},
	note = {Cited By (since 1996):1Export Date: 21 November 2014},
	month = {2014},
	pages = {711 - 720},
	abstract = {Summary: An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000-2008). Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect). Introduction: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000-2008. Methods: From the National Hospital Discharge Register, we selected admissions (aged >=49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age-period-cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results: There were 77,083 hospital admissions (77.4\% women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (increasing-decreasing only among women). Conclusions: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birthmay determine future risk for hip fractures. {\textcopyright} International Osteoporosis Foundation and National Osteoporosis Foundation 2013.},
	keywords = {Age-period-cohort, Hip fractures, Osteoporosis, Population-based study, Time trend},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84899095788\&partnerID=40\&md5=8a5587d6365266284e4fbc4e2be28e7d},
	author = {Alves, S.M. and Castiglione, D. and Oliveira, C.M. and de Sousa, B. and Pina, M.F.}
}
@article {2330,
	title = {Hip fractures cluster in space: An epidemiological analysis in Portugal},
	journal = {Osteoporosis InternationalOsteoporosis Int.},
	volume = {19},
	year = {2008},
	note = {Cited By (since 1996): 7Export Date: 21 November 2012Source: ScopusCODEN: OSINEdoi: 10.1007/s00198-008-0623-1PubMed ID: 18536955Language of Original Document: EnglishCorrespondence Address: De Pina, M. F.; Laborat{\'o}rio de Biomateriais, INEB - Instituto de Engenharia Biom{\'e}dica, Rua do Campo Alegre, 823, Porto 4150-180, Portugal; email: fpina@ineb.up.ptReferences: Center, J., Eisman, J., The epidemiology and pathogenesis of osteoporosis (1997) Baillieres Clin Endocrinol Metab, 11, pp. 23-62. , 1;Cooper, C., Melton III, L.J., Marcus, R., Feldman, D., Kelsey, J., Magnitude and Impact of osteoporosis and fractures (1996) Osteoporosis, pp. 419-434. , Academic Press San Diego; 
Walker-Bone, K., Dennison, E., Cooper, C., Epidemiology of osteoporosis (2001) Rheum Dis Clin North Am, 27, pp. 1-18. , 1; 
Cummings, S.R., Melton III, L.J., Epidemiology and outcomes of osteoporotic fractures (2002) Lancet, 359, pp. 1761-1767; 
Cooper, C., Campion, G., Melton, L.J., Hip fractures in the elderly: A world-wide projection (1992) Osteoporos Int, 2, pp. 285-289; 
Karagas, M.R., Lu-Yao, G.L., Barrett, J.A., Heterogeneity of hip fracture: Age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly (1996) Am J Epidemiol, 143, pp. 677-682. , 7; 
Jordan, K.M., Cooper, C., Epidemiology of osteoporosis (2002) Best Pract Res Clin Rheumatol, 16, pp. 795-806. , 5; 
Orimo, H., Hashimoto, T., Sakata, K., Trends in the incidence of hip fracture in Japan, 1987-1997: The third nationwide survey (2000) J Bone Miner Metab, 18, pp. 126-131; 
Kennedy, S., Goodchild, M., Gopal, S., The small number problem and the accuracy of spatial databases (1994) Accuracy of Spatial Databases, pp. 187-196. , Taylor and Francis London; 
(1995) Interactive Spatial Data Analysis, , Bailey TC, Gatrell AC (eds) Longman, London; 
Anselin, L., Local indicators of spatial association - LISA (1995) Geogr Anal, 27, pp. 93-115. , 2; 
Chevalley, T., Herrmann, F.R., Delmi, M., Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: The difference is not related to the prevalence of institutions for the elderly (2002) Osteoporos Int, 13, pp. 113-118; 
Sanders, K., Nicholson, G.C., Ugoni, A.M., Fracture rates lower in rural than urban communities: The Geelong Osteoporosis Study (2002) J Epidemiol Community Health, 56, pp. 466-470; 
Vaz, A.L., Epidemiology and costs of osteoporotic hip fractures in Portugal (1993) Bone, 14, p. 9. , Suppl 1; 
Lofthus, C.M., Osnes, E.K., Falch, J.A., Epidemiology of hip fractures in Oslo, Norway (2001) Bone, 29, pp. 413-418. , 5; 
Nydegger, V., Rizzoli, R., Rapin, C.H., Epidemiology of fractures of the proximal femur in Geneva: Incidence, clinical and social aspects (1991) Osteoporos Int, 2, pp. 42-47. , 1; 
