Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium

Yong, Eu Leong; Ganesan, Ganga; Ms, Kramer; Logan, Susan; Lau, Tang Ching; Cauley, Jane A.; Tan, Kelvin Bryan

doi:10.1007/s00198-019-04839-5

Cited by 46 publications

(52 citation statements)

References 28 publications

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“…The study population comprised patients aged 50 years or older admitted to Singapore hospitals for first hip fracture during the 18-year period from 2000 to 2017, as described in a previous study. 12 The administrative data sets from the Ministry of Health include all records of all inpatient episodes that are submitted for Medisave and MediShield claim purposes. Claims are based on a unique National Registration Identification Number issued at birth (or, for persons born outside of Singapore, at the time of obtaining residency status) and also include the ethnicity of patients.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

et al. 2020

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IMPORTANCE Examining trends in mortality following hip fracture and its associated factors is important for population health surveillance and for developing preventive interventions. OBJECTIVE To examine temporal trends in, and risk factors associated with, mortality following hip fracture over 18 years in Singapore. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study included men and women aged 50 years and older admitted to Singapore hospitals for first hip fracture identified and followed up from 2000 to 2017. Demographic information, fracture type, and Charlson Comorbidity Index (CCI) score were retrieved from nationwide claims data, and mortality data were from the National Death Registry. Data were analyzed from August 2018 to December 2019. MAIN OUTCOMES AND MEASURES Adjusted hazard ratios (aHRs) and their 95% confidence intervals were estimated using Cox proportional hazards regression. Kaplan-Meier life table methods were used to calculate survival following the hip fracture on a cohort basis. The crude survival over time since fracture was compared by sex, age group, ethnicity, CCI, and fracture type. Standardized mortality ratios (SMRs) were calculated using all-cause mortality obtained from Singapore population life tables. RESULTS Among 36 082 first inpatient admissions for hip fractures (mean [SD] patient age, 78.2 [10.1] years; 24 902 [69.0%] female; 30 348 [84.1%] Chinese, 2863 [7.9%] Malay, 1778 [4.9%] Indian, and 1093 [3.0%] other ethnicity), elevated rates of mortality were observed for male sex

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Section: Methodsmentioning

confidence: 99%

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

et al. 2020

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“…While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture [8,9,11], there is a severe lack of reference data on BMD and prevalence of osteoporosis. A study published in 2002, found Singapore men had 10 and 5% lower bone mineral density in the lumbar spine (LS) and femoral neck, respectively when compared to mean BMD peak of Caucasian reference database [8].…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment – The Yishun Study

Chen

Wee

Pang

et al. 2020

BMC Musculoskelet Disord

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Background While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a severe lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults. Methods We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. We computed T- scores (denoted by TSG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (TDXA), NHANES database (TNHANES), and China (TCHN), and the differences in prevalence compared. We then compared the concordance between TSG and TDXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the World Health Organization (WHO). Results Peak lumbar spine BMD was 1.093 ± 0.168 g/cm2 in women, and 1.041 ± 0.098 g/cm2 for men. Peak whole-body BMD was 1.193 ± 0.93 g/cm2 in women at, and 1.224 ± 0.112 g/cm2 for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in postmenopausal women, and 0.7% in men after 50 years of age. The percentage difference in prevalence range from 60.5–163.6%, when using reference values from TDXA, TNHANES, and TCHN. Comparing diagnosis using TDXA and TSG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. The kappa statistics was 0.81 for women and 0.85 for men. Conclusion: Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may result in unnecessary treatment in some individuals.

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“…There is no published representative data in Lebanon regarding the use of bone-sparing agents; however, the increase in the use of bone-sparing medication in Western populations was found to correlate with a decrease in hip fracture rates. (3,4,(37)(38)(39)(40) Conversely, most Asian countries, with the exception of Hong-Kong, Singapore, and Taiwan, (20,41,42) register a continuous increase in hip fracture IRs. (3,4,(37)(38)(39)(40) Conversely, most Asian countries, with the exception of Hong-Kong, Singapore, and Taiwan, (20,41,42) register a continuous increase in hip fracture IRs.…”

Section: Secular Trendsmentioning

confidence: 99%

“…(37) Most data regarding hip fracture secular trends come from Northern and Central Europe, Northern America, and South-East Asia, (3) where rates have experienced an initial rise followed by either a plateau or decline in the last three decades. (3,4,(37)(38)(39)(40) Conversely, most Asian countries, with the exception of Hong-Kong, Singapore, and Taiwan, (20,41,42) register a continuous increase in hip fracture IRs. (4,32,43,44) The trend of decreasing hip fracture rates noted in Lebanon is similar to the established decline seen in Western societies.…”

Section: Secular Trendsmentioning

confidence: 99%

Secular Trends of Hip Fractures in Lebanon, 2006 to 2017: Implications for Clinical Practice and Public Health Policy in the Middle East Region

Saad

Harb

Bou-Orm

et al. 2019

Journal of Bone and Mineral Research

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Country‐specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long‐term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age‐ and sex‐specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau‐b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = −0.611, p = 0.022) but not in men (τb = −0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long‐term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX‐derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.

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Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium

Cited by 46 publications

References 28 publications

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment – The Yishun Study

Secular Trends of Hip Fractures in Lebanon, 2006 to 2017: Implications for Clinical Practice and Public Health Policy in the Middle East Region

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