Secular trends in the incidence of hip and other osteoporotic fractures

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. 1.

    Cummings SR, Melton LJ III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    PubMed  Article  Google Scholar 

  2. 2.

    Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Johnell O, Gullberg B, Allander E, Kanis JA (1992) The apparent incidence of hip fracture in Europe: a study of national register sources. MEDOS study group. Osteoporos Int 2:298–302

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Yan L, Zhou B, Prentice A, Wang X, Golden MH (1999) Epidemiological study of hip fracture in Shenyang, People’s Republic of China. Bone 24:151–155

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Morales-Torres J, Gutierrez-Urena S (2004) The burden of osteoporosis in Latin America. Osteoporos Int 15:625–632

    PubMed  Article  Google Scholar 

  6. 6.

    Kaastad TS, Meyer HE, Falch JA (1998) Incidence of hip fracture in Oslo, Norway: differences within the city. Bone 22:175–178

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Sanders KM, Nicholson GC, Ugoni AM, Seeman E, Pasco JA, Kotowicz MA (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Community Health 56:466–470

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Gullberg B, Johnell O, Kanis J (1997) Worldwide projections for hip fracture. Osteoporos Int 7:407–413

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Melton LJ III, O’Fallon WM, Riggs BL (1987) Secular trends in the incidence of hip fractures. Calcif Tissue Int 41:57–64

    PubMed  Article  Google Scholar 

  10. 10.

    Evans JG, Seagroatt V, Goldacre MJ (1997) Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968–86. J Epidemiol Community Health 51:424–429

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Frandsen PA, Kruse T (1983) Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates. Acta Orthop Scand 54:681–686

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Zain Elabdien BS, Olerud S, Karlstrom G, Smedby B (1984) Rising incidence of hip fracture in Uppsala, 1965–1980. Acta Orthop Scand 55:284–289

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Melton LJ III, Therneau TM, Larson DR (1998) Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Osteoporos Int 8:68–74

    PubMed  Article  Google Scholar 

  14. 14.

    Melton LJ III, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM et al (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20:687–694

    PubMed  Article  Google Scholar 

  15. 15.

    Rodriguez JG, Sattin RW, Waxweiler RJ (1989) Incidence of hip fractures, United States, 1970–83. Am J Prev Med 5:175–181

    PubMed  CAS  Google Scholar 

  16. 16.

    Bacon WE (1996) Secular trends in hip fracture occurrence and survival: age and sex differences. J Aging Health 8:538–553

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    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 Public Health 92:858–862

    PubMed  Article  Google Scholar 

  18. 18.

    Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (1999) Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 353:802–805

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A, For the Osteoporosis Surveillance Expert Working Group (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Zingmond DS, Melton LJ III, Silverman SL (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15:603–610

    PubMed  Article  Google Scholar 

  22. 22.

    Johansson H, Clark P, Carlos F, Oden A, McCloskey EV, Kanis JA (2010) Increasing age and sex specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security. Osteoporos Int. doi:10.1007/s00198-010-1475-z

    Google Scholar 

  23. 23.

    Jaglal SB, Sherry PG, Schatzker J (1996) The impact and consequences of hip fracture in Ontario. Can J Surg 39:105–111

    PubMed  CAS  Google Scholar 

  24. 24.

    Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905

    PubMed  Article  Google Scholar 

  25. 25.

    Levy AR, Mayo NE, Grimard G (1995) Rates of transcervical and pertrochanteric hip fractures in the province of Quebec, Canada, 1981–1992. Am J Epidemiol 142:428–436

    PubMed  CAS  Google Scholar 

  26. 26.

    Sernbo I, Gullberg B, Johnell O (1993) Hip fracture in Malmo over three decades. Bone 14(Suppl 1):S19–S22

    PubMed  Article  Google Scholar 

  27. 27.

    Rogmark C, Sernbo I, Johnell O, Nilsson JA (1999) Incidence of hip fractures in Malmo, Sweden, 1992–1995. A trend-break. Acta Orthop Scand 70:19–22

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L et al (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    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 17:552–564

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–1838

    PubMed  Article  Google Scholar 

  31. 31.

    Lonnroos E, Kautiainen H, Karppi P, Huusko T, Hartikainen S, Kiviranta I et al (2006) Increased incidence of hip fractures. A population based-study in Finland. Bone 39:623–627

    PubMed  Article  Google Scholar 

  32. 32.

