Osteoporosis International

, Volume 24, Issue 3, pp 849–857 | Cite as

Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis

  • B. McGowan
  • M. C. Casey
  • C. Silke
  • B. Whelan
  • K. Bennett
Original Article



In Ireland, the absolute numbers of hospitalisations for all osteoporotic-type fractures including hip fractures increased between 2000 and 2009 along with the mean length of stay. The cost of hospitalisations for these fractures also increased between 2003 and 2008.


The purposes of the study were to carry out a trend analyses of the total number of osteoporotic-type fractures in males and females aged 50 years and over in Ireland between 2000 and 2009 and to project the number of osteoporotic-type fractures in the Republic of Ireland expected by 2025.


Age- and gender-specific trends in the absolute numbers and direct age-standardised rates of hospitalisations for all osteoporotic-type fractures in men and women ≥50 years were analysed, along with the associated hospitalisation costs and length of stay using the Hospital In-Patient Enquiry system database. Future projections of absolute numbers of osteoporotic-type fractures in years 2015, 2020 and 2025 were computed based on the 2009 incidence rates applied to the projected populations.


Between 2000 and 2009, the absolute numbers of all osteoporotic-type fractures increased by 12 % in females and by 15 % in males while the absolute numbers of hip fractures increased by 7 % in women and by 20 % in men. The age-specific rates for hip fractures decreased in all age groups with the exception of the 55–59-year age group which showed an increase of 4.1 % (p = 0.023) within the study period. The associated hospitalisation costs and length of stay increased. Assuming stable age-standardised incidence rates from 2009 over the next 20 years, the number of all types of osteoporotic-type fractures is projected to increase by 79 % and the number of hip fractures is expected to increase by 88 % by 2025.


Hospitalisations for osteoporotic-type fractures continued to increase in Ireland. Hip fractures increased by 7 % in women and 20 % in men.


Bed days Costs Fractures Osteoporosis Projections Trends 



We would like to thank the Health Research Board in Ireland for providing the funding for this project. We would also like to thank the HSE-PCRS scheme for providing the data on which the study was based and Health Atlas Ireland for providing access to the HIPE data and DRG costs.

