Osteoporosis International

, Volume 19, Issue 8, pp 1139–1145 | Cite as

Trend of hip fracture incidence in Germany 1995–2004: a population-based study

  • A. Icks
  • B. Haastert
  • M. Wildner
  • C. Becker
  • G. Meyer
Original Article

Abstract

Summary

We analyzed hip fracture incidence trends in Germany 1995-2004, using national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p < 0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions.

Introduction

Data concerning actual trends of the hip fracture incidence and differences for sex, age, and region are limited. We analyzed hip fracture incidence trends in Germany 1995-2004, using the national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p < 0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions.

Methods

Analysis of annual hip fracture incidences using the national hospital discharge register. Estimate of age-sex-adjusted changes was found by using Poisson regression (incidence rate ratios, IRR).

Results

The number of patients with at least one hospital admission for hip fracture increased (1995: n = 99,141; 2004: n = 116,281). Crude incidences per 100,000 were 121.2 (95% confidence interval 120.5-121,9) and 140.9 (140.2-141.7), respectively. The age-sex-adjusted hip fracture incidence increased statistically significantly, but only slightly (IRR per year: 1.01; 1.00-1.01; IRR 1995-2004: 1.05, p < 0.01). In men aged 40 years or older, incidences increased. In women, there was a tendency of a decrease up to 74 years of age, but also a significant increase in higher age groups. In people 0-39 years, the incidence declined markedly (IRR 1995-2004, men 0.74; 0.69-0.79, women 0.62; 0.55-0.69, both p < 0.01). The increase was significantly higher in Eastern compared to Western Germany (interaction: p = 0.002), and differences between East and West decreased.

Conclusions

In contrast to earlier years, the hip fracture incidence in Germany 1995-2004 increased only slightly, with a decline in younger people, but increases in older ages, particularly in men. Regional differences decreased.

Keywords

Epidemiology Hip fracture Incidence Population-based register study Trend analysis 

Notes

Acknowledgement

The study was supported by a grant from the North-Rhine Westphalian Ministry of Health and Social Services. We would like the Health Counselling Committee of the North-Rhine Westphalian Chamber of Physicians (Head Dr. Arnold Schüller) for their support. We would further like to thank Dr. Olaf Schoffer, Research Department of the National Statistical Office, for his support in data management, and Prof. Florian Gebhard, Clinic of Surgery, University of Ulm, for his support in interpreting the results.

Funding

The study was supported by a grant from the North-Rhine Westphalian Ministry of Health and Social Services.

Conflict of interest statement

All authors declare that they have no conflict of interest.

