The epidemic of hip fractures: are we on the right track?

Abstract

Background: Hip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population.

Methods and findings: Secular trend analysis of all hospitalizations in the older Dutch population (≥65 years) from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change -0.5%, 95% CI: -0.7; -0.3), compared with the period 1981-1993 (percentage annual change 2.3%, 95% CI: 2.0; 2.7). The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities.

Conclusions: A trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

Figure 1. Absolute Numbers, Crude and Age-Specific Incidence Rates of Hip Fracture-Related Hospitalizations in the Dutch Population ≥65 years (1981–2008).

Period 1 (blue line): 1981–1993, percentual annual change 2.30%, (95% CI: 2.00; 2.59). Period 2 (red line): 1994–2008, percentual annual change −0.50% (95% CI: −0.70; −0.30).

Figure 2. Mean Hospital Admission Duration in Persons Aged ≥65 Years due to a Hip Fracture in the Netherlands between 1981–2008.

* No SD data were available before 1991.

Figure 3. Total Number of Hip Fracture-Related Hospital-Bed-Days in Persons of ≥65 Years in the Netherlands between 1981–2008.