Nationwide decline in incidence of hip fracture.

This epidemiologic study determined the trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, between 1970 and 2004. The results show that the alarming rise in the fracture incidence from early 1970s until late 1990s has been now followed by declining fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns could partly explain the phenomenon. INTRODUCTION: Although osteoporotic fractures of older adults are said to be a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is limited. MATERIALS AND METHODS: This epidemiologic study determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, by taking into account all persons >or= 50 years of age who were admitted to our hospitals for primary treatment of such fracture in 1970-2004. RESULTS: The number of hip fractures among >or= 50-year-old Finns rose very constantly between 1970 (1857 fractures) and 1997 (7122 fractures), but since then, the rise has leveled off (7083 fractures in 2004). After this and because of a continuous rise in population at risk, the crude incidence of hip fracture (showing a clear rise in 1970-1997) decreased between 1997 and 2004, from 438 (per 100,000 persons) in 1997 to 374 in 2004. Concerning the age-adjusted fracture incidence, findings were similar. Until 1997, the age-adjusted incidence of hip fracture clearly increased in both women and men, but thereafter, this incidence declined in both sexes: in women, from 494 in 1997 to 412 in 2004, and in men, from 238 in 1997 to 223 in 2004. CONCLUSIONS: The rise in the incidence of hip fracture in Finland from the early 1970s until the late 1990s has been followed by declining fracture rates. Exact reasons for this are unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns cannot be ruled out.     

The impact of decreasing U.S. hip fracture rates on future hip fracture estimates

Summary

We examined age- and sex-specific hip fracture hospitalization rates among people aged 65 and older using 1990–2010 National Hospital Discharge Survey data. Trends calculated using Joinpoint regression analysis suggest that future increases in hip fractures due to the aging population will be largely offset by decreasing hip fracture rates among women. However, this trend will be counterbalanced by rising numbers of hip fractures among men.

Introduction

From 1990 to 2006, age-adjusted U.S. hip fracture rates among people aged 65 years and older declined significantly. We wanted to determine whether decreasing age group-specific hip fracture rates might offset increases in hip fractures among the aging population over the next two decades.

Methods

This study used data from the National Hospital Discharge Survey, a national probability survey of inpatient discharges from nonfederal U.S. hospitals, to analyze hip fracture hospitalizations, defined as cases with first diagnosis coded ICD-9 CM 820. We analyzed trends in rates by sex and 10-year age groups using Joinpoint analysis software and used the results and projected population estimates to obtain the expected number of hip fractures in 2020 and 2050.

Results

Based on current age- and sex-specific trends in hip fracture hospitalization rates, the number of hip fractures is projected to rise 11.9 %—from 258,000 in 2010 to 289,000 (Projection Interval [PI]?=?193,000–419,000) in 2030. The number of hip fractures among men is expected to increase 51.8 % (PI?=?15.9–119.4 %) while the number among women is expected to decrease 3.5 % (PI?=??44.3–37.3 %). These trends will affect the future distribution of hip fractures among the older population.

Conclusions

Although the number of older people in the U.S.A. will increase appreciably over the next 20 years, the expected increase in the total number of hip fractures will be largely offset by decreasing hip fracture rates among women. However, this trend will be counterbalanced by rising numbers of hip fractures among men.     

Declining incidence of osteoporotic hip fracture in Australia

Summary

Between 1997?C1998 and 2006?C2007 in Australia, the age-standardised incidence rates of hip fractures declined by 20 and 13?%, in females and males, respectively. Although this may be related to the rollout of public health campaigns and strategies addressing osteoporosis, absolute numbers of hip fractures continued to increase.

Background

Previous reports described an increasing trend in osteoporotic hip fracture incidence in Australia in the 1980s with a stabilisation over the 1990s.

Aim

The aim of this study was to describe national trends in the incidence of osteoporotic hip fracture in Australia between 1997?C1998 and 2006?C2007.

Methods

Data on low-trauma hip fractures in persons aged 50?years and over were obtained from the National Hospital Morbidity Database. Cases where the patient was transferred in from another hospital were excluded. Age-standardised incidence rates were calculated and a linear test for trend applied.

