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Although there was evidence of a decline in hip fracture incidence in the northern United States between 1984 and 1987, most historical data in the United States and Northern Europe indicate that the age-adjusted incidence is rising. Analysis of data from Rochester, MN, from 1928 to 1992 demonstrates that age-adjusted hip fracture incidence rates rose in women from 1928 to 1950, and in men from 1928 to 1980, with falling rates thereafter. These trends were accounted for by initial hip fractures due to moderate trauma in the oldest age groups. Current data from this population show decreased incidence rates within 10% of the goals outlined in "Healthy People 2000," especially among women. A better understanding of the reasons for the decline of hip fracture incidence in Rochester, MN, may provide the basis for more focused interventions in similar populations.