Secular trends of hip fractures in Lebanon, 2006 to 2017:​ implications for clinical practice and public health policy in the Middle East region

Saad, Randa K.<sup>1</sup>; Harb, Hilda<sup>2</sup>; Bou‐Orm, Ibrahim R.<sup>3,4</sup>; Ammar, Walid<sup>2</sup>; El‐Hajj Fuleihan, Ghada<sup>1</sup>

Affiliations

¹Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders at the American University of Beirut‐Medical Center, Beirut, Lebanon

²Ministry of Public Health, Beirut, Lebanon

³Higher Institute of Public Health, St. Jospeh University of Beirut, Beirut, Lebanon

⁴Institute for Global Health and Development, Queen Margaret University ‐ Edinburgh, Musselburgh, East Lothian, UK

Abstract and keywords

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 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.

Keywords: HIP FRACTURE; MIDDLE EAST; OSTEOPOROSIS; POPULATION STUDIES; SECULAR TRENDS

Links

DOI: 10.1002/jbmr.3870

PubMed: 31505064

WoS: 000489795700001

History

Received: 2019-04-17

Revised: 2019-07-25

Accepted: 2019-08-25

Online: 2019-09-10

Cited Works (7)

Year	Entry
2009	Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. October 14, 2009;302(10):1573-1579.
2006	Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. December 2006;17(12):1726-1733.
2011	Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA; IOF CSA Working Group on Fracture Epidemiology. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. May 2011;22(5):1277-1288.
2012	Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. September 2012;23(9):2239-2256.
2002	Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. July 2002;17(7):1237-1244.
2014	Ballane G, Cauley JA, Luckey MM, Fuleihan GE-H. Secular trends in hip fractures worldwide: opposing trends east versus west. J Bone Miner Res. August 2014;29(8):1745-1755.
2004	Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B. Fracture risk following an osteoporotic fracture. Osteoporos Int. March 2004;15(3):175-179.