Results

Although the absolute number of hip fracture cases has continued to increase, from 14,769 in 1997?C1998 to 16,412 in 2006?C2007, these numbers are lower than previous predictions based on population ageing. Over the 10-year period, the age-standardised incidence rates in females declined by 20?%, from 370 to 295 per 100,000, while the age-standardised incidence rates in males declined by 13?%, from 200 to 174 per 100,000. Both declines were statistically significant. The sex difference in incidence rates narrowed between 1997?C1998 (females 85?% higher) and 2006?C2007 (females 70?% higher).

Conclusions

The age-standardised incidence of osteoporotic hip fracture in Australia is falling. This may be related to the uptake of bisphosphonates as well as the rollout of public health campaigns and strategies addressing osteoporosis.     

Ten-year hip fracture incidence rate trends in a large California population, 1997–2006

Summary

Hip fractures are a large public health problem with significant negative impact on an individual’s overall health and survival. But while the total numbers of persons affected by hip fractures may be anticipated to increase, incidence rates appear to be declining.

Introduction

To describe annual hip fracture incidence rate trends in an integrated health-care organization over 1997–2006, during which a proactive bone health program was initiated program-wide and other secular trends occurred in the population.

Methods

For this ecologic trend study, we identified all men and women ≥45 years old as of January 1 of each year. Incident fractures for each year were identified using ICD-9 diagnosis codes 820–820.9, excluding all subjects who had fractures in prior years. Annual person-time at risk for hip fracture was determined from enrollment data. Sex- and age-specific and adjusted annual incidence rates were calculated.

Results

The overall annual hip fracture incidence rate for men declined from 1.52/1,000 person-years in 1997 to 1.29/1,000 person-years in 2006, a 15.3% (95% confidence interval [CI]=6.2–24.5) decrease. For women, incidence declined from 2.65/1,000 person-years in 1997 to 2.24/1,000 person-years in 2006, a 15.3% (95% CI=8.7–21.9) decrease. Among subjects aged 85 years or older, incidence rates for men declined from 27.0/1,000 to 18.9/1,000 person-years, and for women they declined from 32.7/1,000 to 27.1/1,000 person-years.

Conclusion

Hip fracture incidence has been declining in all age groups over the past 10 years. While many factors may contribute to this decline, the results are consistent with a potential benefit of the active bone health intervention.     

Continued decline in hip fracture incidence in Norway: a NOREPOS study

Summary

The previously reported decline in age-adjusted hip fracture rates in Norway during 1999–2008 continued after 2008. The annual number of hip fractures decreased in women and increased in men.

Introduction

Norway has among the highest hip fracture incidence rates ever reported despite previously observed declining rates from 1999 through 2008. The aim of the present study was to investigate whether this downward trend continued through 2013, and to compare gender-specific trends in 5 year age-groups during three time periods: 1999–2003, 2004–2008, and 2009–2013.

Methods

All hip fractures (cervical, trochanteric, and sub-trochanteric) admitted to Norwegian hospitals were retrieved. Annual age-standardized incidence rates of hip fracture per 10,000 person-years by gender were calculated for the period 1999–2013. Time trends were tested by age-adjusted Poisson regression.

Results

From 1999 through 2013 there were 140,136 hip fractures in persons aged 50 years and above. Age-adjusted hip fracture incidence rates declined by 20.4 % (95 % CI: 18.6–20.1) in women and 10.8 % (95 % CI: 7.8–13.8) in men, corresponding to an average annual age-adjusted decline of 1.5 % in women and 0.8 % in men. Except for the oldest men, hip fracture rates declined in all age-groups 70 years and older. The average annual number of fractures decreased in women (?0.3 %) and increased in men (+1.1 %).

Conclusions

During the past 15 years, hip fracture rates have declined in Norway. The forecasted growing number of older individuals might, however, cause an increase in the absolute number of fractures, with a substantial societal economic and public health burden.

