Chakhtoura M, Dagher H, Sharara S, et al. - According to this systematic review, the incidence rate ratio (IRR) of major osteoporotic fracture (MOF)/hip fracture may differ between countries. When country-specific fracture IRRs are not used, the variability at older ages may affect Fracture Risk Assessment Tool prediction.

• This research focused on observational studies of MOF and hip fractures in people > 50 years.

• With few exceptions, the IRRs were two to ten times higher in younger age groups compared with older age groups, and in women than in men.

• Within Europe, and using Sweden as a reference, MOF/Hip IRRs in women aged 50–54 years from Finland, Italy, Netherlands, Denmark, and the United Kingdom were reduced by 38% to 60%.

• The results were comparable in men.

• MOF/Hip IRRs were consistently lower in women from European countries compared with Sweden at older ages, by 10%–40% and 11%–51%, at 75–79 years and 85–89 years, respectively.

• Men's and non-European countries' findings were mixed.