The hip fracture incidence curve is shifting to the right

Abstract

Background The number of hip fractures has doubled in the last 30–40 years in many countries. Age-adjusted incidence has been reported to be decreasing in Europe and North America, but is there a decreasing trend in all age groups?Patients and methods This population-based study included all hip-fracture patients over 50 years of age (a total of 2,919 individuals, 31% of whom were men) admitted to Umeå University Hospital, Sweden, from 1993 through 2005.Results The incidence of hip fracture declined between the periods 1993–1996 and 2001–2005: from 706 to 625 hip fractures per 105 women and from 390 to 317 hip fractures per 105 men. However, there was a 114% increase in the number of fractures in women aged 90 or older (12 and 25 hip fractures/year, respectively, in the two time periods). For the period 2001–05, women ≥ 90 years of age accounted for almost the same numbers of hip fractures as women aged 75–79 (27 fractures/year). The rate increased during this period, from 2,700 per 105 women to 3,900 per 105 women > 90 years. In men there were declining trends for both relative and absolute numbers.Interpretation Although age-adjusted incidence declined in the population > 50 years of age, absolute fracture rate and incidence increased in the very old. Women over 90 now have the same absolute number of hip fractures every year as women aged 75–79 years. There was a right-shift in hip fracture distribution towards the oldest old, probably due to an increased number of octo/nonagenarians, a new population of particularly frail old people that hardly existed earlier. Better health among septuagenarians may also have delayed the age at which fractures occurred. This changing pattern will strain orthopedic and geriatric resources even more.

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

“…Gullberg and colleagues (1993) (31) 1950-1991 R(Malmo) þ1.4 þ3.5 -2.6 Bergstrom and colleagues (2009) (33) 1993-2005 R(Umea) -2.6 -0.85 Rosengren and colleagues (2012) (34) 1987-1996 N 0 0 Rosengren and colleagues (2012) (34) 1996-2002 N -1.4 -0.7 Central Europe Germany Wildner and colleagues (1999) (36) 1974-1989 R(East G) þ3.1 þ3.3 Icks and colleagues (2008) (37) 1995-2004 N þ0.2 þ0.9 þ0.4 Netherlands Boereboom and colleagues (1992) (38) 1972-1987 N þ2.3 þ3.6 Goettsch and colleagues (2007) (39) 1993-2002…”

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

“…The incidence of hip fractures increases exponentially with age, resulting in a one-year incidence of 1 % in women aged 80 years in Western countries [1]. An expected increase in life expectancy, higher activity levels of the elderly and a subsequent higher risk of falling cause hip fractures to be an increasing challenge for health care systems [1,2].…”

Trends in hip fracture rates in Canada: An age-period-cohort analysis

“…Over the last decades, several countries have observed declining age-adjusted hip fracture rates. (1)(2)(3)(4)(5) However, few studies have attempted to assess if these declining rates can be attributed to changes occurring over a specific calendar period (period effect) or to changes affecting individuals born at a specific time (cohort effect). (6)(7)(8)(9) Period effects reflect changes occurring at a specific time and affect all individuals regardless of age.…”