Global epidemiology of hip fractures:​ secular trends in incidence rate, post-fracture treatment, and all-cause mortality

Sing, Chor-Wing; Lin, Tzu-Chieh; Bartholomew, Sharon; Bell, J. Simon; Bennett, Corina; Beyene, Kebede; Bosco-Levy, Pauline; Bradbury, Brian D.; Chan, Amy Hai Yan; Chandran, Manju; Cooper, Cyrus; de Ridder, Maria; Doyon, Caroline Y.; Droz-Perroteau, Cécile; Ganesan, Ganga; Hartikainen, Sirpa; Ilomaki, Jenni; Jeong, Han Eol; Kiel, Douglas P.; Kubota, Kiyoshi; Lai, Edward Chia-Cheng; Lange, Jeff L.; Lewiecki, E. Michael; Lin, Julian; Liu, Jiannong; Maskell, Joe; Abreu, Mirhelen Mendes de; O'Kelly, James; Ooba, Nobuhiro; Pedersen, Alma B.; Prats-Uribe, Albert; Prieto-Alhambra, Daniel; Qin, Simon Xiwen; Shin, Ju-Young; Sørensen, Henrik T.; Tan, Kelvin Bryan; Thomas, Tracy; Tolppanen, Anna-Maija; Verhamme, Katia M. C.; Wang, Grace Hsin-Min; Watcharathanakij, Sawaeng; Wood, Stephen J.; Cheung, Ching-Lung; Wong, Ian C. K.

Affiliations

¹Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

²Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA

³Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada

⁴Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia

⁵Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy, St Louis, MO, USA

⁶Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France

⁷School of Pharmacy, The University of Auckland, Auckland, New Zealand

⁸Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

⁹Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK

¹⁰Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands

¹¹Ministry of Health Singapore, Singapore, Singapore

¹²School of Pharmacy, University of Eastern Finland, Kuopio, Finland

¹³School of Pharmacy, Sungkyunkwan University, Suwon, South Korea

¹⁴Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

¹⁵NPO Drug Safety Research Unit Japan, Tokyo, Japan

¹⁶School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

¹⁷University of New Mexico School of Medicine, Albuquerque, NM, USA

¹⁸Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA

¹⁹Rheumatology Service, Internal Medicine Department, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

²⁰School of Pharmacy, The Nihon University, Chiba, Japan

²¹Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark

²²Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK

²³School of Public Health, National University of Singapore, Singapore, Singapore

²⁴Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Mueang Si Khai, Thailand

²⁵Research Department of Practice and Policy, University College London School of Pharmacy, London, UK

Abstract and keywords

In this international study, we examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age- and sex-standardized incidence rates of hip fractures, post-hip fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all-cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databases. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (95% confidence interval [CI] 94.8–95.4) in Brazil to 315.9 (95% CI 314.0–317.7) in Denmark per 100,000 population. Incidence rates decreased over the study period in most countries; however, the estimated total annual number of hip fractures nearly doubled from 2018 to 2050. Within 1 year following a hip fracture, post-hip fracture treatment ranged from 11.5% (95% CI 11.1% to 11.9%) in Germany to 50.3% (95% CI 50.0% to 50.7%) in the United Kingdom, and all-cause mortality rates ranged from 14.4% (95% CI 14.0% to 14.8%) in Singapore to 28.3% (95% CI 28.0% to 28.6%) in the United Kingdom. Males had lower use of anti-osteoporosis medication than females, higher rates of all-cause mortality, and a larger increase in the projected number of hip fractures by 2050. Substantial variations exist in the global epidemiology of hip fractures and postfracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the aging population.

Keywords: OSTEOPOROSIS; HIP FRACTURE; EPIDEMIOLOGY; FRACTURE PREVENTION; MORTALITY

Links

DOI: 10.1002/jbmr.4821

PubMed: 37118993

WoS: 001000075000001

History

Received: 2022-12-22

Revised: 2023-04-20

Accepted: 2023-04-26

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Cited By (2)

Year	Entry
2023	Ebeling PR. Hip fractures and aging: a global problem requiring coordinated global solutions. J Bone Miner Res. August 2023;38(8):1062-1063.
2023	Bermudez B. Effects of Unsaturated Fatty Acids on Bone Strength, Accrual, and Nutrient Trafficking [PhD thesis]. University of Colorado Denver; 2023.