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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 Pasco1,2,
  3. Donna M Urquhart1,
  4. Brian Oldenburg1,
  5. Fahad S Hanna1,3,
  6. Anita E Wluka1,3
  1. 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  2. 2Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Melbourne, Australia
  3. 3The Baker IDI Heart and Diabetes Institute, Melbourne, Australia
  1. Correspondence to Dr Anita E Wluka, School of Public Health and Preventive Medicine, The Alfred Hospital, Monash University, Commercial Road, Melbourne 3004, Victoria, Australia; anita.wluka{at}


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. 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. The methodological quality of studies was assessed, and a best-evidence synthesis was used to summarise the 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. 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.

  • Urban or rural locality
  • hip fracture
  • systematic review
  • fractures
  • osteoporosis
  • urban health

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  • Funding Ms Brennan is supported by NHMRC PhD scholarship (519404). Associate Professor Pasco and Dr Wluka are the recipients of NHMRC Project Grant (436665). Dr Hanna, Dr Urquhart and Dr Wluka are the recipients of NHMRC Public Health and Clinical Fellowships (418961, 284402 and 317840).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.