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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
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, Rockville
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475. https://doi.org/10.1359/jbmr.061113
Gu Q, Koenig L, Mather RC 3rd, Tongue J (2014) Surgery for hip fracture yields societal benefits that exceed the direct medical costs. Clin Orthop Relat Res 472(11):3536–3546. https://doi.org/10.1007/s11999-014-3820-6
Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7. https://doi.org/10.1007/s00198-004-1702-6
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, Fragility Fracture Network Rehabilitation Research Special Interest G (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158
Riggs BL, Melton LJ III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(Suppl):505S–511S. https://doi.org/10.1016/8756-3282(95)00258-4
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579. https://doi.org/10.1001/jama.2009.1462
Gillespie CW, Morin PE (2017) Trends and disparities in osteoporosis screening among women in the United States, 2008–2014. Am J Med 130(3):306–316. https://doi.org/10.1016/j.amjmed.2016.10.018
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:S26
Centers for Medicare & Medicaid Services. Physician fee schedule search. U.S. Centers for Medicare & Medicaid Services
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 Group
Lee E, Wutoh AK, Xue Z, Hillman JJ, Zuckerman IH (2006) Osteoporosis management in a Medicaid population after the Women’s Health Initiative study. J Women's Health (Larchmt) 15(2):155–161. https://doi.org/10.1089/jwh.2006.15.155
Jha S, Wang Z, Laucis N, Bhattacharyya T (2015) Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: an ecological analysis. J Bone Miner Res 30(12):2179–2187. https://doi.org/10.1002/jbmr.2565
Sambrook PN, Chen JS, Simpson JM, March LM (2010) Impact of adverse news media on prescriptions for osteoporosis: effect on fractures and mortality. Med J Aust 193(3):154–156
Waller PC, Evans SJ, Beard K (2006) Drug safety and the media. Br J Clin Pharmacol 61(2):123–126. https://doi.org/10.1111/j.1365-2125.2005.02528.x
McIntosh J, Blalock SJ (2005) Effects of media coverage of Women’s Health Initiative study on attitudes and behavior of women receiving hormone replacement therapy. Am J Health Syst Pharm 62(1):69–74
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):324–333
McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, Hanley DA, Kendler DL, Yuen CK, Lewiecki EM (2013) Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med 126(1):13–20. https://doi.org/10.1016/j.amjmed.2012.06.023
Diab DL, Watts NB (2013) Bisphosphonate drug holiday: who, when and how long. Ther Adv Musculoskelet Dis 5(3):107–111. https://doi.org/10.1177/1759720X13477714
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
Compston JE, Bilezikian JP (2012) Bisphosphonate therapy for osteoporosis: the long and short of it. J Bone Miner Res 27(2):240–242. https://doi.org/10.1002/jbmr.1542
Drake MT, Clarke BL, Lewiecki EM (2015) The pathophysiology and treatment of osteoporosis. Clin Ther 37(8):1837–1850. https://doi.org/10.1016/j.clinthera.2015.06.006
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937. https://doi.org/10.1002/jbmr.2202
Wysowski DK, Greene P (2013) Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002–2012. Bone 57(2):423–428. https://doi.org/10.1016/j.bone.2013.09.008
Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19:335–351 (correction: 2001;2020:2655)
Joinpoint Regression Program. Version 4.5.01 - June 2017 edn Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Insititute
US Preventive Services Task Force (2011) Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. AnnInternMed 154:356–364
Miller PD (2016) Underdiagnosis and undertreatment of osteoporosis: the battle to be won. J Clin Endocrinol Metab 101(3):852–859. https://doi.org/10.1210/jc.2015-3156
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
Khosla S, Shane E (2016) A crisis in the treatment of osteoporosis. J Bone Miner Res 31(8):1485–1487. https://doi.org/10.1002/jbmr.2888
Imel EA, Eckert G, Modi A, Li Z, Martin J, de Papp A, Allen K, Johnston CC, Hui SL, Liu Z (2016) Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates. Bone 83:267–275. https://doi.org/10.1016/j.bone.2015.11.021
Wright NC, Saag KG, Curtis JR, Smith WK, Kilgore ML, Morrisey MA, Yun H, Zhang J, Delzell ES (2012) Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res 27(11):2325–2332. https://doi.org/10.1002/jbmr.1684
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, CDC
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
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
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.
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.
Rights and permissions
About this article
Cite this article
Michael Lewiecki, E., Wright, N.C., Curtis, J.R. et al. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int 29, 717–722 (2018). https://doi.org/10.1007/s00198-017-4345-0