Osteoporosis International

, Volume 22, Issue 9, pp 2487–2497 | Cite as

Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis

  • K. Lippuner
  • A. W. Popp
  • P. Schwab
  • M. Gitlin
  • T. Schaufler
  • C. Senn
  • R. Perrelet
Original Article



In Switzerland, the total number and incidence of hospitalizations for major osteoporotic fractures increased between years 2000 and 2007, while hospitalizations due to hip fracture decreased. The cost impact of shorter hospital stays was offset by the increasing cost per day of hospitalization.


The aim of the study was to establish the trends and epidemiological characteristics of hospitalizations for major osteoporotic fractures (MOF) between years 2000 and 2007 in Switzerland.


Sex- and age-specific trends in the number and crude and age-standardized incidences of hospitalized MOF (hip, clinical spine, distal radius, and proximal humerus) in women and men aged ≥45 years were analyzed, together with the number of hospital days and cost of hospitalization, based on data from the Swiss Federal Statistical Office hospital database and population statistics.


Between 2000 and 2007, the absolute number of hospitalizations for MOF increased by 15.9% in women and 20.0% in men, mainly due to an increased number of non-hip fractures (+37.7% in women and +39.7% in men). Hospitalizations for hip fractures were comparatively stable (−1.8% in women and +3.3% in men). In a rapidly aging population, in which the number of individuals aged ≥45 years grew by 11.1% (women) and 14.6% (men) over the study period, the crude and age-standardized incidences of hospitalizations decreased for hip fractures and increased for non-hip MOF, both in women and men. The length of hospital stay decreased for all MOF in women and men, the cost impact of which was offset by an increase in the daily costs of hospitalization.


Between years 2000 and 2007, hospitalizations for MOF continued to increase in Switzerland, driven by an increasing number and incidence of hospitalizations for non-hip fractures, although the incidence of hip fractures has declined.


Cost Epidemiology Fractures Hip Osteoporosis Switzerland 



This work was supported by a research grant from Amgen Switzerland AG. We are grateful to Dr. Philippe Kress, Kressmed, Glattbrugg, Switzerland for his contribution to data analysis and his critical review of the manuscript. Amgen (Europe) GmbH and GlaxoSmithKline Ltd provided funds to Bioscript Stirling Ltd for editing and styling support.

Conflicts of interest

K. Lippuner has received research grants through the Osteoporosis Policlinic, University of Bern from Amgen, Novartis, Roche, Servier, and MSD. He has received speaker fees and/or was a member of a paid advisory board of Amgen, Daiichi Sankyo, Eli Lilly, MSD, Novartis, Nycomed Roche, and Servier. A. Popp has received consulting fees from Amgen, Eli Lilly, and MSD and also Speakers bureau from Daiichi-Sankyo, and Synthes. P. Schwab, C. Senn, and R. Perrelet have nothing to declare. M. Gitlin and T. Schaufler are employees of Amgen and may own stock and/or stock options.


