Hip fracture trends in the United States, 2002 to 2015
- 1.7k Downloads
An analysis of United States (US) Medicare claims data from 2002 to 2015 for women aged ≥ 65 years found that age-adjusted hip fracture rates for 2013, 2014, and 2015 were higher than projected, resulting in an estimated increase of more than 11,000 hip fractures.
Hip fractures are a major public health concern due to high morbidity, mortality, and healthcare expenses. Previous studies have reported a decrease in the annual incidence of hip fractures in the US beginning in 1995, coincident with the introduction of modern diagnostic tools and therapeutic agents for osteoporosis. In recent years, there has been less bone density testing and fewer prescriptions for osteoporosis treatments. The large osteoporosis treatment gap raises concern of possible adverse effects on hip fracture rates.
We assessed hip fracture incidence in the US to determine if the previous decline in hip fracture incidence continued. Using 2002 to 2015 Medicare Part A and Part B claims for women ≥ 65 years old, we calculated age-adjusted hip fracture rates, weighting to the 2014 population.
We found that hip fracture rates declined each year from 2002 to 2012 and then plateaued at levels higher than projected for years 2013, 2014, and 2015.
The plateau in age-adjusted hip fracture incidence rate resulted in more than 11,000 additional estimated hip fractures over the time periods 2013, 2014, and 2015. We recommend further study to assess all factors contributing to this remarkable change in hip fracture rate and to develop strategies to reduce the osteoporosis treatment gap.
KeywordsDXA Fracture Medicare Osteoporosis Reimbursement
Chris Hogan of Direct Research, LLC, participated in the development of this manuscript by extracting, collecting, and categorizing data from primary CMS dataset sources.
Acquisition and analysis of data for this study was provided by the National Bone Health Alliance and the International Society for Clinical Densitometry.
Compliance with ethical standards
Conflicts of interest
Dr. Lewiecki has received institutional grant/research support from Amgen, Merck, and Lilly; he has served on scientific advisory boards for Amgen, Merck, Lilly, and Radius. Dr. Steven is a paid data analyst for the International Society for Clinical Densitometry. Dr. Siris is a consultant for Amgen and Radius. Dr. Wright has received institutional grant/research support from Amgen and is a consultant for Pfizer. Dr. Saag has received research grants from Amgen, Lilly, and Merck and has served on scientific advisory boards for Amgen, Merck, and Radius. Dr. Adler has nothing to disclose. Dr. Singer has served on scientific advisory boards for Amgen, Lilly, and Radius; is a consultant for Amgen, Lilly, Merck, Radius, Medtronic, and Hologic; and is on the speakers’ bureau for Amgen and Lilly. Dr. Gagel has nothing to disclose.
- 1.US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the surgeon general. US Department of Health and Human Services, Office of the Surgeon General, RockvilleGoogle Scholar
- 9.Lewiecki EM, Adler RA, Curtis JR, Gagel R, Saag KG, Singer AJ, Siris E, Wright NC, Yun H, Steven PM (2016) Hip fractures and declining DXA testing: at a breaking point? J Bone Miner Res 31:S26Google Scholar
- 10.Centers for Medicare & Medicaid Services. Physician fee schedule search. U.S. Centers for Medicare & Medicaid ServicesGoogle Scholar
- 11.The Lewin Group (2007) Assessing the costs of performing DXA services in the office-based setting (survey data report prepared for American Association of Clinical Endocrinologists. International Society for Clinical Densitometry, The Endocrine Society, and American College of Rheumatology). The Lewin GroupGoogle Scholar
- 17.Brown JP, Morin S, Leslie W, Papaioannou A, Cheung AM, Davison KS, Goltzman D, da Hanley, Hodsman A, Josse R, Jovaisas A, Juby A, Kaiser S, Karaplis A, Kendler D, Khan A, Ngui D, Olszynski W, Ste-Marie LG, Adachi J (2014) Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays. Can Fam Physician 60(4):324–333PubMedPubMedCentralGoogle Scholar
- 20.Boonen S, Ferrari S, Miller PD, Eriksen EF, Sambrook PN, Compston J, Reid IR, Vanderschueren D, Cosman F (2012) Postmenopausal osteoporosis treatment with antiresorptives: effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective. J Bone Miner Res 27(5):963–974. https://doi.org/10.1002/jbmr.1570 CrossRefPubMedGoogle Scholar
- 26.Joinpoint Regression Program. Version 4.5.01 - June 2017 edn Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer InsitituteGoogle Scholar
- 27.US Preventive Services Task Force (2011) Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. AnnInternMed 154:356–364Google Scholar
- 29.Kim SC, Kim DH, Mogun H, Eddings W, Polinski JM, Franklin JM, Solomon DH (2016) Impact of the U.S. Food and Drug Administration’s safety-related announcements on the use of bisphosphonates after hip fracture. J Bone Miner Res 31(8):1536–1540. https://doi.org/10.1002/jbmr.2832 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Looker AC, Frenk SM (2015) Percentage of adults aged 65 and over with osteoporosis or low bone mass at the femur neck or lumbar spine: United States, 2005–2010. Division of Health and Nutrition Examination Surveys, CDCGoogle Scholar
- 34.US Census Bureau (2016) Population 65 years and over in the United States, 2015 American Community Survey 1-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S0103&prodType=table Accessed November 13, 2017
- 35.US Census Bureau (2001) Female population by age, race and Hispanic or Latino origin for the United States: 2000 https://www.census.gov/population/www/cen2000/briefs/phc-t9/tables/tab03.pdf, Accessed November 13, 2017