Secular trends in the incidence of hip and other osteoporotic fractures

Abstract

Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide.

Figure 1

Secular trends in the incidence of hip fracture; 1928-1982 (Reproduced from Melton LJ et al. Calcif. Tissue Int. 1987; 41:57-64).

Figure 2

Age-adjusted incidence rates for hip fracture in Rochester, Minnesota, USA: 1928-2006 (Reproduced from Melton LJ et al, Osteoporos Int 2009; 20:687-694

Figure 3

Age-specific incidence rates of hip fracture (per 100,000 person-years) in men and women, by birth cohort (Reproduced from Samelson EJ et al. Am J Pub Health 2002; 92:858-862).

Figure 4

Secular trends in hip fracture worldwide: annual change in age- and sex-adjusted hip fracture incidence

Figure 5

Trends in hospitalisation for hip fracture in England and Wales; 1968-1985 (Reproduced from Spector TD et al, Br Med J 1990; 300:1178-84).

Figure 6

Age and gender-specific hip fracture incidence in Tottori Prefecture, Japan: 1986-2001 (Reproduced from Hagino H et al. Osteoporos Int. 2005; 16:1963-68).

Figure 7

Secular change in the incidence of vertebral fracture in Rochester, Minnesota (Reproduced from Cooper C et al. Calcif Tissue Int 1992; 51:100-104).