Incidence and mortality of hip fractures in the United States

wbldb

Brauer, Carmen A.¹; Coca-Perraillon, Marcelo²; Cutler, David M.^2,3; Rosen, Allison B.^2,4

Incidence and mortality of hip fractures in the United States

JAMA. October 14, 2009;302(10):1573-1579

©2009 American Medical Association. All rights reserved.

Affiliations

¹Division of Orthopedic Surgery, University of Calgary, Alberta Children’s Hospital, Alberta, Canada

²National Bureau of Economic Research, Cambridge, Massachusetts

³Department of Economics, Harvard University, Cambridge, Massachusetts

⁴Division of General Medicine and Department of Health Management and Policy, University of Michigan Schools of Medicine and Public Health, Ann Arbor
Abstract

Context: Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care.

Objective: To examine trends in hip fracture incidence and resulting mortality over 20 years in the US Medicare population.

Design, Setting, and Patients: Observational study using data from a 20% sample of Medicare claims from 1985-2005. In patients 65 years or older, we identified 786 717 hip fractures for analysis. Medication data were obtained from 109 805 respondents to the Medicare Current Beneficiary Survey between 1992 and 2005.

Main Outcome Measures: Age- and sex-specific incidence of hip fracture and age- and risk-adjusted mortality rates.

Results: Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100 000 (95% confidence interval [CI], 921.7-992.9) for women and 414.4 per 100 000 (95% CI, 401.6-427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100 000 (95% CI, 958.3-970.1) in 1986 to 1050.9 (95% CI, 1045.2-1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7-798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8-397.0) to 456.6 (95% CI, 452.0-461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1-372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates.

Conclusion: In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.
Links

DOI: 10.1001/jama.2009.1462

PubMed: 19826027

WoS: 000270721800026

Cited Works (10)

Year	Entry
2001	McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Wasnich RD, Greenwald M, Kaufman J-M, Chesnut CH, Reginster J-Y; Hip Intervention Program Study Group. Effect of risedronate on the risk of hip fracture in elderly women: Hip Intervention Program Study Group. NEJM. February 1, 2001;344(5):333-340.
2001	van Staa TP, Dennison EM, Leufkens HGM, Cooper C. Epidemiology of fractures in England and Wales. Bone. January 2001;29(6):517-522.
2000	Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int. August 2000;11(7):556-561.
2003	Kanis JA, Oden A, Johnell O, Laet CD, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. May 2003;32(5):468-473.
2007	Burge R, Dawson‐Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis‐related fractures in the United States, 2005–2025. J Bone Miner Res. March 2007;22(3):465-475.
2009	Melton LJ III, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, Therneau TM, Leibson CL. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. May 2009;20(5):687-694.
1987	Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. January 1, 1987;40(5):373-383.
2009	Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. February 4, 2009;301(5):513-521.
1997	Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. August 18, 1997;103(2)(suppl 1):S12-S19.
1992	Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. November 1992;2(6):285-289.

Cited By (35)