     

Fall-induced fractures of the calcaneus and foot in older people: nationwide statistics in Finland between 1970 and 2013 and prediction for the future

Background

Although fall-induced fractures of elderly persons are a major problem, epidemiologic knowledge on their time trends is limited. We assessed the trends in fall-induced fractures of the calcaneus and foot in older Finns between 1970 and 2013.

Methods

The current trends in the number and incidence (per 100 000 persons) of fall-induced fractures of the calcaneus and foot of older Finns were determined by taking into account individuals 50-year-olds or older who were admitted to Finnish hospitals for primary treatment of such injury in 1970–2013.

Results

The number and raw incidence of these fractures increased considerably between 1970 and 2013, from 64 (number) and 5.6 (incidence) in 1970, to 325 and 15.0, respectively, in 2013. The age-adjusted incidence of fracture was higher in men than women and showed a clear rise in both sexes in 1970–2013, from 7.2 to 15.2 in men (111 % increase), and from 4.3 to 13.9 in women (223 % increase). A similar rise was observed in the age-specific incidences. If trends in the age-specific fracture incidence continue at the same rate as were observed in 1970–2013, and the 50-year-old or older population increases as predicted (by 15 % by the year 2030), the annual number of fall-induced fractures of the calcaneus and foot in this population will be 1.8 times higher in the year 2030 (580 fractures) than it was in 2013 (325 fractures).

Conclusions

The number of fall-induced fractures of the calcaneus and foot among Finns 50 years of age or older has risen sharply between 1970 and 2013 with a rate that cannot be explained merely by demographic changes. Further studies should examine the reasons for the rise and possibilities for fracture prevention.

     

Sex- and age-specific incidence of non-traumatic fractures in selected industrialized countries

Summary

Various methodological approaches have estimated the incidence of osteoporosis-related fractures, making comparisons difficult. This study estimated the incidence rates of non-traumatic fractures in 12 countries using standard definitions. Applying these rates to the 2010 population figures of these countries, a total of 5.2 million non-traumatic fractures were estimated, mostly in women.

Purpose

The purpose of this study was to estimate annual country-, sex-, and age-specific incidence of non-traumatic hip, vertebral, and other fractures for women aged ??50 and men ??60?years and the number of fractures expected in 12 countries based on these incidence rates.

Methods

Electronically indexed medical literature and relevant web sites were reviewed to identify studies reporting age- and sex-specific fracture incidence rates to obtain estimates of the proportion of fractures considered to be non-traumatic and to gather relevant census data. From these data, we extrapolated to estimate the number of fractures in 12 countries in North America, Europe, Japan, and Australia.

Results

Annual non-traumatic hip fracture incidence rates were highest for women in Sweden, Denmark, and Finland. In women, vertebral fractures were more common than hip fractures. The incidence of vertebral fractures was highest among Scandinavian and Canadian women. In men, Scandinavians had the highest incidence of hip fractures, while Australian men had the highest incidence of vertebral fractures. Hip and vertebral fracture incidence increased steeply with age for both women and men. Age appears to exert less influence on the incidence of fractures at sites other than hip and vertebrae. In 2010, 5.2 million non-traumatic fractures were expected in the 12 countries studied, of which 2.8 million were at the hip or spine. Women accounted for most of the total non-traumatic fracture burden (77?%).

Conclusions

Non-traumatic fractures pose a significant burden, affecting millions of women and men in countries around the world each year.     

Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970-2006 and prediction for the future

INTRODUCTION: Low-trauma fractures of older adults have been recognized as a major public health problem in developed societies with aging populations. However, nationwide information on recent fracture trends is rather scarce. METHODS: We determined the trend in the number and incidence (per 100,000 persons) of low-trauma ankle fracture among elderly people in Finland by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fracture in 1970-2006. RESULTS: The number of low-trauma ankle fractures among 60-year-old or older Finnish persons increased steadily and sharply between 1970 (369 fractures) and 1997 (1668 fractures), but since then, the increase has leveled off (1670 fractures in 2006). The raw incidence of low-trauma ankle fracture, showing a clear rise from 57 fractures per 100,000 persons in 1970 to 169 fractures in 1997, somewhat decreased between 1997 and 2006 (to 144 fractures in 2006). Observations on the age-adjusted fracture incidence were similar. During 1970-1997, the age-adjusted incidence of low-trauma ankle fracture clearly rose in both women and men, but thereafter, the incidence declined; in women, from 199 in 1997 to 173 in 2006, and in men, from 123 in 1997 to 100 in 2006. CONCLUSIONS: The sharp increase in the incidence of low-trauma ankle fracture in Finnish older adults from early 1970s until late 1990s has been followed by stabilized, slightly declining fracture rates. Reasons for this are not known, but a cohort effect toward a healthier aging population with improved functional ability and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.     