Hernandez, J., Olmos, J.M., Alonso, M.A., Trend in hip fracture epidemiology over a 14-year period in a Spanish population (2006) Osteoporos Int, 17, pp. 464-470; 
Giversen, I.M., Time trends of age-adjusted incidence rates of first hip fractures: A register-based study among older people in Viborg County, Denmark, 1987-1997 (2006) Osteoporos Int, 17, pp. 552-564; 
Coster, A., Haberkamp, M., Allolio, B., Incidence of femoral neck fractures in the German Federal Republic in comparison to other countries (1994) Soz Praventivmed, 39, pp. 287-292. , 5; 
Paspati, I., Galanos, A., Lyritis, G.P., Hip fracture epidemiology in Greece during 1977-1992 (1998) Calcif Tissue Int, 62, pp. 542-547. , 6; 
Kannus, P., Niemi, S., Parkkari, J., Hip fractures in Finland between 1970 and 1997 and predictions for the future (1999) Lancet, 353, pp. 802-805. , 9155
},
	month = {2008///},
	pages = {1797 - 1804},
	abstract = {Summary: Using Portuguese hospital registers (2000-2002) we calculated age-standardized incidence rates of hip fractures. Spatial clusters of high incidence rates were found, with annual averages (per 100,000 inhabitants) varying from 154.4 to 572.2 and 77.3 to 231.5 for women and men, respectively. Geographic inequalities in the occurrence of hip fractures were also found. Introduction: The aim of this study was to identify spatial patterns in the incidence of hip fracture in Portugal during the period 2000 to 2002. Methods: From the National Hospital Discharge Register, admissions of patients (50 years of age or more) with low-energy hip fracture were selected. Age-standardized incidence rates in relation to the municipality of the patients{\textquoteright} place of residence were calculated. Empirical Bayes estimators were used to smooth the local risk and spatial statistics methods were used to identify spatial clusters. Results: Of 25,634 hip fractures in individuals aged 50 years or more caused by low or moderate impact, 19,759 occurred in women (age, mean{\textpm}SD, 80.6{\textpm}8.6 years) and 5,875 in men (age 77.7{\textpm}10.0 years). Incidence rates increased exponentially with age, being higher in women nation-wide (female to male ratio from 1.5 to 5.1). Significant geographic differences were found: the incidence rates (95\% CI) varied from 154.4 (153.6-155.3) to 572.2 (569.5-575.0) in women and 77.3 (76.64-78.05) to 231.5 (229.9-233.0) in men per 100,000 inhabitants. Spatial autocorrelation values (Moran index) were 0.56 and 0.45 for women and men, respectively. Conclusion: Spatial clusters (p<0.0001) of high incidences were identified. Geographic differences in incidence rates were about threefold. Some regions had incidence rates as high as some north European countries. The geographic inequalities could be due to environmental or socioeconomic factors, but further investigation needs to be done to confirm this hypothesis. {\textcopyright} 2008 International Osteoporosis Foundation and National Osteoporosis Foundation.},
	keywords = {adult, Age Distribution, aged, Aged, 80 and over, article, Bayes Theorem, Bone Density, Cluster Analysis, Databases, Factual, falling, Female, fracture, geographic information system, Geographic information systems, hip fracture, Hip fractures, human, Humans, incidence, international classification of diseases, major clinical study, male, Middle Aged, Osteoporosis, Portugal, priority journal, Risk Factors, sex difference, Sex Distribution, Space-Time Clustering, Spatial analysis, Spatial clusters, Spatial dependency},
	isbn = {0937941X (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-55049139569\&partnerID=40\&md5=b45540fcad776b6887f165463b053202},
	author = {De Pina, M.F. and Alves, S.M. and Barbosa, M. and Barros, H.}
}
@article {2380,
	title = {Epidemiology of femur fractures in Portugal},
	journal = {Epidemiologia das fracturas do f{\'e}mur em Portugal: Fracturas do colo do f{\'e}mur versus fracturas de outras localiza{\c c}{\~o}es n{\~a}o especificadas do f{\'e}murArquivos de MedicinaArq. Med.},
	volume = {21},
	year = {2007},
