Abstract
Summary
We studied sex-specific incidence rates in a population 50 years or older in the UK. In the period of 1990–2012, the overall rate of fracture did not change, but there were marked secular alterations in the rates of individual fracture types, particularly hip and spine fractures in the elderly.
Introduction
There is increasing evidence of secular changes in age- and sex- adjusted fracture incidence globally. Such observations broadly suggest decreasing rates in developed countries and increasing rates in transitioning populations. Since altered fracture rates have major implications for healthcare provision and planning, we investigated secular changes to age- and sex-adjusted fracture risk amongst the UK population aged 50 years or above from 1990 till 2012.
Methods
We undertook a retrospective observational study using the Clinical Practice Research Datalink (CPRD), which contains the health records of 6.9 % of the UK population. Site-specific fracture incidence was calculated by calendar year for men and women separately, with fracture type categorised according to ICD-9 classification. Linear regression analysis was used to calculate mean annualised change in absolute incidence. For presentational purposes, mean rates in the first 5 years and last 5 years of the period were calculated.
Results
Overall fracture incidence was unchanged in both women and men from 1990 to 2012. The incidence of hip fracture remained stable amongst women (1990–1994 33.8 per 10,000 py; 2008–2012 33.5 per 10,000 py; p trend annualised change in incidence = 0.80) but rose in men across the same period (10.8 to 13.4 per 10,000 py; p = 0.002). Clinical vertebral fractures became more common in women (8.9 to 11.8 per 10,000 py; p = 0.005) but remained comparable in men (4.6 to 5.9 per 10,000 py; p = 0.72). Similarly, the frequency of radius/ulna fractures did not change in men (9.6 to 9.6 per 10,000 py; p = 0.25), but, in contrast, became less frequent in women (50.4 to 41.2 per 10,000 py; p = 0.001). Secular trends amongst fractures of the carpus, scapula, humerus, foot, pelvis, skull, clavicle, ankle, patella, and ribs varied according to fracture site and sex.
Conclusion
Although overall sex-specific fracture incidence in the UK population 50 years or over appears to have remained stable over the last two decades, there have been noticeable changes in rates of individual fracture types. Given that the impact of a fracture on morbidity, mortality, and health economy varies according to fracture site, these data inform the provision of healthcare services in the UK and elsewhere.
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References
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288
Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413
Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT (2002) Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health 92(5):858–862
Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M, Llorca J, Gonzalez-Macias J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17(3):464–470
Rogmark C, Sernbo I, Johnell O, Nilsson JA (1999) Incidence of hip fractures in Malmo, Sweden, 1992–1995. A trend-break. Acta Orthop Scand 70(1):19–22
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579. doi:10.1001/jama.2009.1462
Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302(8):883–889. doi:10.1001/jama.2009.1231
Orces CH (2011) Trends in hip fracture rates in Ecuador and projections for the future. Rev Panam Salud Publica 29(1):27–31
Chau PH, Wong M, Lee A, Ling M, Woo J (2013) Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001–09. Age Ageing 42(2):229–233. doi:10.1093/ageing/afs177
Siggeirsdottir K, Aspelund T, Jonsson BY, Mogensen B, Gudmundsson EF, Gudnason V, Sigurdsson G (2014) Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989–2008. Osteoporos Int 25(1):211–219. doi:10.1007/s00198-013-2422-6
Oudshoorn C, Hartholt KA, Zillikens MC, Panneman MJ, van der Velde N, Colin EM, Patka P, van der Cammen TJ (2012) Emergency department visits due to vertebral fractures in the Netherlands, 1986–2008: steep increase in the oldest old, strong association with falls. Injury 43(4):458–461. doi:10.1016/j.injury.2011.09.014
Nanninga GL, de Leur K, Panneman MJ, van der Elst M, Hartholt KA (2014) Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age Ageing 43(5):648–653. doi:10.1093/ageing/aft212
Palvanen M, Kannus P, Niemi S, Parkkari J (1998) Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol 14(2):159–164
Palvanen M, Kannus P, Niemi S, Parkkari J (2004) Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int 15(8):649–653
Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46(5):1355–1358. doi:10.1016/j.bone.2009.11.025
Kannus P, Niemi S, Palvanen M, Sievanen H, Parkkari J, Jarvinen M (2008) Rising incidence of low-trauma fractures of the calcaneus and foot among Finnish older adults. J Gerontol A Biol Sci Med Sci 63(6):642–645
Kannus P, Niemi S, Parkkari J, Sievanen H, Palvanen M (2009) Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006. Osteoporos Int 20(1):43–46. doi:10.1007/s00198-008-0625-z
Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ 3rd (2014) Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 29(3):581–589. doi:10.1002/jbmr.2072
