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The association between urban or rural locality and hip fracture in community-based adults: A systematic review
  1. Sharon L Brennan1,
  2. Julie A Pasco2,
  3. Donna M Urquhart1,
  4. Brian Oldenburg1,
  5. Fahad S Hanna3,
  6. Anita E Wluka4
  1. 1 Monash University, Australia;
  2. 2 University of Melbourne, Australia;
  3. 3 Monash University, The Baker Heart Research Institute, Australia;
  4. 4 Monash University, Baker IDI Heart and Diabetes Institute, Australia
  1. * Corresponding author; email: anita.wluka{at}


Background: Urban or rural locality has been suggested to influence musculoskeletal health, with lower bone mineral density (BMD) and greater prevalence of fracture identified in urban residents. We systematically reviewed the literature regarding urban or rural locality as a risk factor for an increased risk of hip fracture.

Methods: A computer-aided search of Medline, EMBASE, CINAHL and PsychINFO, January 1966 to November 2007 was conducted to identify studies investigating the relationship between urban or rural locality and the occurrence of hip fracture. Their methodological quality was assessed, and a best-evidence synthesis used to summarise the results.

Results: Fourteen cohort studies and one case-control study were identified for inclusion in this review, indicating a lack of literature in the field. Best evidence analysis identified moderate evidence for residents of rural regions to have lower risk of hip fracture compared to urban residents.

Conclusion: Examining principal mechanisms for the observed relationship between urban/rural locality and hip fracture, such as factors at the person or area level, may help to identify modifiable risk factors and inform appropriate prevention strategies.

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