These vastly larger numbers suggest that the revised estimates will be much more reliable, especially among younger men and women. The 2006

NIS rates for the oldest age group are somewhat greater than the Olmsted County figures, but this likely reflects a shift to older average ages within the 85+ age group due to secular demographic changes in the underlying population [26]. Finally, the more recent overall 2006 NIS rates are 16% lower than RG7420 comparably age- and sex-adjusted NIS rates from 2001 (4.31 per 1,000), reflecting the ongoing decline in hip fracture incidence observed nationally [22–25]. US-FRAX will use the 1-year age intervals for hip fracture, a significant improvement in accuracy over the previous 5-year age data (John IWR-1 Kanis, May 11, 2009, personal communication). The major impact of the change in base hip fracture incidence will be among younger women and men, where hip fracture probability

estimates could be up to 40% lower than those currently produced by US-FRAX. Table 1 Estimated annual hip fracture incidence (per 1,000) comparing current and revised rates Age-group Olmsted County, MN, 1989–1991 [21] National Inpatient Sample, 2006 Rate No. of fractures Rate No. of fractures Women 50–54 0.66 5 0.29 2,197 55–59 0.83 5 0.57 3,992 60–64 1.65 9 1.05 5,679 65–69 2.21 11 2.03 8,690 70–74 2.75 12 3.94 14,578 75–79 8.61 33 7.93 27,488 80-84 18.38 57 14.47 42,322 85+ 24.88 85 26.05 82,383

Subtotal 5.37a 217 4.97a 187,339 Men 50–54 0.40 3 0.28 2,062 55–59 0.32 2 0.38 2,528 60–64 0.81 4 0.66 3,333 65–69 1.89 8 1.18 4,510 70–74 1.60 5 2.10 6,462 75–79 5.34 12 4.02 10,355 Resveratrol 80–84 5.97 8 8.13 14,724 85+ 15.01 16 16.30 23,060 Subtotal 2.10a 58 2.09a 67,034 Total 3.86b 275 3.64b 254,373 aIncidence per 1,000 directly age-adjusted to the 2006 US non-Hispanic white population bIncidence per 1,000 directly age- and sex-adjusted to the 2006 US non-Hispanic white population Fig. 1 a, b Comparison of hip fracture incidence rates ( ) to the incidence of any one of four (hip, spine, forearm, or humerus) major osteoporotic fractures ( ) among non-Hispanic white men (a) and non-Hispanic white women (b) by single year of age (smoothed data) US-FRAX 10-year major osteoporotic fracture probability Because hip fractures represent the minority of osteoporotic fractures [29], a focus on hip fractures alone could be misleading for high-risk younger individuals whose 10-year risk relates more to spine and wrist fractures. Consequently, FRAX® also estimates the patient’s 10-year likelihood of any one of four major osteoporotic fractures (4 fracture risk: proximal femur, clinical vertebral, distal radius, or proximal humerus fractures), and some revisions in those calculations were indicated as well.