Elsevier

Bone

Volume 39, Issue 3, September 2006, Pages 623-627
Bone

Increased incidence of hip fractures. A population based-study in Finland

https://doi.org/10.1016/j.bone.2006.03.001Get rights and content

Abstract

In Central Finland, the age-specific incidence of hip fractures did not change between the years 1982–1983 and 1992–1993 though the total number of hip fractures increased by 11% due to population aging. The objective of this study was to define the current hip fracture rates and the characteristics of patients with hip fracture.

The population at risk consisted of 240,000 persons living in the Central Finland Health Care District. Hip fracture patients were identified by using the hospital discharge register, the operation lists, and the register of the Department of Anesthesiology. Patients' residential status, weight, and height, date and time of hip fracture, place of accident and mechanism and type of fracture were obtained from medical records.

A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to the hospital for treatment of an acute hip fracture in 2002–2003. The mean age of the patients was 79 (SD 13) years. Among patients aged ≥ 50 years (n = 577), 80.8% of the hip fractures had occurred indoors, 97.6% with a low-energetic mechanism, and 22.7% during the nighttime. The ratio of trochanteric to cervical fractures was 2:3. Between 1992–1993 and 2002–2003, the total number of hip fractures increased by 70%, from 351 to 597. The fracture rates per 1000 person-years in the age group ≥ 55 years were 2.0 and 3.9 in 1992–1993 and 2.8 and 5.6 in 2002–2003 for men and women, respectively. The corresponding age-adjusted incidence rate ratio (IRR) for men was 1.36 (95% CI: 1.06 to 1.76), P = 0.017, and for women 1.25 (95% CI: 1.07 to 1.47), P = 0.006. Among men, the IRR was highest in the age group 75–84 years, IRR = 1.67 (95% CI: 1.08 to 2.65), while among women, it was highest in the age group ≥ 85 years, IRR = 1.33 (95% CI: 1.02 to 1.75).

The total number of hip fractures almost doubled within 10 years, and the age-adjusted incidence rate increased in both sexes. The accretion of the hip fracture incidence was more than could be explained merely by changes in population size and structure.

Introduction

In older people, hip fractures are one of the most serious health care problems associated with substantial mortality, morbidity, and economic costs [1], [2], [3]. The incidence of hip fractures increases with age, and the total number of fractures is still expected to rise due to population aging [4]. An increase in age- and gender-specific incidences, independent of the growing number of older people, has also been described in several European countries [5], [6], [7], [8]. In contrast, some studies have reported a leveling off and even a decrease in hip fracture incidence [9], [10], [11], [12].

Current epidemiologic data of hip fractures is needed for planning of health care, particularly operative treatment and rehabilitation, and for targeting fracture prevention. In Central Finland, the total number of hip fractures increased by 11% (from 317 to 351) between the years 1982–1983 and 1992–1993, but no statistically significant changes in the age- and gender-stratified incidence rates were observed [13]. The annual hip fracture rates per 1000 persons in the age group ≥ 55 years were 1.8 and 3.8 in 1982–1983 and 2.0 and 3.9 in 1992–1993 for men and women, respectively. The purpose of this study was to define the characteristics of patients with hip fracture, the current incidence of hip fractures, and potential changes in the hip fracture incidence within a 10-year period in Central Finland.

Section snippets

Patients and methods

Five percent of the 5.24 million Finnish population live in the Central Finland Health Care District, which consists of 30 municipalities. In case of an acute hip fracture, the majority of patients are referred to Central Finland Hospital in Jyväskylä for surgical assessment. Only part the residents of the three southernmost municipalities use another hospital, and therefore, these municipalities were excluded from the study. Persons living in the study area on January 1, 2002, and December 31,

Characteristics of all patients with hip fracture

A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to Central Finland Hospital for treatment of an acute hip fracture during the years 2002 and 2003. The mean age of the patients was 78.7 (SD 12.8) years. Only 20 (3.4%) patients were younger than 50 years. At the time of hip fracture, men were an average of 10 years younger than women (mean age: 72.1 SD 17.6 years vs. 81.7 SD 8.5 years), P < 0.001. Preceding the fracture, 464 (77.7%) patients had been community

Discussion

Within the 10-year period, the total number of hip fractures increased by 70%. In 2002–2003, the mean age of the patients with hip fracture was 79 years, and the female patients were an average of 10 years older than the male patients. A total of 577 (96.6%) patients were ≥ 50 years old. Although four fifths of them were community dwelling, only a fifth of the hip fractures occurred outdoors. This might be indicative of limited physical activity of these patients. Only every thirtieth hip

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