Osteoporosis International

, Volume 21, Issue 3, pp 399–408 | Cite as

Fragility fractures of the hip and femur: incidence and patient characteristics

  • J. W. Nieves
  • J. P. Bilezikian
  • J. M. Lane
  • T. A. Einhorn
  • Y. Wang
  • M. Steinbuch
  • F. Cosman
Original Article



Using national discharge and medical claims data, we studied the epidemiology of femoral fractures from 1996 to 2006. The annual hip fracture incidence declined from 600/100,000 to 400/100,000, without decline in the more rare femur fractures. Incidence rates for subtrochanteric and femoral shaft fractures were each below 20 per 100,000.


This study’s purpose is to describe the site-specific epidemiology of femur fractures among people aged 50 and older.


Using the National Hospital Discharge Survey from 1996 to 2006 and a large medical claims database (MarketScan®), we studied epidemiology of all femur fractures. Hip fractures were grouped together; subtrochanteric, shaft, and distal femur fractures were kept separate.


In females, the overall hospital discharge rates of hip fracture decreased from about 600/100,00 to 400/100,000 person-years from 1996 to 2006. Subtrochanteric, femoral shaft, and lower femur rates remained stable, each approximately 20 per 100,000 person-years. Similar trends but lower rates existed in males. No significant trends were found in any of these fractures during the more recent years of 2002–2006 (MarketScan data). Using MarketScan, the overall incidence of hip fracture was <300/100,000 person-years; incidence of subtrochanteric and femoral shaft fractures combined was <25/100,000 person-years and distal femur fracture incidence was <18/100,000 person-years in females; rates were lower in males. The incidence of hip and other femur fractures increased exponentially with age.


We found no evidence of an increasing incidence of any femoral fracture. Hip fracture incidence is declining but the incidence of each of the more rare femur fractures (distal to the lesser trochanter) is stable over time.


Bisphosphonates Femoral fractures Femoral shaft Subtrochanteric 



We thank the following people for their help in preparing this manuscript: David Cahall from Sanofi-aventis, Karen Driver, Didier Huber, Andrea Klemes, Jeff L. Lange, Darrel Russell, Richard Sheer, J. Mike Sprafka, and Diane Vonderheide from Procter and Gamble, and Barbara McCarty Garcia.

Conflicts of interest and financial disclosures

Dr. Nieves has attended advisory meetings for Merck and Bayer and is a member of the Speakers Bureau for Sciele Pharma, Inc.

Dr. Bilezikian is a consultant to the Alliance for Better Bone Health (a Procter & Gamble and Sanofi-aventis partnership), Merck, Lilly, Novartis, and Johnson & Johnson, has received research grants from the Alliance for Better Bone Health and Radius, and is on the Speakers Bureau for the Alliance for Better Bone Health, Novartis, and Lilly.

Dr. Lane is a consultant to BioMimetics, DFine, Innovative Clinical Solutions, Orthovita, Osteotech, Soteira, Zelos, and Zimmer, has received research grants from The Charles Cohn Foundation, and is on the Speakers Bureau for Lilly, Novartis, Procter & Gamble, and Sanofi-aventis.

Dr. Einhorn is a consultant to Eli Lilly, Novartis, Zelos, Amgen, and Pfizer and has received grants from Zelos.

Dr. Wang is an employee of Procter and Gamble.

Dr. Steinbuch is an employee of Procter and Gamble and holds company stock.

Dr. Cosman is a consultant or on an advisory board for Novartis, Eli Lilly, Merck, Amgen, Procter and Gamble, Pfizer, and Zosano and on the Speakers Bureau for Novartis and Eli Lilly.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • J. W. Nieves
    • 1
    • 2
  • J. P. Bilezikian
    • 1
  • J. M. Lane
    • 3
  • T. A. Einhorn
    • 4
  • Y. Wang
    • 5
  • M. Steinbuch
    • 5
  • F. Cosman
    • 1
    • 2
  1. 1.Departments of Epidemiology and MedicineColumbia UniversityNew YorkUSA
  2. 2.Clinical Research CenterHelen Hayes HospitalWest HaverstrawUSA
  3. 3.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  4. 4.Boston University Orthopaedic Surgical AssociatesBostonUSA
  5. 5.Epidemiology and Health OutcomesProcter & Gamble PharmaceuticalsMasonUSA

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