    Abrahamsen B, Vestergard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21:373–380

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Spector TD, Cooper C, Lewis AF (1990) Trends in admissions for hip fracture in England and Wales, 1968–85. BMJ 300:1173–1174

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Balasegaram S, Majeed A, Fitz-Clarence H (2002) Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Public Health Med 23:11–17

    Google Scholar 

  35. 35.

    Boereboom FT, de Groot RR, Raymakers JA, Duursma SA (1991) The incidence of hip fractures in The Netherlands. Neth J Med 38:51–58

    PubMed  CAS  Google Scholar 

  36. 36.

    Goettsch WG, de Jong RB, Kramarz P, Herings RM (2007) Developments of the incidence of osteoporosis in The Netherlands: a PHARMO study. Pharmacoepidemiol Drug Saf 16:166–172

    PubMed  Article  Google Scholar 

  37. 37.

    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 40:1284–1289

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Mann E, Icks A, Haastert B, Meyer G (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr 8:35

    PubMed  Article  Google Scholar 

  39. 39.

    Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–1145

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Pentek M, Horvath C, Boncz I, Falusi Z, Toth E, Sebestyen A et al (2008) Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003. Osteoporos Int 19:243–249

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwetter E, Chandran M, Borgstrom F (2010) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int. doi:10.1007/s00198-010-1271-9

    Google Scholar 

  42. 42.

    Maravic M, Taupin P, Landais P, Roux C (2010) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int. doi:10.1007/s00198-010-1255-9

    PubMed  Google Scholar 

  43. 43.

    Agnusdei D, Camporeale A, Gerardi D, Rossi S, Bocchi L, Gennari C (1993) Trends in the incidence of hip fracture in Siena, Italy, from 1980 to 1991. Bone 14(Suppl 1):S31–S34

    PubMed  Article  Google Scholar 

  44. 44.

    Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M et al (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470

    PubMed  Article  Google Scholar 

  45. 45.

    Rockwood PR, Horne JG, Cryer C (1990) Hip fractures: a future epidemic? J Orthop Trauma 4:388–393

    PubMed  CAS  Google Scholar 

  46. 46.

    Fielden J, Purdie G, Horne G, Devane P (2001) Hip fracture incidence in New Zealand, revisited. N Z Med J 114:154–156

    PubMed  CAS  Google Scholar 

  47. 47.

    Chang KP, Center JR, Nguyen TV, Eisman JA (2004) Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 19:532–536

    PubMed  Article  Google Scholar 

  48. 48.

    Boufous S, Finch CF, Lord SR (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626

    PubMed  Google Scholar 

  49. 49.

    Chalmers J, Ho KC (1970) Geographical variations in senile osteoporosis. The association with physical activity. J Bone Joint Surg Br 52:667–675

    PubMed  CAS  Google Scholar 

  50. 50.

    Lau EM, Cooper C, Wickham C, Donnan S, Barker DJ (1990) Hip fracture in Hong Kong and Britain. Int J Epidemiol 19:1119–1121

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Lau EM, Cooper C, Fung H, Lam D, Tsang KK (1999) Hip fracture in Hong Kong over the last decade—a comparison with the UK. J Public Health Med 21:249–250

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China the Beijing Osteoporosis Project. Am J Epidemiol 144:901–907

    PubMed  CAS  Google Scholar 

  53. 53.

    Koh LK, Saw SM, Lee JJ, Leong KH, Lee J (2001) Hip fracture incidence rates in Singapore 1991–1998. Osteoporos Int 12:311–318

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R (2005) Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001. Osteoporos Int 16:1963–1968

    PubMed  Article  Google Scholar 

  55. 55.

    Hagino H, Furukawa K, Fujiwara S, Okano T, Katagiri H, Yamamoto K et al (2009) Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int 20:543–548

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018

    PubMed  Article  Google Scholar 

  57. 57.

    Ling X, Cummings SR, Mingwei Q, Xihe Z, Xioashu C, Nevitt M et al (2000) Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project. J Bone Miner Res 15:2019–2025

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Cooper C, Atkinson EJ, Kotowicz M, O’Fallon WM, Melton LJ III (1992) Secular trends in the incidence of postmenopausal vertebral fractures. Calcif Tissue Int 51:100–104

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Islam S, Liu Q, Chines A, Helzner E (2009) Trend in incidence of osteoporosis-related fractures among 40- to 69-year-old women: analysis of a large insurance claims database, 2000–2005. Menopause 16:77–83

    PubMed  Article  Google Scholar 

  60. 60.

    Lad SP, Patil CG, Lad EM, Boakye M (2007) Trends in pathological vertebral fractures in the United States: 1993 to 2004. J Neurosurg Spine 7:305–310

    PubMed  Article  Google Scholar 

  61. 61.

