Quantitative modelling of hip fracture trends in 14 European countries: testing variations of a shared reversal over time

Abstract

Qualitative similarities between hip fracture trends in different countries suggests variations of the same epidemic. We tested a single statistical shape to describe time trends in Europe, while allowing for country-level variability. Using data from 14 countries, we modelled incidence rates over time using linear mixed-effects models, including the fixed effects of calendar year and age. Random effects were tested to quantify country-level variability in background rates, timing of trend reversal and tempo of reversal. Mixture models were applied to identify clusters of countries defined by common behavioural features. A quadratic function of time, with random effects for background rates and timing of trend reversal, adjusted well to the observed data. Predicted trend reversal occurred on average in 1999 in women (peak incidence about 600 per 100 000) and 2000 in men (about 300 per 100 000). Mixture modelling of country-level effects suggested three clusters for women and two for men. In both sexes, Scandinavia showed higher rates but earlier trend reversals, whereas later trend reversals but lower peak incidences were found in Southern Europe and most of Central Europe. Our finding of a similar overall reversal pattern suggests that different countries show variations of a shared hip fracture epidemic.

Hip fracture rates and time trends in use of anti-osteoporosis medications in Denmark for the period 2005 to 2015: Missed opportunities in fracture prevention

“…Taken together, this study confirms that Danish hip fracture rates continued to decline from 2005 to 2015 parallel to the decrease in most other European countries [21] against a backdrop of stagnating use of drugs licensed for osteoporosis. Prior epidemiological studies have suggested that this is mainly caused by a protective cohort effect specific to women born in the 1930s [22] which will be followed by a return to higher age specific fracture rates, with the hip fracture burden further magnified by the increase in the number of the oldest old in Northern Europe and in the number of persons at high risk of fracture [23].…”

<p>Polypharmacy and injurious falls in older adults: a nationwide nested case-control study</p>

“…Sweden has one of the highest incidence rates of fall-related injuries and fatal falls among older adults in Europe 1. Falls often cause serious physical injuries (eg fractures), that in turn lead to functional impairment, disability, reduced social activities, lowered quality of life, and increased risk of mortality 2,3.…”

Incidence of Hip Fracture in the Eastern Mediterranean Region- A Systematic Review and Meta-Analysis

“…A study on 14 European countries indicated the predicted maximum hip fracture incidence rate from 376 per 100,000 population in Portugal to 1390 per 100,000 population in Sweden among females, and from 157 per 100,000 population/year in Portugal to 742 per 100,000 population/year in Sweden among males . (26) The results of this study, however, should be interpreted with caution because of differences in number of studies, being nationwide or local scale, and lack of reporting the age-standardized rate in some studies. Following subgroup analysis, we did not find a significant difference between studies conducted before and after 2006.…”