Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium

  • E. L. YongEmail author
  • G. Ganesan
  • M.S. Kramer
  • S. Logan
  • T.C. Lau
  • J.A. Cauley
  • K.B. TanEmail author
Original Article



Despite an increase in absolute numbers, the age-standardized incidence of hip fractures in Singapore declined in the period 2000 to 2017. Among the three major ethnic groups, Chinese women had the highest fracture rates but were the only group to show a temporal decline.


A study published in 2001 predicted a 30–50% increase in Singapore hip fracture incidence rates over the ensuing 30 years. To test that prediction, we examined the incidence of hip fracture in Singapore from 2000 to 2017.


We carried out a population-based study of hip fractures among Singapore residents aged ≥ 50 years. National medical insurance claims data were used to identify admissions with a primary discharge diagnosis of hip fracture. Age-adjusted rates, based on the age distribution of the Singapore population of 2000, were analyzed separately by sex and ethnicity (Chinese, Malay, or Indian).


Over the 18-year study period, 36,082 first hip fractures were recorded. Total hip fracture admissions increased from 1487 to 2729 fractures/year in the years 2000 to 2017. Despite this absolute increase, age-adjusted fracture rates declined, with an average annual change of − 4.3 (95% CI − 5.0, − 3.5) and − 1.1 (95% CI − 1.7, − 0.5) fractures/100,000/year for women and men respectively. Chinese women had 1.4- and 1.9-fold higher age-adjusted rates than Malay and Indian women: 264 (95% CI 260, 267) versus 185 (95% CI 176, 193) and 141 (95% CI 132, 150) fractures/100,000/year, respectively. Despite their higher fracture rates, Chinese women were the only ethnic group exhibiting a decline, most evident in those ≥ 85 years, in age-adjusted fracture rate of − 5.3 (95% CI − 6.0, − 4.5) fractures/100,000/year.


Although the absolute number of fractures increased, steep drops in elderly Chinese women drove a reduction in overall age-adjusted hip fracture rates. Increases in the older population will lead to a rise in total number of hip fractures, requiring budgetary planning and new preventive strategies.


Ethnic differences Hip fracture rates Singapore 



This study was partially funded by a Singapore National Medical Research Council Grant (Number CSASI16May007) to ELY.

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2019_4839_MOESM1_ESM.docx (79 kb)
Supplementary Table 1 (DOCX 79 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNational University of SingaporeSingaporeSingapore
  2. 2.Division of Policy, Research and EvaluationMinistry of HealthSingaporeSingapore
  3. 3.Departments of Epidemiology, Biostatistics & Occupational Health and of PediatricsMcGill University Faculty of MedicineMontrealCanada
  4. 4.Department of MedicineNational University Hospital, National University of SingaporeSingaporeSingapore
  5. 5.Graduate School of Public Health, Department of EpidemiologyUniversity of PittsburghPittsburghUSA
  6. 6.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore

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