Calcif Tissue Int (1994) 54:365-369 Calcified Tissue International 9 1994Springer-Verlag New York Inc. Clinical Investigations The Epidemiology of Osteoporotic Fractures in a Mediterranean Country Y. Muscat Baron, M. Brincat, R. Galea, A. Muscat Baron Department of Obstetrics and Gynaecology, St. Luke's Hospital Medical School, University of Malta, Malta Received: 17 June 1993 / Accepted: 18 November 1993 Abstract. A population study was carried out over a period of 3 years (1987-1989) to determine the incidence of osteo- porotic fractures. Fractures diagnosed in the two acute hos- pitals of the Maltese Islands were collected and classified according to the fracture site, age, sex, and patient's resi- dence. Fractures in the Maltese Islands can only be diag- nosed and adequately treated in these two general hospitals. A total of 8780 fractures were examined. Fracture of the neck of the femur was the most common fracture for which patients were admitted to the hospital. There were twice (1.96) as many females as males hospitalized for this frac- ture, giving an annual incidence of 262/100,000 females to 134/100,000 males over the age of 45. The fracture incidence was 2-3 times less than that found in North European coun- tries, but was similar to the fracture rates obtained in Med- iterranean studies. Fracture radius was the most frequent fracture treated on an outpatients basis. In over 45-year- olds, the female predominance persisted, giving a ratio of 3.65:1. This gave an annual incidence of 452/100,000 females to 150/100,000 males. Again, the fracture incidence obtained was significantly lower than that of Northern European countries. Other long bones showed a similar female to male (F:M) ratio in the cohort over 45 years of age. The bones showing this F:M ratio were the humerus (3.9:1), fibula (1.89:1), and tibia (1.6:1). Below45 years of age males had more fractures than females for any bone studied. The epi- demiological graphs obtained were similar to those of other studies suggesting that similar factors influence the develop- ment of osteoporosis. Further studies are required to ana- lyze these factors in detail. Key words: Osteoporosis -- Incidence -- Femoral fractures -- Forearm fractures. The incidence of postmenopausal osteoporosis is assuming greater significance due to the continuing increase of the elderly population. However, the true incidence of osteopo- rotic fractures is difficult to assess because population stud- ies are few. Correspondence to: Y. Muscat Baron Several studies have been carried out to ascertain the true magnitude of the problem [1-5]. In general, these stud- ies tend to analyze the incidence of hip fractures which are among the classical osteoporotic fractures leading to a huge morbidity and mortality. The relationship of these fractures to the effect of menopause and hypoestrogenemia was first made by Albright in 1941 [6]; however, the higher incidence of the fractures in women when compared with men was recognized as early as 1881 [7]. Fewer studies have been carried out looking at other fracture sites, such as the radius [51. This study has attempted to enumerate most of the frac- tures occurring in a population over a 3-year period in order to establish whether postmenopausal osteoporotic fractures is significant in the population studied, and also to compare the incidence of these fractures with studies from neighbor- ing populations and those from different climates. Comparisons are obviously hampered by the fact that few population studies exist. Although the population of the Mal- tese Islands is a relatively small one, this study still consti- tutes one of the largest groups studied comprehensively, and the number of fractures collected constitutes one of the larg- est numbers investigated in the course of one study. The population study involved the collection and classi- fication of all the fractures diagnosed in the two general hos- pitals (both inpatients and outpatients) on the Maltese Is- lands over a period of 3 years (1987-1989). Assessing the incidence of certain fractures in different countries may shed some light on variables that may influence postmenopausal osteoporosis. Various variables have been implicated in the development of osteoporosis. Two of the many postulated as being protective are prolonged exposure to sunlight (influ- enced by the country's latitude) and a high calcium diet [2, 3], both present in the Maltese Islands. Other variables such as genetic factors may also affect the incidence of osteopo- rotic fractures in the Mediterranean. Materials and Methods The Maltese Islands are situated in the middle of the Mediterranean Sea about 60 miles south of Italy. The Maltese population according to the 1988 census was 327,000; 99,199 were over 45 years of age (44,886 males and 54,313 females) [8]. There are two acute general hospitals: St. Luke's Hospital Medical School on the Island of Malta