Population Trends in BMD Testing, Treatment, and Hip and Wrist Fracture Rates: Are the Hip Fracture Projections Wrong?

Abstract

A worldwide epidemic of hip fractures has been predicted. Time trends in BMD testing, bone-sparing medications and hip and wrist fractures in the province of Ontario, Canada, were examined. From 1996 to 2001, BMD testing and use of bone-sparing medications increased each year, whereas despite the aging of the population, wrist and hip fracture rates decreased.Introduction: If patients with osteoporosis are being diagnosed and effective treatments used with increasing frequency in the population, rates of hip and wrist fractures will remain stable or possibly decrease. We report here time trends in BMD testing, prescriptions for bone-sparing medications, hip and wrist fracture rates, and population projections of fracture rates to 2005 in the province of Ontario, Canada. Materials and Methods: Ontario residents have universal access to Medicare. To examine time trends in BMD testing, all physician claims for DXA from 1992 to 2001 were selected from the Ontario Health Insurance Plan (OHIP) database. Trends in prescribing were examined from 1996 to 2003 using data from the Ontario Drug Benefit plan, which provides coverage to persons Ն65 years of age. Actual numbers of hip and wrist fractures were determined for 1992-2000 and population projections for 2001-2005 using time-series analysis. Wrist fractures were identified in the OHIP database and hip fractures through hospital discharge abstracts. Results: From 1992 to 2001, the number of BMD tests increased 10-fold. There has been a steady increase in the number of persons filling prescriptions for antiresorptives (12,298 in 1996 to 225,580 in 2003) and the majority were for etidronate. For women, the rate of decline for wrist fractures is greater than that for hip fractures. The rate of hip fracture was fairly constant around 41 per 10,000 women Ն50 years between 1992 and 1996. In 1997, the hip fracture rate began to decrease, and the population projections suggest that this downward trend will continue to a rate of 33.1 per 10,000 in 2005. Conclusions: Our findings suggest that fracture rates may be on the decline, despite the aging of the population, because of increased patterns of diagnosis and treatment for osteoporosis.

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…Our observed temporal trends are consistent with previous studies [13,14,33]. A Canadian study [13] In a similar American study [33], age-adjusted hip fracture rates fell by 20 % between 1993 and 2003; however, in the cohort 75 years and older, age-adjusted rates fell by 4.0 % in women but increased by 6.8 % in men.…”

“…A Canadian study [13] In a similar American study [33], age-adjusted hip fracture rates fell by 20 % between 1993 and 2003; however, in the cohort 75 years and older, age-adjusted rates fell by 4.0 % in women but increased by 6.8 % in men. An Ontario study spanning 1992 to 2000 [14] observed a decline in hip and wrist fracture rates beginning in 1997, correlating with an increase in bone mass density (BMD) testing and osteoporosis medications.…”

“…The downward trend in overall fracture rates is likely partly attributable to the rapid increase in osteoporosis medication use in the last half of the 1990s (e.g., alendronate for osteoporosis was approved in 1995 in the USA and Canada) [14]. However, low rates of treatment in high-risk individuals [38], particularly for men, and evidence of a decreasing trend prior to the approval of bisphosphonates for treating osteoporosis, suggest other factors are also responsible.…”

“…Previous studies examining temporal trends found that hip fracture rates have been stable or declining in the last two decades both in Canada and internationally [12][13][14]. Fewer studies have examined non-hip fracture trends, and the majority of population-based studies do not make a distinction between institutionalized versus community-dwelling seniors, yet LTC cohorts are older, frailer, and at increased risk of falls and fractures [15,16].…”

Incidence and Mortality of Hip Fractures in the United States

“…A typical patient with a hip fracture spends US $40 000 in the first year following hip fracture for direct medical costs and almost $5000 in subsequent years. 1,[18][19][20] Despite recent literature indicating that the hip fracture incidence may be stabilizing or decreasing, [21][22][23][24][25][26][27][28][29] concern still exists that because of the aging of the population, the hip fracture incidence will increase worldwide unless additional steps are taken. 7,19,20,22,[30][31][32][33][34][35] Understanding the incidence and postsurgical outcome of hip fractures is a vital first step in improving population health.…”