	note = {Export Date: 21 November 2012Source: ScopusCODEN: ARQMELanguage of Original Document: PortugueseCorrespondence Address: Alves, S.F.; Laborat{\'o}rio de Biomateriais, Instituto de Engenharia Biom{\'e}dica (INEB), Rua do Campo Alegre, 823, 4150-180 Porto, Portugal; email: smfalves@gmail.comReferences: Aroso-Dias, A., Epidemiologia da Osteoporose em Portugal: An{\'a}lise comparative com outros pa{\'\i}ses. (2000) Acta Reumatol Port, 97, pp. 21-31;De Laet, C.E.D.H., Pols, H.A.P., Fractures in the elderly: Epidemiology and demography (2000) Baillieres Clin Endocrinol Metab, 14, pp. 171-179; 
Eisman, J., The epidemiology and pathogenesis of osteoporosis (1997) Baillieres Clin Endocrinol Metab, 11, pp. 23-62. , Center J; 
Dennison, E., Cooper, C., Epidemiology of Osteoporotic Fractures (2000) Horm Res, 54, pp. 58-63; 
Amin, S., Felson, D.T., Osteoporosis in Men (2001) Rheum Dis Clin North Am, 27, pp. 19-47; 
Jordan, K.M., Cooper, C., Epidemiology of osteoporosis (2002) Best Pract Res Clin Rheumatol, 16, pp. 795-806; 
Kanis, J.A., Diagnosis of osteoporosis and assessment of fracture risk (2002) Lancet North Am Ed, 59, pp. 1929-1936; 
Cooper, C., Melton III, L.J., Magnitude and Impact of Osteoporosis and Fractures (1996) Osteoporosis, pp. 419-434. , Marcus R, Feldman D, Kelsey J, editors, Academic Press, San Diego;; 
Trombetti, A., Herrmann, F., Hoffmeyer, P., Schurch, M.A., Bonjour, J.P., Rizzoli, R., Survival and potential years of life lost after hip fracture in men and age-matched women (2002) Osteoporos Int, 13, pp. 731-737; 
O{\textquoteright}Neill, T.W., Roy, D.K., The epidemiology and scale of the problem (2003) Hosp Med, 64, pp. 517-520; 
Cummings, S.R., Melton III, L.J., Epidemiology and outcomes of osteoporotic fractures (2002) Lancet, 359, pp. 1761-1767; 
www.ine.pt, Instituto Nacional de EstatisticaWalker-Bone, K., Dennison, E., Cooper, C., Epidemiology of Osteoporosis (2001) Rheum Dis Clin North Am, 27, pp. 1-18; 
Gold, D.T., The Nonskeletal Consequences of Osteoporotic Fractures - Psycologic and Social Outcomes (2001) Rheum Dis Clin North Am, 27, pp. 255-262
},
	month = {2007///},
	pages = {77 - 81+127},
	abstract = {Fractures related to osteoporosis have been increasing in many countries. Femoral neck fractures have been widely studied, however little is known about other femur fractures and its relationship with osteoporosis. The main objective of this study is the comparison between the incidence of neck fractures attributed to osteoporosis with the ones that occurs in other places of femur other than the neck, in the same conditions. It was used a national database, under the regulation of a governmental institute, with registers from 2000 to 2002. From the total number of femural fractures the authors selected the registers corresponding to individuals with more than fifty years of age and due to low impact, it were analysed separately the femoral neck fractures (International Classification of Diseases codes, 9                        th Revision, Clinical Modification, ICD9-CM codes 820 and derivates) from the fractures that occurred in other locations in the femur (ICD9-CM codes 821 and derivates). Case fatality rates and the incidence rates were calculated for that period of time, and an analysis of the variables age, days and costs of hospital admission as well as of the variable destination after discharge. Only 7.6\% of the femural fractures were coded as 821.x, all the others were coded as 820.x. In both groups the fractures were more frequent in women (above 75\%) and showed an exponential increase with age. The costs were higher in the 820.x fractures which also presented higher case fatality rates. {\textcopyright}ArquiMed, 2007.
},
	keywords = {adult, aged, article, Female, femur, femur fracture, fracture, hip fracture, human, incidence, Low impact, male, Osteoporosis, outcome assessment, Portugal, risk assessment, survival},
	isbn = {08713413 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-38949187951\&partnerID=40\&md5=bb28b6850d1e7d2f67a7f0c9be4c8ff9},
	author = {Alves, S.F. and Pina, M.D.F. and Barbosa, M.}
}
