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. 2009 May;20(5):687-94.
doi: 10.1007/s00198-008-0742-8. Epub 2008 Sep 17.

Secular trends in hip fracture incidence and recurrence

L J Melton 3rd  1 , A E Kearns, E J Atkinson, M E Bolander, S J Achenbach, J M Huddleston, T M Therneau, C L Leibson
Affiliations

Secular trends in hip fracture incidence and recurrence

L J Melton 3rd et al. Osteoporos Int. 2009 May.

Abstract

The decline in hip fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent hip fracture among survivors of the first fracture.

Introduction: Hip fracture incidence is declining in North America, but trends in hip fracture recurrence have not been described.

Methods: All hip fracture events among Olmsted County, Minnesota residents in 1980-2006 were identified. Secular trends were assessed using Poisson regression, and predictors of recurrence were evaluated with Andersen-Gill time-to-fracture regression models.

Results: Altogether, 2,752 hip fractures (median age, 83 years; 76% female) were observed, including 311 recurrences. Between 1980 and 2006, the incidence of a first-ever hip fracture declined by 1.37%/year for women (p < 0.001) and 0.06%/year for men (p = 0.917). Among 2,434 residents with a first-ever hip fracture, the cumulative incidence of a second hip fracture after 10 years was 11% in women and 6% in men with death treated as a competing risk. Age and calendar year of fracture were independently associated with hip fracture recurrence. Accounting for the reduction in first-ever hip fracture rates over time, hip fracture recurrence appeared to decline after 1997.

Conclusion: A recent reduction in hip fracture recurrence is somewhat greater than expected from the declining incidence of hip fractures generally. Additional research is needed to determine the extent to which this can be attributed to improved patient management.

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Figures

Fig. 1
Fig. 1
Age-adjusted incidence (per 100,000 person-years) of first-ever hip fracture among women and men residing in Rochester (1928-2006) or rural Olmsted County (1980-2006), Minnesota, by calendar year.
Fig. 2
Fig. 2
Cumulative incidence of a recurrent hip fracture among 2434 Olmsted County, Minnesota, women and men who had a first-ever hip fracture in 1980-2006, with follow-up censored at death or with deaths treated as a competing risk.
Fig. 3
Fig. 3
Observed compared to expected recurrent hip fractures over time among 2434 Olmsted County, Minnesota, residents with a first-ever hip fracture in 1980-2006. (Dotted lines indicate the 95% confidence interval.)
See this image and copyright information in PMC

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