Epidemiological burden of postmenopausal osteoporosis in France from 2010 to 2020: estimations from a disease model

Summary

This article estimates the present and future burden of postmenopausal osteoporosis in France in women aged 50?years and over.

Methods

We adapted an existing model developed for Sweden to France. For each year of the study from 1970 to 2020, the ??incident cohort?? (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using annual cycles. Health states were based on the number of fractures (hip, vertebral, non-hip non-vertebral) and deaths. Transition probabilities reflected fracture site-specific risks of subsequent fractures and of death. Country-specific model inputs included population size and life tables from 1970 to 2020 and incidence of hip fracture.

Results

The model estimated that the number of postmenopausal osteoporotic women was expected to increase from 3.0 million to 3.4 million between 2010 and 2020 (+15.3?%). Assuming that the incidence of fracture by age group does not change over time, the model predicted that the overall number of osteoporotic fractures would increase from 204,234 fractures in 2010 to 241,261 in 2020 (+18.1?%), hip (20.3?%), vertebral (19.0?%) and non-hip non-vertebral fractures (17.0?%).

Conclusion

The aging of the population is expected to drive a marked increase in the prevalence of osteoporosis and in the number of osteoporotic fractures. These data may assist future planning for appropriate heath care provision.     

Age-adjusted incidence rates of hip fractures between 2006 and 2009 in Rabat, Morocco

Summary

This study, characterizing the incidence of hip fracture in the province of Rabat, showed that age- and sex-specific rates remained stable between 2006 and 2009. The demographic projections estimated for Morocco indicate that between 2010 and 2030, the expected annual number of hip fractures would increase about twofold.

Introduction

No data on hip fracture incidence trends exist from Africa. The aim of the study was to determine time trends in hip fracture rates for the province of Rabat and to forecast the number of hip fractures expected in Morocco up to 2030.

Methods

All hip fracture cases registered during the years 2006–2009 were collected at all the public hospitals and private clinics with a trauma unit and/or a permanent orthopedic surgeon across the province.

Results

Over the 4-year period, 723 (54.3 %) hip fractures were recorded in women and 607 (45.6 %) in men. The age- and gender-specific incidence of hip fracture rose steeply with advancing age. Hip fractures occurred later in women 75.0 (10.7) years than in men 73.3 (11.0) years (p?=?0.014), and its incidence was higher in women than in men [85.9 (95 % CI 79.7–92.2) per 100,000 person-years vs. 72.7 (95 % CI 66.9–78.5)]. The incidence remained globally stable over the period study, and the linear regression analysis showed no significant statistical difference. For the year 2010, there were 4,327 hip fractures estimated in Morocco (53.3 % in women). Assuming no change in the age- and sex-specific incidence of hip fracture from 2010 to 2030, the number of hip fractures in men is expected to increase progressively from 2,019 to 3,961 and from 2,308 to 4,259 in women.

Conclusion

The age-specific incidence of hip fracture between the years 2006 and 2009 remained stable in Morocco, and the number of expected hip fractures would double between 2010 and 2030.     

An increase in the incidence of hip fractures in Tangshan,China

Summary

We determined the number and incidence of hip fractures in Tangshan, China, in 2010. Compared with data we reported in Tangshan from 1994, the crude and age-specific incidence increased significantly for both sexes, especially in women. Strategies are needed for effective fracture prevention in the future.

