Incidence Rates and Trends of Hip/Femur Fractures in Five European Countries: Comparison Using E-Healthcare Records Databases


Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003–2009 in five European countries. The study was performed using seven electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression analysis for both crude and standardized IRs. Sex- and age-standardized IRs for the UK, Netherlands, and Spanish DBs varied from 9 to 11 per 10,000 person-years for the general population and from 22 to 26 for those ≥50 years old; the German DB showed slightly higher IRs (about 13 and 30, respectively), whereas the Danish DB yielded IRs twofold higher (19 and 52, respectively). IRs increased exponentially with age in both sexes. The ratio of females to males was ≥2 for patients aged ≥70–79 years in most DBs. Statistically significant trends over time were only shown for the UK DB (CPRD) (+0.7 % per year, P < 0.01) and the Danish DB (−1.4 % per year, P < 0.01). IRs of hip/femur fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period.

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The research leading to these results was conducted as part of the PROTECT consortium (Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium; which is a public–private partnership coordinated by the European Medicines Agency. The authors thank the excellent collaboration of physicians in the participating countries, whose contribution in recording their professional practice with high-quality standards made possible the availability of databases used in this research. M. L. De Bruin is employed by Utrecht University as a senior researcher conducting research under the umbrella of the WHO Collaborating Centre for pharmaceutical policy and regulation. This center receives no direct funding or donations from private parties, including the pharmaceutical industry. Research funding from public–private partnerships, e.g., IMI, TI Pharma (, is accepted under the condition that no company-specific product or company-related study is conducted. The center has received unrestricted research funding from public sources, e.g., the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board (MEB), and the Dutch Ministry of Health. The Escher Project is a project of the Top Institute Pharma (TI Pharma), a public–private partnership of the Dutch Government, academia, and pharmaceutical companies. The Escher Project focuses on regulatory science. The PROTECT project is a collaborative European project that comprises a program to address limitations of current methods in the field of pharmacoepidemiology and pharmacovigilance. The projects within the Escher Project and the PROTECT project are of a general nature and do not involve specific companies, products, or therapeutic areas. M. Miret was a Merck employee at the time this research was done; she is not currently working there. C. Schneider received an unconditional grant from Merck Serono, Geneva. S. Schmiedl received honoraria for a lecture from a German pharmaceutical company (Rottapharm Madaus, Cologne, Germany). M. C. H. De Groot received unrestricted funding for pharmacoepidemiological research from the Dutch private–public Top Institute Pharma. A. Bate is a Pfizer employee. A. Ruigómez and L. A. García-Rodríguez are employed by CEIFE, which has received research funding from AstraZeneca R&D (Mölndal, Sweden) and Bayer Pharma (Berlin, Germany). L. A. García-Rodríguez has also served as a speaker and an advisory board member for the above-mentioned companies. S. Johansson is an Astra Zeneca employee. R. Schlienger is a full-term Novartis employee and owns Novartis shares. R. Reynolds is an employee and a stockholder of Pfizer. O. H. Klungel received unrestricted funding for pharmacoepidemiological research from the Dutch private–public Top Institute Pharma.


The PROTECT project has received support from the Innovative Medicines Initiative Joint Undertaking (IMI JU; under Grant 115004, resources of which are composed of financial contributions from the European Union’s Seventh Framework Programme (FP7/2007–2013) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies’ in-kind contributions. In addition, as a special form of the IMI JU grant, Utrecht University and Alcalá University received a direct financial contribution from Pfizer and AstraZeneca, respectively. M. Miret, A. Bate, R. Schlienger, S. Johansson, and R. Reynolds belong to EFPIA member companies in the IMI JU, and costs related to their part in the research were carried by the respective company as in-kind contributions under the IMI JU scheme. The views expressed are those of the authors only and not of their respective institutions or companies.

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Correspondence to G. Requena or F. J. de Abajo.

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G. Requena, F. J. de Abajo, V. Abbing-Karahagopian, C. Huerta, Y. Alvarez, U. Hesse, H. Gardarsdottir, P. C. Souverein, J. Slattery, M. Rottenkolber, M. Gil, F. de Vries, and D. Montero declare they have no conflict of interest.

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Requena, G., Abbing-Karahagopian, V., Huerta, C. et al. Incidence Rates and Trends of Hip/Femur Fractures in Five European Countries: Comparison Using E-Healthcare Records Databases. Calcif Tissue Int 94, 580–589 (2014).

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  • Hip fracture
  • Incidence rate
  • Electronic health-care record
  • European country