References

  1. 1.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRefGoogle Scholar
  2. 2.
    Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250PubMedGoogle Scholar
  3. 3.
    Kannus P, Pakkari J, Niemi S (1995) Age-adjusted incidence of hip fractures. Lancet 346:350–351CrossRefGoogle Scholar
  4. 4.
    Wildner M, Clark DE (2001) Hip fracture incidence in East and West Germany. Reassessment 10 years after unification. Osteoporos Int 12:136–139PubMedCrossRefGoogle Scholar
  5. 5.
    Finsen V, Johnsen LG, Trano G, Hansen B, Sorensen Sneve K (2004) Hip fracture incidence in central Norway: A follow up study. Clin Orthop 419:173–178PubMedCrossRefGoogle Scholar
  6. 6.
    Giversen IM (2006) Time trends of age-adjusted incidence rates of first hip fractures: a register-based study among older people in Viborg County, Denmark, 1987–1997. Osteoporos Int 17:552–564PubMedCrossRefGoogle Scholar
  7. 7.
    Lönnroos E, Kautiainen H, Karppi P, Huusko T, Hartikainen S, Kiviranta I, Sulkava R (2006) Increased incidence of hip fractures. A population based study in Finland. Bone 39:623–627PubMedCrossRefGoogle Scholar
  8. 8.
    Bjorgul K, Reikeras O (2007) Incidence of hip fracture in southeastern Norway. Int Orthop 31:665–669PubMedCrossRefGoogle Scholar
  9. 9.
    Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jakkimainen L, Adachi JD (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905PubMedCrossRefGoogle Scholar
  10. 10.
    Hernandez JL, Olmos JM, Alonso MA, Gonzales-Fernandez CR, Martinez J, Pajaron M, Llorca J, Gonzales-Macias J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470PubMedCrossRefGoogle Scholar
  11. 11.
    Gehlbach SH, Avrunin JS, Puleo E (2006) Trends in hospital care for hip fracture. Osteopor Int 18:585–591CrossRefGoogle Scholar
  12. 12.
    Kannus P, Niemi S, Parkkari J, Palvanan M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. Bone Mineral Res 21:1836–1838CrossRefGoogle Scholar
  13. 13.
    Löfmann O, Berglund K, Larsson L, Toss G (2002) Changes in hip fracture epidemiology: Redistribution between ages, genders, and fracture types. Osteopor Int 13:18–25CrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention (2006) Fatalities and injuries from falls among older adults-United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep 55:1221–1224Google Scholar
  15. 15.
    Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991-2000): Reversal of a secular trend. Bone 40:1284–1289PubMedCrossRefGoogle Scholar
  16. 16.
    Hoffmann F, Glaeske G (2006) Incidence of proximale femure fracture in Germany. Individual-based analysis of a statutory health insurance‘ population. Gesundheitswesen 68:161–164PubMedCrossRefGoogle Scholar
  17. 17.
    Le CT (2003) Introductory biostatistics. Wiley, WeinheimGoogle Scholar
  18. 18.
    Nymark T, Lauritsen JM, Ovesen O, Rock ND, Jeune B (2006) Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Ortop 77:109–113CrossRefGoogle Scholar
  19. 19.
    Lesic A, Jarebinski M, Pekmezovic T, Bumbasirevic M, Spasovski D, Atkinson HDE (2007) Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000. Arch Orthop Trauma Surg 127:179–183PubMedCrossRefGoogle Scholar
  20. 20.
    Johnell O, Gullberg B, Allander E, Kanis A, and the MEDOS Study Group (1992) The apparent incidence of hip fracture in Europe: A study of national register sources. Osteoporos Int 2:298–302PubMedCrossRefGoogle Scholar
  21. 21.
    Icks A, Haastert B, Meyer G (2007) Remarkable decline in hip fracture incidence in younger age groups in Germany. Am J Publ Health 97:1733–1734CrossRefGoogle Scholar
  22. 22.
    LÖGD (Institute for the Public Health Service). Available at: http://www.loegd.nrw.de. Accessed March 10, 2007
  23. 23.
    Centers for Disease Control and Prevention (CDC) (2006) National trends in injury hospitalizations, 1979-2001. National Hospital Discharge Survey. Available at: http://www.cdc.gov. Accessed March 23, 2007
  24. 24.
    Robert-Koch Institute (ed) (2006) National Health Report for Germany. RKI, BerlinGoogle Scholar
  25. 25.
    Schwabe U, Paffrath D (eds) (2005) Drug prescription report, Germany 2005. Springer Heidelberg New YorkGoogle Scholar
  26. 26.
    Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T (2003) Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 51:306–313PubMedCrossRefGoogle Scholar
  27. 27.
    Meyer G, Warnke A, Bender R, Mühlhauser I (2003) Effect on hip fractures of increased use of hip protectors in nursing homes: cluster-randomised controlled trial. BMJ 326:76–78PubMedCrossRefGoogle Scholar
  28. 28.
    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 Publ Health 92:858–862CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • A. Icks
    • 1
    • 2
    • 7
  • B. Haastert
    • 3
  • M. Wildner
    • 4
  • C. Becker
    • 5
  • G. Meyer
    • 6
  1. 1.Faculty of Public Health, Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
  2. 2.North-Rhine Westphalian Chamber of PhysiciansDüsseldorfGermany
  3. 3.mediStatisticaNeuenradeGermany
  4. 4.Bavarian Health and Food Safety AuthorityOberschleissheimGermany
  5. 5.Center of GeriatricsRobert Bosch HospitalStuttgartGermany
  6. 6.Institute of Public Health and Nursing ResearchBremen UniversityBremenGermany
  7. 7.Faculty of Public HealthBielefeld UniversityDüsseldorfGermany

Personalised recommendations