Introduction

The aims of the study were to determine the incidence of cervical and trochanteric fractures of the proximal femur in Tangshan, China, in 2010 and to compare the incidence with data from 1994.

Methods

The orthopedic departments of 15 hospitals in Tangshan were visited in 2010; the medical records and radiographs of patients who had sustained cervical and trochanteric fractures were reviewed. The absolute number of admissions was collated and the incidence rate per 100,000 person years was calculated, adjusted by different age ranges, and gender. We then calculated the age-standardized incidence in 2010 as compared with those from 1994.

Results

The population of Tangshan in 2010 was determined to be 3,075,382 (1,558,173 males; 1,517,209 females); there were 1,509 cervical and trochanteric fractures (in 745 males and 764 females). The overall incidence was 47.8 and 50.4 fractures per 100,000 per year for men and women, respectively. Females showed a higher fracture incidence than males in those aged 55 years and over. Comparing the 2010 data with the 1994 findings, the incidence increased by 85 % in men and by 306 % in women; age-specific increases were observed in all female and male groups (except the 55–59 years age group).

Conclusions

Compared with the results in 1994, the incidence of hip fracture has markedly increased in 2010 in Tangshan, China. It is necessary to implement a comprehensive policy for hip fracture prevention in our communities.     

Epidemiology of fracture in the Russian Federation and the development of a FRAX model

Summary

The incidence of hip, forearm and humeral fractures was studied in two cities from the Russian Federation. Fracture rates were used to create a FRAX model for Russia and to estimate the current and future burden of fracture.

Purpose

There is scant information on the epidemiology of fracture in Russia. The aim of the study was to determine the incidence of major fractures in order to populate a new FRAX model and to characterise the burden and future burden of fractures.

Methods

The number of hip, forearm and humeral fractures was determined in two Russian cities with a well-defined catchment population over a 2?C3-year period. Incidence rates for the two cities were merged and used to populate a FRAX model for Russia. Incidence rates were also applied to the general population in 2010 and 25?years later in 2035.

Results

A total of 6,012 fractures were documented. For hip fracture, 27?% of cases in Pervouralsk and 1.8?% in Yaroslavl were not registered in the hospital data base. The incidence of index fractures increased with age and was higher in women than in men. The lifetime probability of hip fracture at the age of 50?years was 4?% in men and 7?% in women. The total number of hip fractures estimated in 2010 (112,000) is expected to rise to 159,000 in 2035. The estimated number of major fractures will rise from 590,000 to 730,000 over the same time interval.

Conclusions

Fragility fractures pose a serious health care problem in Russia. Urgent steps are needed to improve the acute management of hip fracture and long-term care of other osteoporotic fractures.     

Epidemiology of Osteoporotic Pelvic Fractures in Elderly People in Finland: Sharp Increase in 1970–1997 and Alarming Projections for the New Millennium

The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were admitted to hospitals in 1970–1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures were expressed as the number of patients per 100 000 individuals. The total number of osteoporotic pelvic fractures increased considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding fracture incidence (per 100 000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were 232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country (about 900 fractures per year) may treble by the year 2030 (about 2700 fractures per year). We conclude that the number of osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related fractures. Received: 5 July 1999 / Accepted: 9 November 1999     

Who are the older Australians referred for a bone density scan? Data from the Barwon region

Summary

This study aimed to estimate the incidence rate of hip fracture during 2008–2010 in Shiraz, Iran. Overall, the standardized age-related incidence were 329.6/100,000 in men and 1,589.7/100,000 in women. The incidence rate in females was remarkably higher than the previous studies in Iran.

Purpose

This study aims to determine the incidence rate of hip fracture and its possible changes during 2008–2010 in Shiraz, Iran.

Materials and methods

This study reviewed and abstracted the hospital records, demographic, and clinical data of 1,923 patients aged 50 years or older with first time hip fracture admitted to private and public hospitals of Shiraz, Iran during 2008–2010 The age-adjusted incidence rate of hip fracture was determined along with association between gender, age, site of fracture, and socioeconomic status (SES) with the incidence rate.

