Methods Data sources For the calibration of FRAX, we used two different sources of data: (1) the national hospitalization registry of the Netherlands and (2) the Dutch national mortality statistics. Hip fractures in the Netherlands were identified using the national hospitalization registry (“Landelijke Medische Registratie, LMR”) [8]. The vast majority of patients who sustain a hip fracture are recorded as inpatient hospitalizations. The LMR is therefore the best option to estimate national Bucladesine nmr incidence rates of hip fractures

in the Netherlands. Up to 2004, the completeness of the LMR has been shown to be very high (98.9% in 2004) [9], and the database has been widely used for various research purposes [10–18]. Since 2005, however, the number of missing records in the LMR has increased, probably as a result of the

stepwise introduction of a new reimbursement system in hospitals. The proportion of missing records was estimated at 3.3% in 2005, 10.5% in 2006, and 12.0% in 2007 [9]. The register is held by several licensees; in this paper, we have used LMR data from Statistics Netherlands for the years 2004/2005. The reason for choosing 2004 Dasatinib and 2005 was that we considered a 1.1% rate of under-recording as acceptable, but not a >10% (from 2005 on) missing rate. Data for 2004 were delivered in an aggregated report by Statistics Netherlands. In contrast to hip fractures, incidence of osteoporotic fractures could not be determined using national registries (including LMR), because a dedicated registry with routinely recorded osteoporotic fractures does not exist in the Netherlands. Therefore, the World Health Organization Collaborating Centre for Metabolic Bone Disease used the population of Sweden in order to impute incidence rates of major osteoporotic MycoClean Mycoplasma Removal Kit fractures in the Netherlands [19, 20]. In Malmö, radiography referrals are recorded for all fractures that

come to medical attention. For each age and sex category, incidence rate ratios for major osteoporotic fractures to hip fractures were calculated in this Swedish population [20]. It was assumed that these age- and gender-specific ratios found in Malmö are comparable to those in the Netherlands. This assumption has also been used for many of the FRAX models with incomplete epidemiological information. Available information suggests that the age- and gender-stratified pattern of fracture is very similar in the Western world and Selleck Verteporfin Australia, although it should be noted that incidence rates for vertebral fracture as judged by vertebral morphometry may be underestimated in some of these data sources [19]. Mortality rates were extracted using the national mortality registry, available from Statistics Netherlands. When a patient dies, doctors and coroners are obliged to fill out a death certificate. The national mortality registry has a high degree of completeness because of the legal requirement.