Elsevier

Bone

Volume 40, Issue 5, May 2007, Pages 1284-1289
Bone

Incidence of hip fracture over a 10-year period (1991–2000): Reversal of a secular trend

https://doi.org/10.1016/j.bone.2006.12.063Get rights and content

Abstract

Introduction

Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. With the ageing of the population, a marked increase in the number of fractures is expected. Furthermore, many studies reveal an increase of the age-adjusted hip fracture incidence. We specifically examined secular changes in the incidence of hip fracture in women and men aged 50 years and over in the well-defined area of Geneva, Switzerland.

Materials and methods

All hip fractured patients were retrospectively identified from the computer medical records of the main hospital, which is receiving 95% of hip fractures occurring in a well-defined area.

Results

From 1991 to 2000, 4115 hip fractures were recorded in 2981 women and 822 men with a mean age (± S.D.) of 83.1 ± 8.9 and 78.3 ± 11.6 years, respectively. A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1 ± 1.9 (median 1.44) years after the first event without gender difference. The overall incidence of hip fractures was 455 (95% CI: 439–471) per 100,000 person-years in women and 153 (95% CI: 143–163) in men. The number of hip fractures remained constant (412 (95% CI: 397–426)), but the mean age of these patients increased each year by 0.13 year in women (p = 0.019) and by 0.04 year in men (NS). Furthermore, the age-adjusted incidence of hip fractures, standardized to the 2000 Geneva population, decreased significantly by 1.4% (95% CI: − 2.6 to − 0.1) per year in women (p = 0.021), but remained stable in men (0.5% (95% CI: − 1.7 to + 2.8) per year, p = 0.66). The overall female/male ratio of hip fracture incidence was 2.99 (95% CI: 2.80–3.18, p < 0.001) and significantly decreased by 0.07 (95% CI: − 0.13 to − 0.01) per year (p = 0.024).

Conclusion

Despite an increase in the population at risk and in the mean age of hip fractured women, there was a significant decrease in age-adjusted incidence in women but not in men. These results may suggest a reversal of the previously observed secular trend.

Introduction

Hip fractures are a major cause of public health burden because they result in increased morbidity, mortality and high health care costs [1], [2]. About half of previously independent elderly victims become partly or completely dependent for activities of daily living [3], [4] and an excess mortality is observed within the first year after the fracture [5], [6], [7]. In conjunction with the increasing life expectancy and rising proportion of the elderly throughout the world, the absolute number and incidence of hip fractures are expected to significantly increase over the next few decades [1], [8], [9], [10]. There is a large country-to-country variation in hip fracture incidence [11]. Besides, numerous studies have reported an increase of age-adjusted hip fracture incidence, corresponding to a secular trend [9], [12], [13], [14]. In contrast, some studies have suggested that this increase was however leveling off [15], [16], [17], [18], [19], [20], [21], [22], or even that fracture risk may decrease [18], [23], [24]. A population with a rapidly growing proportion of elderly, thus of high risk patients would allow one to further appreciate the phenomenon. Geneva has one of the oldest populations in Switzerland, a country that already has one of the longest life expectancies in the world [6]. The Geneva area is well suited for a long term study of hip fracture because of its geographical situation and medical care set up, since virtually all hip fractures occurring in the area are referred to the same hospital. Long-term data on secular changes in women and men within a well-defined community are still rare. The aim of our study was to specifically examine over a decade the age distribution of patients with hip fracture and secular changes in the incidence rates of hip fracture in a population of women and men aged 50 years and over with a particularly high proportion of elderly.

Section snippets

Patients and methods

More than 95% of all hip fractures occurring in the Geneva area of 400,000 inhabitants, of which 15% are aged 65 or older, are referred to the same hospital and 92% of these hip fractures were due to a fall from standing height, defining thereby an osteoporotic origin [6], [25]. All patients discharged between 1991 and 2000 with the diagnosis of hip fracture (ICD-10 code: S72.0 and S72.1) were retrospectively identified from the hospital computer records [26]. All diagnoses made before 1996

Overall characteristics

Over a 10-year period from 1991 to 2000, 4115 hip fractures (3257 in women and 858 in men) were recorded in 2981 women and 822 men aged 50 years and over, respectively (Table 1). A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1 ± 1.9 (median 1.44) years ± S.D. after the first event without gender difference. Although the incidence of hip fractures increased with advancing age, the absolute number peaked in men at 80–84 years and in women at 85–89 years of age and

Discussion

The aging of the population has led many to predict a worldwide epidemic of hip fractures because of the increasing number of elderly people in the population who are at risk for fracture [1], [10], [28]. In Switzerland, the proportion of the population aged 50 years and over is expected to rise from 33.3% in 2000 to 41.3% in 2020, and those aged 65 and over will rise from 15.4% to 20% [10]. Therefore, the number of osteoporosis-attributable hip fractures is expected to rise from 8375 to 11,353

Acknowledgments

We are grateful to the staff of the service of medical data processing for extracting the data file from the hospital information system and to Mr. Pierre Pauli, from the Office Cantonal de la Statistique, Geneva, for providing us with detailed official population data. University Hospitals of Geneva that supported this work are acknowledged.

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