This study shows that in the Italian population aged >or=45, hospitalizations following hip fracture and AMI between 1999 and 2002 were comparable, while hip fractures' direct costs were higher and grew faster than costs for AMI. Hip fractures in Italy are a serious medical problem and a leading health-cost driver.

Hip fractures of the elderly are increasing and represent a major health problem in industrialized countries such as Italy.

Objectives: The aim of this study was to evaluate the trend of the incidence and costs of hip fractures in Italy. Methods: The incidence of hip fractures after 45 years of age in both females and males during the years 1999-2002 was obtained by analyzing the Italian Ministry of Health national hospitalization database, according to the diagnosis codes of International Classification of Diseases, Clinical Modification, 9° edition (IDC-9-CM) that indicate femoral fracture. We have computed all direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRG) referring to hip fractures. The expenses of rehabilitation and indirect expenses were based on estimates. Results: In 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999; 77% were female and 80% were over 75 years of age. In 2002 the direct costs of hospitalization, in the patients over 65 years alone, were almost 400 milion euros, with an increase of 15% as compared to 1999. Considering also estimated rehabilitation costs, social aid and indirect costs, we estimate that hip fractures due to age-related osteoporosis created over a billion euros in expenses in 2002. Conclusions: Preventive intervention regarding the risk of hip fracture in elderly patients is urgent

Femoral fractures are associated with a high rate of mortality, especially in the elderly, and high social and economic burdens. The impact of femoral fractures is of particular importance in countries like Italy with a progressively ageing population. Therefore, to quantify the real impact of femoral fractures, we studied national hospitalisation records. In a previous report we described the incidence and costs of hip fractures, while here we report our findings on the numbers and types of surgical interventions. We evaluated national records for operations of hip replacement and femoral fracture reduction in adults ≥45 years of age. Over 120 000 surgical hip interventions were performed in 2002; of these, more than 72 000 were directly attributable to femoral fractures. Between 1999 and 2002, the number of operations for femoral fractures increased by 7.1%, and in each year we observed a predominance of women and elderly, in line with the increased prevalence of osteoporosis in these populations. Together with our findings on an increased number of hospitalisations, these data indicate that in Italy the prevalence of hip fractures is increasing, and that women and elderly are the most affected. Primary prevention programmes to sensitise the population to the risks of osteoporotic fractures and to reduce the incidence, especially in high-risk subjects, are urgently needed.