Results

The mean age of subjects was 74.7 years (±10.6 years). Age-adjusted incidence rates for hip fracture, standardized to the 2000 US white male and female populations were 329.57 and 1,589.71 per 10⁵, respectively, while totally it was 461.1 per 10⁵. The incidence rate of hip fracture in females was higher than that of males in their 60s (1,229.2 versus 793.3), 70s (4,130.3 versus 2,835.3), and early 80s (4,506.8 versus 3,820.5) per 100,000. The hip fracture incidence in high SES area (157.1 per 100,000) followed by low SES regions (152.5 per 100,000) were higher compared to middle SES area (38.1 per 100,000) and towns around Shiraz (27.7 per 100,000) with fracture of the neck of femur being the most frequent affliction (391 per 100,000).

Conclusions

The rate of hip fracture is increasing in the area under study particularly in women and to a greater extent in those aged 60 years or older. Therefore, it is necessary to pay special attention to primary and secondary prevention of hip fracture.     

“Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures?

Summary

Pathologic fractures are often excluded in epidemiologic studies of osteoporosis. Using Medicare administrative data, we identified persons with vertebral and hip fractures. Among these, 48% (vertebral) and 3% (hip) of the fractures were coded as pathologic. Only 25% and 66% of persons with these pathologic fractures had evidence for malignancy.

Introduction

Analyses of osteoporosis-related fractures that use administrative data often exclude pathologic fractures (ICD-9 733.1x) due to concern that these are caused by cancer. We examined “pathologic” fractures of the vertebrae and hip to evaluate their contribution to fracture incidence and assessed the evidence for a malignancy.

Methods

We studied US Medicare beneficiaries age ≥65 with new fractures identified using ICD-9 diagnosis codes 733.13 (pathologic vert), 805.0, 805.2, 805.4, 805.8 (nonpathologic vert); and 733.14 (pathologic hip), 820.0, 820.2, 820.8 (nonpathologic hip). We further examined the proportion of cases with a diagnosis of a malignancy proximate to the fracture.

Results

We identified 44,120 individuals with a vertebral fracture and 60,354 with a hip fracture. Approximately 48% of vertebral fractures and 3% of hip fractures were coded as pathologic. For only approximately 25% of persons with a “pathologic” vertebral fracture ICD-9 code, but 66% of persons with a “pathologic” hip fracture, there was evidence of a possible cancer diagnosis.

Conclusion

Among US Medicare beneficiaries, one fourth of pathologic vertebral fracture and two thirds of pathologic hip fracture cases had evidence for a malignancy. Particularly for vertebral fractures, excluding persons with pathologic fractures in epidemiologic analyses that utilize administrative claims data substantially underestimates the burden of fractures due to osteoporosis.     

Burden of postmenopausal osteoporosis in Germany: estimations from a disease model

Summary

This article describes the adaptation of a model assessing the incidence of osteoporotic fractures and prevalence of postmenopausal osteoporosis (PMO) in Germany.

Purpose

The purpose of this paper is to estimate the epidemiological burden of PMO in Germany from 2010 to 2020.

Methods

For each year of the study, the ??incident cohort?? (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures (1, 2 or ??3) and deaths. Although the fracture site was not explicitly accounted for in the model structure, the site (hip, vertebral, non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected the site-specific risk of death and of subsequent fractures. Model inputs included population size and life tables from 1970 to 2020, incidence of fracture and BMD by age in the general population (mean and standard deviation).

Results

In 2010, the number of osteoporotic fractures was estimated at 349,560 in women aged 50?years or more, including 80,177 hip and 48,550 vertebral fractures. By 2020, the population is expected to grow by 13.1?%. As a result, the number of fractures is predicted to increase by 15.2?%. The improvement in life expectancy is predicted to lead to a relatively smaller increase in the number of deaths attributable to fractures (+12.8?%), but also to an increase in the prevalence of women with multiple prior fractures (+25.5?%).

Conclusion

The PMO disease model, first developed for Sweden, was adapted to Germany. Due to the ageing of the population, the number of osteoporotic fractures is expected to increase markedly by +15.2?% by 2020.     