Leslie WD, Sadatsafavi M, Lix LM, Azimaee M, Morin S, Metge CJ, Caetano P (2011) Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22(7):2137–2143. doi:10.1007/s00198-010-1470-4
Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8(1–2):137. doi:10.1007/s11657-013-0137-0
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521
Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105
Walley T, Mantgani A (1997) The UK General Practice Research Database. Lancet 350(9084):1097–1099. doi:10.1016/s0140-6736(97)04248-7
Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, Smeeth L (2015) Data resource profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. doi:10.1093/ije/dyv098
Chisholm J (1990) The Read clinical classification. BMJ 300(6732):1092
Van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HG (2000) The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results. Pharmacoepidemiol Drug Saf 9(5):359–366. doi:10.1002/1099-1557(200009/10)9:5<359::AID-PDS507>3.0.CO;2-E
Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgstrom F (2011) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 22(2):685–692. doi:10.1007/s00198-010-1271-9
Maravic M, Taupin P, Landais P, Roux C (2011) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int 22(3):797–801. doi:10.1007/s00198-010-1255-9
Crisp A, Dixon T, Jones G, Cumming RG, Laslett LL, Bhatia K, Webster A, Ebeling PR (2012) Declining incidence of osteoporotic hip fracture in Australia. Arch Osteoporos 7:179–185. doi:10.1007/s11657-012-0095-y
Langley J, Samaranayaka A, Davie G, Campbell AJ (2011) Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007. Osteoporos Int 22(1):105–111. doi:10.1007/s00198-010-1205-6
Balasegaram S, Majeed A, Fitz-Clarence H (2001) Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Public Health Med 23(1):11–17
Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29(5):413–418
Goettsch WG, de Jong RB, Kramarz P, Herings RM (2007) Developments of the incidence of osteoporosis in the Netherlands: a PHARMO study. Pharmacoepidemiol Drug Saf 16(2):166–172. doi:10.1002/pds.1245
Mann E, Icks A, Haastert B, Meyer G (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr 8:35. doi:10.1186/1471-2318-8-35
Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19(8):1139–1145. doi:10.1007/s00198-007-0534-6
Klop C, Gibson-Smith D, Elders PJ, Welsing PM, Leufkens HG, Harvey NC, Bijlsma JW, van Staa TP, de Vries F (2015) Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000–2010. Osteoporos Int 26(7):1919–1928. doi:10.1007/s00198-015-3098-x
Kanis JA, Svedbom A, Harvey N, McCloskey EV (2014) The osteoporosis treatment gap. J Bone Miner Res 29(9):1926–1928. doi:10.1002/jbmr.2301
Evans JG, Seagroatt V, Goldacre MJ (1997) Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968–86. J Epidemiol Community Health JID 51(4):424–429, 7909766
Baird J, Kurshid MA, Kim M, Harvey N, Dennison E, Cooper C (2010) Does birthweight predict bone mass in adulthood? A systematic review and meta-analysis. Osteoporos Int 22:1323–1334
Javaid MK, Eriksson JG, Kajantie E, Forsen T, Osmond C, Barker DJ, Cooper C (2011) Growth in childhood predicts hip fracture risk in later life. Osteoporos Int 22(1):69–73
Harvey NC, Javaid MK, Arden NK, Poole JR, Crozier SR, Robinson SM, Inskip HM, Godfrey KM, Dennison EM, Cooper C (2010) Maternal predictors of neonatal bone size and geometry: the Southampton Women’s Survey. J Dev Orig Health Dis 1(1):35–41
Harvey N, Dennison E, Cooper C (2014) Osteoporosis: a lifecourse approach. J Bone Miner Res 29(9):1917–1925. doi:10.1002/jbmr.2286
Cooper C, Harvey NC, Bishop NJ, Kennedy S, Papageorghiou AT, Schoenmakers I, Fraser R, Gandhi SV, Carr A, D’Angelo S, Crozier SR, Moon RJ, Arden NK, Dennison EM, Godfrey KM, Inskip HM, Prentice A, Mughal MZ, Eastell R, Reid DM, Javaid MK (2016) Maternal gestational vitamin D supplementation and offspring bone health (MAVIDOS): a multicentre, double-blind, randomised placebo-controlled trial. Lancet Diabetes Endocrinol 4:393–402. doi:10.1016/s2213-8587(16)00044-9
Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, McLellan AR, Stenmark J, Pierroz DD, Schneider MC, Kanis JA, Akesson K, Cooper C (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture(R) Best Practice Framework tool. Osteoporos Int 26(11):2573–2578. doi:10.1007/s00198-015-3192-0
Acknowledgments
TPvS and NCH are joint senior author. EMC is supported by the NIHR. The work was supported by a grant from the National Osteoporosis Society. This work was further supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.
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The work was supported by a grant from the National Osteoporosis Society. This work was further supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.
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T. P. van Staa and N. C. Harvey are joint senior author.
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van der Velde, R.Y., Wyers, C.E., Curtis, E.M. et al. Secular trends in fracture incidence in the UK between 1990 and 2012. Osteoporos Int 27, 3197–3206 (2016). https://doi.org/10.1007/s00198-016-3650-3
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DOI: https://doi.org/10.1007/s00198-016-3650-3