  1. 1.
    (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  2. 2.
    Lippuner K, Johansson H, Kanis JA et al (2010) FRAX assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–389PubMedCrossRefGoogle Scholar
  3. 3.
    Lippuner K, Johansson H, Kanis JA et al (2009) Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 20:1131–1140PubMedCrossRefGoogle Scholar
  4. 4.
    Kanis JA, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRefGoogle Scholar
  5. 5.
    Melton LJ 3rd, Kearns AE, Atkinson EJ et al (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20:687–694PubMedCrossRefGoogle Scholar
  6. 6.
    Gehlbach SH, Avrunin JS, Puleo E (2007) Trends in hospital care for hip fractures. Osteoporos Int 18:585–591PubMedCrossRefGoogle Scholar
  7. 7.
    Brauer CA, Coca-Perraillon M, Cutler DM et al (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579PubMedCrossRefGoogle Scholar
  8. 8.
    Leslie WD, O'Donnell S, Jean S et al (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889PubMedCrossRefGoogle Scholar
  9. 9.
    Jaglal S (2007) Falling hip fracture rates. J Bone Miner Res 22:1098, author reply 1099PubMedCrossRefGoogle Scholar
  10. 10.
    Orimo H, Yaegashi Y, Onoda T et al (2009) Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends. Arch Osteoporos 4:71–77PubMedCrossRefGoogle Scholar
  11. 11.
    Kannus P, Niemi S, Parkkari J et al (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–1838PubMedCrossRefGoogle Scholar
  12. 12.
    Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21:373–380PubMedCrossRefGoogle Scholar
  13. 13.
    Maravic M, Taupin P, Landais P et al (2010) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int. doi: 10.1007/s00198-010-1255-9
  14. 14.
    Chevalley T, Guilley E, Herrmann FR et al (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289PubMedCrossRefGoogle Scholar
  15. 15.
    Guilley E, Chevalley T, Herrmann F et al (2008) Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women. Osteoporos Int 19:1741–1747PubMedCrossRefGoogle Scholar
  16. 16.
    Mann E, Icks A, Haastert B et al (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994–2006. BMC Geriatr 8:35PubMedCrossRefGoogle Scholar
  17. 17.
    Hernandez JL, Olmos JM, Alonso MA et al (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470PubMedCrossRefGoogle Scholar
  18. 18.
    Wildner M, Clark DE (2001) Hip fracture incidence in East and West Germany: reassessement ten years after unification. Osteoporos Int 12:136–139PubMedCrossRefGoogle Scholar
  19. 19.
    Icks A, Haastert B, Wildner M et al (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–1145PubMedCrossRefGoogle Scholar
  20. 20.
    Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16(Suppl 2):S8–S17PubMedCrossRefGoogle Scholar
  21. 21.
    Lippuner K, von Overbeck J, Perrelet R et al (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 7:414–425PubMedCrossRefGoogle Scholar
  22. 22.
    (2009) Swiss Federal Statistical Office. Plausibility of medical statistics: the MedPlaus 5.0 concept. Available online under ≤http://www.freudiger.com/download/mp5_konzept_D_20091029.pdf≥. Accessed Oct 2010
  23. 23.
    (2004) Swiss Federal Statistical Office. Data quality evaluation of medical statistics in 1998–2001. Available online under ≤http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/22/publ.html?publicationID=1306≥. Accessed Oct 2010
  24. 24.
    Lewinnek GE, Kelsey J, White AA 3rd et al (1980) The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthop Relat Res 152:35–43Google Scholar
  25. 25.
    (2009) Swiss Federal Statistical Office. Hospital statistics between year 2000 and year 2007. Available online under http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/03/01/data/01.html and http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/03/01/key/01.html. Accessed 15 Feb 2010
  26. 26.
    Robine JM, Paccaud F (2005) Nonagenarians and centenarians in Switzerland, 1860–2001: a demographic analysis. J Epidemiol Community Health 59:31–37PubMedCrossRefGoogle Scholar
  27. 27.
    Mathers CD, Murray CJL, Lopez AD et al (2001) World Health Organization global programme on evidence for health policy. Discussion Paper No. 38 http://www.who.int/healthinfo/paper38.pdf. Accessed 13 May 2006
  28. 28.
    Bundesamt für Statistik: Mortality and life expectancy tables. http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/06/blank/key/04.html. Accessed 20 Feb 2010
  29. 29.
