The 21st-Century Landscape of Adult Fractures: Cohort Study of a Complete Adult Regional Population

Abstract

Recent reports on adult fracture epidemiology have focused mainly on the hip in the elderly, in whom increasing rates lately have changed to a decline. New reports of the preponderance of nonhip fractures in health expenditure call for a wider scope. We therefore examined current overall and site-specific fracture epidemiology in adults. We ascertained all fractures diagnosed in inpatient and outpatient care in all men and women aged 20 years or older in Skåne County, Sweden, from 1999 to 2010 (10 million person-years). For each fracture type, we estimated age-specific and sex-specific rates and evaluated potential time trends. We found 205,908 fractures yielding an overall fracture rate of 192 per 10,000 person-years. The age-standardized overall fracture rate increased by 1.2 per 10,000 and year (95% confidence interval, 0.8 to 1.5), but time trends were different for different fracture types, age strata, and for men and women. For example, in both women and men aged !50 years the rates of proximal humerus fracture increased (0.6 and 0.2 per 10,000 and year, respectively) while hip fracture rates declined (À1.0 and À0.3 per 10,000/year, respectively). Overall age-specific number of fractures increased with age in women but was stable in men. The increasing overall fracture rate is a major concern in the context of a growing and aging population. Effective and affordable preventive strategies and treatments should be an urgent priority to meet the challenges, especially in older women in whom most fractures occur. Comprehensive current detailed data, as provided in this study, may serve as reference for projections and for cost calculations of fracture care in other settings before results of similar examinations are available there.

Humeral fractures due to low-energy trauma: an epidemiologicalsurvey in patients referred to a large emergency department in Northern Italy

“…However, when considering the more recent studies, the incidence in this study was much lower than that observed in Sweden [24] or Austria [11] in subjects over 50. A substantial variability in fracture rates has been consistently reported in different countries for reasons largely unknown.…”

Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden

“…For estimation of temporal trends, we tabulated data by year and used Poisson regression of annual direct age-standardized incidence rates (with the average population during the examined years as the standard population) and included 95% confidence intervals (95% CI) to describe uncertainty. The validity of the register, in terms of distal forearm fractures, has previously been examined with a sensitivity of 90% and positive predictive value of 94% for the register data compared to gold standard [7]. …”

Deterioration of Cortical Bone Microarchitecture: Critical Component of Renal Osteodystrophy Evaluation

“…A small increase in cortical porosity disproportionately affects bone strength and may potentially contribute to bone fragility [9, 29]. This is significant, given that more than 70% of all fractures occur at non-vertebral sites [30, 31] that are rich in both cortical and trabecular bone. A number of studies have demonstrated a relationship of fracture to the deterioration of cortical architecture with aging and metabolic disease [3, 6-8].…”