Year	Entry
2019	Hansen D, Bazel C, Pelizzari P, Pyenson B; National Osteoporosis Foundation. Medicare Cost of Osteoporotic Fractures: The Clinical and Cost Burden of an Important Consequence of Osteoporosis. Seattle, WA: Milliman Inc; August 2019. Milliman Research Report.
2020	Rajapakse CS, Farid AR, Kargilis DC, Jones BC, Lee JS, Johncola AJ, Batzdorf AS, Shetye SS, Hast MW, Chang G. MRI-based assessment of proximal femur strength compared to mechanical testing. Bone. April 2020;133:115227.
2020	Vilaca T, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: a systematic review and meta-analysis update. Bone. August 2020;137:115457.
2021	Grassi L, Fleps I, Sahlstedt H, Väänänen SP, Ferguson SJ, Isaksson H, Helgason B. Validation of 3D finite element models from simulated DXA images for biofidelic simulations of sideways fall impact to the hip. Bone. January 2021;142:115678.
2021	Liew D, Chapurlat RD, Sornay-Rendu E, Lespessailles E, Peng Y, Seeman E. Cost-effectiveness of treatment of women aged 70 years and older with both osteopenia and microstructural deterioration. Bone. January 2021;142:115682.
2021	Unim B, Minelli G, Da Cas R, Manno V, Trotta F, Palmieri L, Galluzzo L, Maggi S, Onder G. Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017. Bone. January 2021;142:115752.
2021	Iseri K, Carrero JJ, Evans M, Runesson B, Stenvinkel P, Lindholm B, Berg HE, Felländer-Tsai L, Qureshi AR. Secular trends in hip fracture incidence and subsequent mortality in dialysis patients and the general population in Sweden. Bone. June 2021;147:115909.
2021	Singleton RC, Pharr GM, Nyman JS. Increased tissue-level storage modulus and hardness with age in male cortical bone and its association with decreased fracture toughness. Bone. July 2021;148:115949.
2022	Wu C-Y, Lee H-S, Tsai C-F, Hsu Y-H, Yang H-Y. Secular trends in the incidence of fracture hospitalization between 2000 and 2015 among the middle-aged and elderly persons in Taiwan: a nationwide register-based cohort study. Bone. January 2022;154:116250.
2023	Jones BC, Wehrli FW, Kamona N, Deshpande RS, Vu B-TD, Song HK, Lee H, Grewal RK, Chan TJ, Witschey WR, MacLean MT, Josselyn NJ, Iyer SK, al Mukaddam M, Snyder PJ, Rajapakse CS. Automated, calibration-free quantification of cortical bone porosity and geometry in postmenopausal osteoporosis from ultrashort echo time MRI and deep learning. Bone. June 2023;171:116743.
2020	Wang J, Zhang W, Wang X, Li C, Li J, Zhao Y, Chen L, Qi X, Qiao L, Da W, Liu L, Xu C, Zhu S, Li Y, Zhang H, Sha N, Wang Q, Zhu Y, Luo J, Cui X, Liang Q, Lu S, Shi Q, Wang Y, Shu B. Urban–rural differences in bone mineral density and its association with reproductive and menstrual factors among older women. Calcif Tiss Int. June 2020;106(6):637-645.
2020	Mortensen SJ, Mohamadi A, Wright CL, Chan JJ, Weaver MJ, Keudell Av, Nazarian A. Medications as a risk factor for fragility hip fractures: a systematic review and meta-analysis. Calcif Tiss Int. July 2020;107(1):1-9.
2021	Pimentel A, Ureña-Torres P, Bover J, Fernandez-Martín JL, Cohen-Solal M. Bone fragility fractures in CKD patients. Calcif Tiss Int. April 2021;108(4):539-550.
2017	Fuchs RK, Kersh ME, Carballido-Gamio J, Thompson WR, Keyak JH, Warden SJ. Physical activity for strengthening fracture prone regions of the proximal femur. Curr Osteoporos Rep. February 2017;15(1):43-52.
2014	Ali AA, Cristofolini L, Schileo E, Hu H, Taddei F, Kim RH, Rullkoetter PJ, Laz PJ. Specimen-specific modeling of hip fracture pattern and repair. J Biomech. January 22, 2014;47(2):536-543.
2014	Grassi L, Väänänen SP, Yavari SA, Jurvelin JS, Weinans H, Ristinmaa M, Zadpoor AA, Isaksson H. Full-field strain measurement during mechanical testing of the human femur at physiologically relevant strain rates. J Biomech Eng. November 2014;136(11):111010.
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.
2015	Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: an ecological analysis. J Bone Miner Res. December 2015;30(12):2179-2187.
2017	Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E. Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res. March 2017;32(3):424-430.
2020	Saad RK, Harb H, Bou‐Orm IR, Ammar W, El‐Hajj Fuleihan G. Secular trends of hip fractures in Lebanon, 2006 to 2017: implications for clinical practice and public health policy in the Middle East region. J Bone Miner Res. January 2020;35(1):71-80.
2022	Buettmann EG, Goldscheitter GM, Hoppock GA, Friedman MA, Suva LJ, Donahue HJ. Similarities between disuse and age-induced bone loss. J Bone Miner Res. August 2022;37(8):1417-1434.
2022	Zimmerman K, Liu X, von Kroge S, Stabach P, Lester ER, Chu EY, Srivastava S, Somerman MJ, Tommasini SM, Busse B, Schinke T, Carpenter TO, Oheim R, Braddock DT. Catalysis-independent ENPP1 protein signaling regulates mammalian bone mass. J Bone Miner Res. September 2022;37(9):1733-1749.
2023	Su Y-H, Chien K-L, Yang S-H, Chia W-T, Chen J-H, Chen Y-C. Nonalcoholic fatty liver disease is associated with decreased bone mineral density in adults: a systematic review and meta-analysis. J Bone Miner Res. August 2023;38(8):1092-1103.
2023	Grassi L, Väänänen SP, Jehpsson L, Ljunggren Ö, Rosengren BE, Karlsson MK, Isaksson H. 3D finite element models reconstructed from 2D dual-energy x-ray absorptiometry (DXA) images improve hip fracture prediction compared to areal BMD in osteoporotic fractures in men (MrOS) Sweden cohort. J Bone Miner Res. September 2023;38(9):1258-1267.
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.
2020	Luo Y. Age-related periosteal expansion at femoral neck among elderly women may maintain bending stiffness, but not femoral strength. Osteoporos Int. February 2020;31(2):371-377.
2020	Lewiecki EM, Chastek B, Sundquist K, Williams SA, Weiss RJ, Wang Y, Fitzpatrick LA, Curtis JR. Osteoporotic fracture trends in a population of US managed care enrollees from 2007 to 2017. Osteoporos Int. July 2020;31(7):1299-1304.
2021	Binkley N, Orwoll E, Chapurlat R, Langdahl BL, Scott BB, Giezek H, Santora AC. Randomized, controlled trial to assess the safety and efficacy of odanacatib in the treatment of men with osteoporosis. Osteoporos Int. January 2021;32(1):173-184.
2018	Moore ER. The Primary Cilium Encourages Osteogenic Behavior in Periosteal Osteochondroprogenitors and Osteocytes During Juvenile Skeletal Development and Adult Bone Adaptation [PhD thesis]. Columbia University; 2018.
2013	Ali A. Development of a Computational Approach to Assess Hip Fracture and Repair: Considerations of Intersubject and Surgical Alignment Variability [Master's thesis]. University of Denver; November 2013.
2019	Beltejar M-JG. Understanding the Genetic Basis for Bone-Matrix Quality [PhD thesis]. University of Rochester; 2019.
2018	Tang T. Fracture Mechanisms and Structural Fragility of Human Femoral Cortical Bone [PhD thesis]. Vancouver, BC: University of British Columbia; April 2018.
2018	Pendleton MM. Effects of Spaceflight- and Clinically-Relevant Ionizing Radiation Exposure on Bone Biomechanics [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2018.
2020	Singleton RC. A Study of Aging in Male Cortical Bone Using Nanoindentation [PhD thesis]. Knoxville, University of Tennessee; August 2020.
2020	Hamandi FMRA. Hierarchical Structure, Properties and Bone Mechanics At Macro, Micro, and Nano Levels [PhD thesis]. Dayton, OH: Wright State University; 2020.