The Epidemic of Hip Fractures: Are We on the Right Track?

Abstract

BackgroundHip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population.Methods and FindingsSecular trend analysis of all hospitalizations in the older Dutch population (≥65 years) from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change −0.5%, 95% CI: −0.7; −0.3), compared with the period 1981–1993 (percentage annual change 2.3%, 95% CI: 2.0; 2.7). The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities.ConclusionsA trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

The impact of falls in the elderly

“…However, there seems yet to be no clear answer to this incidence decline. One of the most striking observations is the disparity in decline of the male and female incidence rates, Chevalley et al (Hartholt et al, 2011a). One explanation for this observation could be the lack of awareness and preventive measures against osteoporosis in men.…”

Obesity and Risk of Hip Fracture in Adults: A Meta-Analysis of Prospective Cohort Studies

“…Hip fracture is a major part of osteoporotic fractures, and is associated with low independence, excess morbidity and high mortality [3], [4]. With the increasing ageing population and the high prevalence of osteoporosis, hip fracture is causing more serious damage to the public health [1], [5]. Thus, to decrease the prevalence of hip fracture, multifaceted interventions for preventing hip fracture are urgently needed [6]–[8].…”

Cohort profile: Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

“…Before the research network started, it had been estimated that around 9,000 persons suffered a hip fracture annually in Norway [1] -that means a new hip fracture every hour. The highest incidence of hip fractures ever reported worldwide, was from Oslo [2,3], the capital city of Norway, with rates twice as high as in Amsterdam [4,5]. Within Norway considerable geographic differences was also reported, and in 1989 the incidence was 50% higher in Oslo compared to the rural county of Sogn and Fjordane on the western coast [6].…”