Have you ever heard of a fracture belt? I used to live in the South, so I know there's a Bible belt, but this is the first I've heard of a fracture belt.

Fracture belt refers to the higher number of fractures observed in a geographical region. Several studies have been done looking at specific types of fractures (e.g., wrist, ankle).

One study of Medicare patients (over age 65) showed a much higher rate of ankle fractures in North Carolina compared with California. Another similar study (again using the national Medicare database) found a similar higher rate of wrist fractures in patients from the eastern portion of the United States, specifically the northeastern section of the United States.

Several factors may be linked with this pattern of distribution. For example, weather conditions in that area with more ice and snow than in other places could be an important regional difference. Limited exposure to sunlight resulting in higher levels of osteoporosis and lack of water with fluoride in it could contribute to the higher level of osteoporosis-linked fractures. And possibly more involvement in sports activities may affect the rate of falls and subsequent fractures.

Studies on this problem are fairly limited. Most of the data has come from Medicare records rather than large randomized trials. Medicare has a fairly shallow depth of information collected. It does not include how fractures occurred, type of fracture, results of treatment, or even the functional status of the patient. So although we can identify the locations of fracture belts, the whys and wherefores remain unknown for the most part.