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Hip fracture trends in the United States, 2002 to 2015

A Correction to this article was published on 27 August 2018

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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.

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Change history

  • 27 August 2018

    The name of the first author, E.M. Lewiecki, was rendered incorrectly in the original publication. The publisher regrets any inconvenience and is pleased to correct the error here.


  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, Rockville

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7.

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  PubMed Central  Google Scholar 

  6. Riggs BL, Melton LJ III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(Suppl):505S–511S.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. 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.

    Article  PubMed  Google 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:S26

    Google Scholar 

  10. Centers for Medicare & Medicaid Services. Physician fee schedule search. U.S. Centers for Medicare & Medicaid Services

  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 Group

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. 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

    PubMed  Google Scholar 

  15. Waller PC, Evans SJ, Beard K (2006) Drug safety and the media. Br J Clin Pharmacol 61(2):123–126.

    Article  PubMed  Google Scholar 

  16. 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

    PubMed  Google 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):324–333

    PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  CAS  Google Scholar 

  19. Diab DL, Watts NB (2013) Bisphosphonate drug holiday: who, when and how long. Ther Adv Musculoskelet Dis 5(3):107–111.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  PubMed  CAS  Google Scholar 

  21. Compston JE, Bilezikian JP (2012) Bisphosphonate therapy for osteoporosis: the long and short of it. J Bone Miner Res 27(2):240–242.

    Article  PubMed  Google Scholar 

  22. Drake MT, Clarke BL, Lewiecki EM (2015) The pathophysiology and treatment of osteoporosis. Clin Ther 37(8):1837–1850.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. 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)

    Article  PubMed  CAS  Google Scholar 

  26. Joinpoint Regression Program. Version 4.5.01 - June 2017 edn Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Insititute

  27. US Preventive Services Task Force (2011) Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. AnnInternMed 154:356–364

    Google Scholar 

  28. Miller PD (2016) Underdiagnosis and undertreatment of osteoporosis: the battle to be won. J Clin Endocrinol Metab 101(3):852–859.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Khosla S, Shane E (2016) A crisis in the treatment of osteoporosis. J Bone Miner Res 31(8):1485–1487.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    Article  PubMed  Google 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, CDC

  34. US Census Bureau (2016) Population 65 years and over in the United States, 2015 American Community Survey 1-Year Estimates. Accessed November 13, 2017

  35. US Census Bureau (2001) Female population by age, race and Hispanic or Latino origin for the United States: 2000, Accessed November 13, 2017

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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.

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Correspondence to E. Michael Lewiecki.

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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.

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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).

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  • DXA
  • Fracture
  • Medicare
  • Osteoporosis
  • Reimbursement