    Bengner U, Johnell O, Redlund-Johnell I (1988) Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif Tissue Int 42:293–296

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Melton LJ III, Amadio PC, Crowson CS, O’Fallon WM (1998) Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 8:341–348

    PubMed  Article  Google Scholar 

  63. 63.

    Boufous S, Finch C, Lord S, Close J, Gothelf T, Walsh W (2006) The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia. Bone 39:1144–1148

    PubMed  Article  Google Scholar 

  64. 64.

    Jonsson B, Bengner U, Redlund-Johnell I, Johnell O (1999) Forearm fractures in Malmo, Sweden. Changes in the incidence occurring during the, 1950s, 1980s and 1990s. Acta Orthop Scand 70:129–132

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Oskam J, Kingma J, Klasen HJ (1998) Fracture of the distal forearm: epidemiological developments in the period 1971–1995. Injury 29:353–355

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Lauritzen JB, Schwarz P, Lund B, McNair P, Transbol I (1993) Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int 3:127–132

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Kannus P, Niemi S, Palvanen M, Sievanen H, Parkkari J, Jarvinen M (2008) Rising incidence of low-trauma fractures of the calcaneus and foot among Finnish older adults. J Gerontol A Biol Sci Med Sci 63:642–645

    PubMed  Google Scholar 

  68. 68.

    Palvanen M, Kannus P, Niemi S, Parkkari J (2004) Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int 15:649–653

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    Palvanen M, Kannus P, Niemi S, Parkkari J (1998) Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol 14:159–164

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Kannus P, Niemi S, Parkkari J, Sievanen H, Palvanen M (2009) Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006. Osteoporos Int 20:43–46

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Boufous S, Finch C, Lord S, Close J (2005) The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 36:1323–1329

    PubMed  Article  Google Scholar 

  72. 72.

    Siris ES, Selby PL, Saag KG, Borgstrom F, Herings RM, Silverman SL (2009) Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 122(Suppl 2):S3–S13

    PubMed  Article  Google Scholar 

  73. 73.

    Guilley E, Chevalley T, Herrmann F, Baccino D, Hoffmeyer P, Rapin CH, Rizzoli R (2008) Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women. Osteoporos Int 19:1741–1747

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    Lees B, Molleson T, Arnett TR, Stevenson JC (1993) Differences in proximal femur bone density over two centuries. Lancet 341:673–675

    PubMed  Article  CAS  Google Scholar 

  75. 75.

    Hui SL, Slemenda CW, Johnston CC Jr (1990) The contribution of bone loss to postmenopausal osteoporosis. Osteoporos Int 1:30–34

    PubMed  Article  CAS  Google Scholar 

  76. 76.

    Kyle UG, Pichard C (2006) The Dutch Famine of 1944–1945: a pathophysiological model of long-term consequences of wasting disease. Curr Opin Clin Nutr Metab Care 9:388–394

    PubMed  Article  Google Scholar 

  77. 77.

    Dennison E, Hindmarsh P, Fall C, Kellingray S, Barker D, Phillips D et al (1999) Profiles of endogenous circulating cortisol and bone mineral density in healthy elderly men. J Clin Endocrinol Metab 84:3058–3063

    PubMed  Article  CAS  Google Scholar 

  78. 78.

    Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ et al (2006) Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 367:36–43

    PubMed  Article  CAS  Google Scholar 

  79. 79.

    Mahon P, Harvey N, Crozier S, Inskip H, Robinson S, Arden N et al (2009) Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res 25:14–19

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the Medical Research Council, International Osteoporosis Foundation and NIHR Musculoskeletal Biomedical Research Unit, Oxford. The manuscript was prepared by Vivienne Cresdee and Gill Strange. It is endorsed by the Committee of Scientific Advisors of the IOF.

Conflicts of interest

None.

Author information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to C. Cooper.

Additional information

The IOF CSA Working Group on Fracture Epidemiology: Adachi J., Borgström F., Dimai H.P., Clark P., Lau E., Lewiecki E.M., Lips P., Lorenc R., McCloskey E., Ortolani S., Papaioannou A., Silverman S., Wahl D.A., and Yoshimura N.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cooper, C., Cole, Z.A., Holroyd, C.R. et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22, 1277 (2011). https://doi.org/10.1007/s00198-011-1601-6

Download citation

Keywords

  • Epidemiology
  • Hip fracture
  • Incidence
  • Osteoporosis
  • Temporal trend