Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People

Abstract

Epidemiological data about pelvic fractures are limited. Until today, most studies only analyzed inpatient data. The purpose of this study was to estimate incidence rates of pelvic fractures in the German population aged 60 years or older, based on outpatient and inpatient data. We conducted a retrospective population-based observational study based on routine data from a large health insurance company in Germany. Age and sex-specific incidence rates of first fractures between 2008 and 2011 were calculated. We also standardized incidence rates with respect to age and sex in the German population. Multiple Poisson regression models were used to evaluate the association between the risk of first pelvic fracture as outcome and sex, age, calendar year and region as independent variables. The total number of patients with a first pelvic fracture corresponded to 8,041 and during the study period 5,978 insured persons needed inpatient treatment. Overall, the standardized incidence rate of all first pelvic fractures was 22.4 [95% CI 22.0–22.9] per 10,000 person-years, and the standardized incidence rate of inpatient treated fractures 16.5 [16.1–16.9]. Our adjusted regression analysis confirmed a significant sex (RR 2.38 [2.23–2.55], p < 0.001, men as reference) and age effect (higher risk with increasing age, p < 0.001) on first fracture risk. We found a slight association between calendar year (higher risk in later years compared to 2008, p = 0.0162) and first fracture risk and a further significant association with region (RR 0.92 [0.87–0.98], p = 0.006, Westfalen-Lippe as reference). The observed incidences are considerably higher than incidences described in the international literature, even if only inpatient treated pelvic fractures are regarded. Besides which, non-inclusion of outpatient data means that a relevant proportion of pelvic fractures are not taken into account. Prevention of low energy trauma among older people remains an important issue.

Excess Mortality After Pelvic Fractures Among Older People

“…We included all people aged 60 years or older who were continuously insured for at least 1 year between January 1, 2007, and December 31, 2011 (4,511,645 person‐years under risk). The selection process is presented in detail elsewhere . Most persons were insured during the whole study period with the AOK NordWest.…”

“…The selection process is presented in detail elsewhere. (11) Most persons were insured during the whole study period with the AOK NordWest.…”

“…Consequently, low‐energy fractures are assumed to affect a growing number of individuals, and an increase of the incidence of pelvic fracture has already been reported . In Germany, the incidence of pelvic fractures was found to be even higher when compared with other countries . Even though pelvic fractures are assumed to be associated with a significant increase in mortality, up to now data are limited .…”

“…(3,(6)(7)(8)(9)(10) In Germany, the incidence of pelvic fractures was found to be even higher when compared with other countries. (11) Even though pelvic fractures are assumed to be associated with a significant increase in mortality, up to now data are limited. (2,12,13) Studies report the 1-year mortality after pelvic fractures to be fairly considerable, ranging from 8% up to 27%.…”

Lumbopelvic Stabilisation in Patients Over 50 with Posterior Pelvic Ring Fracture

“…Changes in demographics and an increasing life expectancy worldwide [1] have contributed to a higher incidence of pelvic ring fractures in older adults [2][3][4][5][6]. Standard surgical techniques such as ilio sacral screw fixation have limitations, particularly with osteoporotic patients, and are associated with a high complication rate.…”