Conflicts of interest



  1. 1.
    Anonymous (1993) Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  2. 2.
    Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16:S3–S7PubMedCrossRefGoogle Scholar
  3. 3.
    Melton LJ 3rd, Kearns AE, Atkinson EJ et al (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20:687–694PubMedCrossRefGoogle Scholar
  4. 4.
    Gehlbach SH, Avrunin JS, Puleo E (2007) Trends in hospital care for hip fractures. Osteoporos Int 18:585–591PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Leslie WD, O’Donnell S, Jean S et al (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889PubMedCrossRefGoogle Scholar
  7. 7.
    Jaglal S (2007) Falling hip fracture rates. J Bone Miner Res 22:1098, author reply 1099PubMedCrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Kannus P, Niemi S, Parkkari J et al (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–1838PubMedCrossRefGoogle Scholar
  10. 10.
    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
  11. 11.
    Maravic M, Taupin P, Landais P et al (2010) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int 22:797–801. doi: 10.1007/s00198-010-1255-9 PubMedCrossRefGoogle Scholar
  12. 12.
    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
  13. 13.
    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
  14. 14.
    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
  15. 15.
    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
  16. 16.
    Wildner M, Clark DE (2001) Hip fracture incidence in East and West Germany: reassessement ten years after unification. Osteoporos Int 12:136–139PubMedCrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    Green C, Molony D, Fitzpatrick C, O’Rourke K (2010) Age-specific incidence of hip fracture in the elderly: a healthy decline. Surgeon 8(6):310–313PubMedCrossRefGoogle Scholar
  19. 19.
    Dodds MK, Codd MB, Looney A, Mulhall KJ (2009) Incidence of hip fracture in the Republic of Ireland and future projections: a population-based study. Osteoporos Int 20:2105–2110PubMedCrossRefGoogle Scholar
  20. 20.
    Interim Performance Monitoring Report May 2008. National Service Plan, Accessed 13 Jun 2011
  21. 21.
    The Diagnosis Related Groups (DRGs) to adjust payment mechanisms for health system providers. Accessed 13 Jun 2011
  22. 22.
    Lippuner K, Popp AW, Schwab P, Gitlin M et al (2011) Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis. Osteoporosis Int 22:2487–2497. doi: 10.1007/s00198-010-1487-8 CrossRefGoogle Scholar
  23. 23.
    Cooper C, Cole ZA, Holroyd CR et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288PubMedCrossRefGoogle Scholar
  24. 24.
    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
  25. 25.
    Schnitzer T, Bone HG, Crepaldi G et al (2000) Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group. Aging (Milano) 12:1–12Google Scholar
  26. 26.
    Brown JP, Kendler DL, McClung MR et al (2002) The efficacy and tolerability of risedronate once a week for the treatment of post-menopausal osteoporosis. Calcif Tissue Int 71:103–111PubMedCrossRefGoogle Scholar
  27. 27.
    Chestnut CH, Skag A, Christiansen C et al (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249CrossRefGoogle Scholar
  28. 28.
    Reginster JY, Adami S, Lakatos P et al (2006) Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study. Ann Rheum Dis 65:654–661PubMedCrossRefGoogle Scholar
  29. 29.
    Delmas PD, McClung MR, Zanchetta JR et al (2008) Efficacy and safety of risedronate 150 mg once a month in the treatment of postmenopausal osteoporosis. Bone 42:36–42PubMedCrossRefGoogle Scholar
  30. 30.
    Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Törring O, Gallagher JC, Farrerons J, Wang A, Franchimont N, San Martin J, Grauer A, McClung M (2011) Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 96(6):1727–1736PubMedCrossRefGoogle Scholar
  31. 31.
    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):105–111PubMedCrossRefGoogle Scholar
  32. 32.
    McGowan B, Bennett K (2012) Adherence with antiosteoporosis medications: a primary–care study. Prescriber, 34–37Google Scholar
  33. 33.
    Hulme PA, Krebs J, Ferguson SJ et al (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976) 31:1983–2001CrossRefGoogle Scholar
  34. 34.
    Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Holenbeak CS (2012) Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg 94:9–17PubMedCrossRefGoogle Scholar
  35. 35.
    Population Ageing in Ireland. Projections 2002–2021 ( Accessed 10 Jun 2011
  36. 36.
    Statistics/Health in Ireland: Key Trends, 2010/Population and Life Expectancy…and_life_expectancy/figure_1-3.html Accessed 10 Jun 2011
  37. 37.
    Raisz LG (2005) Clinical practice screening for osteoporosis. N Engl J Med 353(2):164–171PubMedCrossRefGoogle Scholar
  38. 38.
    Chrischilles EA, Dashback EJ, Rubenstein LM, Cook JR, Tabor HK, Black DM, Fracture Intervention Trial Research Group (2001) The effect of alendronate on fracture-related healthcare utilization and costs: the fracture intervention trial. Osteoporos Int 12:654–660PubMedCrossRefGoogle Scholar
  39. 39.
    Johnell O, Jonssen B, Jonssen L, Black D (2003) Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314PubMedCrossRefGoogle Scholar
  40. 40.
    Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352PubMedCrossRefGoogle Scholar
  41. 41.
    Reginster JY, Felsenberg D, Boonen S, Diez-Perez A, Rizzoli R, Brandi ML, Spector TD, Brixen K, Goemaere S, Cormier C, Balogh A, Delmas PD, Meunier PJ (2008) Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: results of a five-year randomized, placebo-controlled trial. Arthris Rheum 58(6):1687–1695CrossRefGoogle Scholar
  42. 42.
    Lundkvist J, Johnell O, Cooper C, Sykes D (2006) Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women. Osteoporos Int 17:201–211PubMedCrossRefGoogle Scholar
  43. 43.
    Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C, Freedom Trial (2009) Denosumab for the prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 351(8):756–765CrossRefGoogle Scholar
  44. 44.
    Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296:1029–1031PubMedCrossRefGoogle Scholar
  45. 45.
    Report of the National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of Osteoporosis throughout Life. Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population. 2008 January.…/Older/Strategy_to_Prevent_Falls_and_Fractures_in_Ireland’s_Ageing_Population_-_Full_report.pdf
  46. 46.
    White C (2010) UK hip fracture audit shows wide variation in standards of care. BMJ 341:c4813PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • B. McGowan
    • 1
    • 3
  • M. C. Casey
    • 2
  • C. Silke
    • 3
  • B. Whelan
    • 3
  • K. Bennett
    • 1
  1. 1.Department of Pharmacology and Therapeutics, Trinity Centre for Health SciencesSt. James’s HospitalDublin 8Ireland
  2. 2.Osteoporosis and Bone Health Clinic, Medicine for the ElderlySt. James’s HospitalDublin 8Ireland
  3. 3.The North Western Rheumatology UnitOur Lady’s HospitalManorhamiltonIreland

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