    Bundesamt für Statistik. Szenarien zur Bevölkerungsentwicklung der Schweiz 2005–2050. http://www.bfs.admin.ch/bfs/portal/de/index/news/publikationen.Document.83713.pdf. Accessed 14 May 2008
  30. 30.
    Bergstrom U, Jonsson H, Gustafson Y et al (2009) The hip fracture incidence curve is shifting to the right. Acta Orthop 80:520–524PubMedCrossRefGoogle Scholar
  31. 31.
    Rossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRefGoogle Scholar
  32. 32.
    Beral V, Banks E, Reeves G (2002) Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet 360:942–944PubMedCrossRefGoogle Scholar
  33. 33.
    Meyer HE, Lofthus CM, Sogaard AJ et al (2009) Change in the use of hormone replacement therapy and the incidence of fracture in Oslo. Osteoporos Int 20:827–830PubMedCrossRefGoogle Scholar
  34. 34.
    Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541PubMedCrossRefGoogle Scholar
  35. 35.
    Black DM, Delmas PD, Eastell R et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRefGoogle Scholar
  36. 36.
    Melton LJ 3rd, Kanis JA, Johnell O (2005) Potential impact of osteoporosis treatment on hip fracture trends. J Bone Miner Res 20:895–897PubMedCrossRefGoogle Scholar
  37. 37.
    Chapuy MC, Arlot ME, Duboeuf F et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedCrossRefGoogle Scholar
  38. 38.
    Birks YF, Porthouse J, Addie C et al (2004) Randomized controlled trial of hip protectors among women living in the community. Osteoporos Int 15:701–706PubMedCrossRefGoogle Scholar
  39. 39.
    Harada A, Mizuno M, Takemura M et al (2001) Hip fracture prevention trial using hip protectors in Japanese nursing homes. Osteoporos Int 12:215–221PubMedCrossRefGoogle Scholar
  40. 40.
    Kiel DP, Magaziner J, Zimmerman S et al (2007) Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. JAMA 298:413–422PubMedCrossRefGoogle Scholar
  41. 41.
    Tinetti ME, Baker DI, King M et al (2008) Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 359:252–261PubMedCrossRefGoogle Scholar
  42. 42.
    Dargent-Molina P, Favier F, Grandjean H et al (1996) Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 348:145–149PubMedCrossRefGoogle Scholar
  43. 43.
    Looker AC, Melton LJ 3rd, Harris TB et al (2010) Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res 25:64–71Google Scholar
  44. 44.
    Kannus P, Niemi S, Parkkari J et al (2009) Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006. Osteoporos Int 20:43–46PubMedCrossRefGoogle Scholar
  45. 45.
    Kannus P, Palvanen M, Niemi S et al (2008) Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970–2006 and prediction for the future. Bone 43:340–342PubMedCrossRefGoogle Scholar
  46. 46.
    Palvanen M, Kannus P, Niemi S et al (2009) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358PubMedCrossRefGoogle Scholar
  47. 47.
    Hulme PA, Krebs J, Ferguson SJ et al (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976) 31:1983–2001Google Scholar
  48. 48.
    (2004) 5-year comparison of the inpatient and outpatient costs between 1999 and 2003. Swiss Health Observatory OBSAN. http://www.obsan.admin.ch/bfs/obsan/de/index/05/01.Document.105404.pdf. Accessed 16 Jun 2010
  49. 49.
    Cranney A, Tugwell P, Zytaruk N et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. IV. Meta-analysis of raloxifene for the prevention and treatment of postmenopausal osteoporosis. Endocr Rev 23:524–528PubMedCrossRefGoogle Scholar
  50. 50.
    Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645PubMedCrossRefGoogle Scholar
  51. 51.
    Siris ES, Harris ST, Eastell R et al (2005) Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study. J Bone Miner Res 20:1514–1524PubMedCrossRefGoogle Scholar
  52. 52.
    Tang BM, Eslick GD, Nowson C et al (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–666PubMedCrossRefGoogle Scholar
  53. 53.
    Suhm N, Lamy O, Lippuner K (2008) Management of fragility fractures in Switzerland: results of a nationwide survey. Swiss Med Wkly 138:674–683PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • K. Lippuner
    • 1
  • A. W. Popp
    • 1
  • P. Schwab
    • 2
  • M. Gitlin
    • 3
  • T. Schaufler
    • 4
  • C. Senn
    • 1
  • R. Perrelet
    • 1
  1. 1.Osteoporosis Policlinic, InselspitalBern University Hospital, University of BernBernSwitzerland
  2. 2.Swiss Federal Statistical OfficeNeuchâtelSwitzerland
  3. 3.Amgen (Europe) GmbHZugSwitzerland
  4. 4.Amgen (Switzerland) AGZugSwitzerland

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