Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis

Despite wide variations in hip rates fractures worldwide, reasons for such differences are not clear. Furthermore, secular trends in the age-specific hip fracture rates are changing the world map of this devastating disease, with the highest rise projected to occur in developing countries. The aim of our investigation is to systematically characterize secular trends in hip fractures worldwide, examine new data for various ethnic groups in the United States, evidence for divergent temporal patterns, and investigate potential contributing factors for the observed change in their epidemiology. All studies retrieved through a complex Medline Ovid search between 1966 and 2013 were examined. For each selected study, we calculated the percent annual change in age-standardized hip fracture rates de-novo. Although occurring at different time points, trend breaks in hip fracture incidence occurred in most Western countries and Oceania. After a steep rise in age-adjusted rates in these regions, a decrease became evident sometimes between the mid-seventies and nineties, depending on the country. Conversely, the data is scarce in Asia and South America, with evidence for a continuous rise in hip fracture rates, with the exception of Hong-Kong and Taiwan that seem to follow Western trends. The etiologies of these secular patterns in both the developed and the developing countries have not been fully elucidated, but the impact of urbanization is at least one plausible explanation. Data presented here show close parallels between rising rates of urbanization and hip fractures across disparate geographic locations and cultures. Once the proportion of the urban population stabilized, hip fracture rates also stabilize or begin to decrease perhaps due to the influence of other factors such as birth cohort effects, changes in bone mineral density and BMI, osteoporosis medication use and/or lifestyle interventions such as smoking cessation, improvement in nutritional status and fall prevention.

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“…McGowan and colleagues (2013) (43) (47) 1988-2002 R(Cantabria) þ2.8 þ3 þ2.8 Arias and colleagues (2013) (48) 2002-2008…”

Section: North Americamentioning

confidence: 99%

“…(43) Hip fracture trends in Austria were examined for the entire Austrian population aged 50 years and above between 1989 and 2008. (44) In women, the age-standardized incidence increased Fig.…”

Section: Central Europementioning

confidence: 99%

Secular Trends in Hip Fractures Worldwide: Opposing Trends East Versus West

Ballane

Cauley

Luckey

et al. 2014

Journal of Bone and Mineral Research

165

118

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“…Assum ing a constant agestandardized fracture incidence, McGowan et al estimate that by 2025 the absolute numbers of osteo porotic and hip fractures in Ireland will rise by 79% and 88%, respectively. The validity of this assumption is open to debate as several studies, including that by McGowan and col leagues, 3 have shown evidence of a tendency for age standardized rates to be declining. The error in this assumption is, how ever, likely to be small in comparison with the effect of the changing population demo graphics, and the estimates reached are very much in keeping with projections for other European countries.…”

Section: H Edwards and C Coopermentioning

confidence: 96%

“…In one European country, Ireland, McGowan and colleagues give a unique insight into the trends in fracture incidence and burden in the past decade and also provide projec tions for the absolute number of fragility fractures up to 2025. 3 In acute public hospitals across Ireland, data on the absolute number of fragility fractures occurring each year from 2000 to 2009 were collected using a national database of coded discharge summaries, the Hospital InPatient Enquiry system.…”

Section: H Edwards and C Coopermentioning

confidence: 99%

The growing cost of fractures in Ireland

Edwards

Cooper

2012

Nat Rev Endocrinol

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“…Hip fractures are regarded as the most severe type of fragility fracture with a 20-30% mortality rate within one year of fracture (McGowan et al, 2013). NICE guidelines also show that approximately 20% of people who were previously living in the community are discharged directly to nursing homes post hip fractures.…”

Section: Introductionmentioning

confidence: 99%