Stable incidence of surgical treatment and hospitalisation for humeral shaft fractures among 0- to 16-year-old patients in Finland from 1987 to 2010

Background

Studies among children experiencing fractures report an increasing trend toward operative management. In the present study, we examined whether the same trend has occurred for humeral shaft fractures in accordance with increasing interest toward intramedullary nailing and other operative treatments. The number, incidence and treatment of all hospitalised 0- to 16-year-old patients with humeral shaft fractures in Finland was assessed over a recent 24-year period.

Method

The study included the entire adolescent (0–16 years) population in Finland during the 24-year period from January 1, 1987, to December 31, 2010. Data on hospitalised patients who sustained humeral shaft fractures were obtained from the nationwide National Hospital Discharge Register (NHDR) of Finland.

Results

During the study period, there were a total of 1,165 hospitalisations with a main or secondary diagnosis of humeral shaft fracture. The incidence of hospitalisation due to humeral shaft fractures was 4.8 per 100,000 person-years. The incidence increased only slightly among girls from 3.3 per 100,000 person-years in 1987 to 5.3 per 100,000 person-years in 2010. The incidence of reposition and casting was 1.1 per 100,000 person-years and the incidence of reposition with osteosynthesis, including intramedullary nailing, was 1.4 per 100,000 person-years. The specific incidence of intramedullary nailing remained low with no signs of increased incidence, and the incidence was 0.3 per 100,000 person-years. There were no significant changes in the incidence of surgical treatment during the 24-year study period.

Conclusion

Despite an overall increasing trend toward operative management of fractures in children, conservative management remains the treatment of choice for humeral shaft fractures based on the low and steady incidence of surgical treatment during the 24-year study period. In addition, the incidence of hospitalisation for fractures remained low without a significant increase during the study period.     

Racial/ethnic differences in hip and diaphyseal femur fractures

Summary

Contemporary femur fracture rates were examined in northern California women and compared by race/ethnicity. During 2006–2012, hip fracture rates declined, but diaphyseal fracture rates increased, especially in Asians. Women with diaphyseal fracture were younger and more likely to be bisphosphonate-treated. These disparities in femur fracture should be further examined.

Introduction

The epidemiology of diaphyseal femur fracture differs from proximal femur (hip) fracture, although few studies have examined demographic variations in the current era. This study examines contemporary differences in low-energy femur fracture by race/ethnicity in a large, diverse integrated health-care delivery system.

Methods

The incidence of hip and diaphyseal fracture in northern California women aged ≥50 years old during 2006–2012 was examined. Hip (femoral neck and pertrochanteric) fractures were classified by hospital diagnosis codes, while diaphyseal (subtrochanteric and femoral shaft) fractures were further adjudicated based on radiologic findings. Demographic and clinical data were obtained from health plan databases. Fracture incidence was examined over time and by race/ethnicity.

Results

There were 10,648 (97.3 %) hip and 300 (2.7 %) diaphyseal fractures among 10,493 women. The age-adjusted incidence of hip fracture fell from 281 to 240 per 100,000 women and was highest for white women. However, diaphyseal fracture rates increased over time, with a significant upward trend in Asians (9 to 27 per 100,000) who also had the highest rate of diaphyseal fracture. Women with diaphyseal fracture were younger than women with hip fracture, more likely to be of Asian race and to have received bisphosphonate drugs. Women with longer bisphosphonate treatment duration were also more likely to have a diaphyseal fracture, especially younger Asian women.

Conclusion

During 2006 to 2012, hip fracture rates declined, but diaphyseal fracture rates increased, particularly among Asian women. The association of diaphyseal fracture and bisphosphonate therapy should be further investigated with examination of fracture pattern.     

Rheumatoid arthritis and incident fracture in women: a case–control study

Background

To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia.

Methods

Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994–2001 were eligible for inclusion as cases (n?=?1,008). The control population (n?=?172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age-adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann–Whitney U-test to examine age-differences.

Results

Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p?=?0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p?<?0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p?=?0.22).

Conclusion

Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.