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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256
International Osteoporosis Foundation (2008) Osteoporosis in the European Union in 2008: ten years of progress and ongoing challenges. http://www.sante.public.lu/publications/maladies-traitements/osteoporose/osteoporosis-eu-2008/osteoporosis-eu-2008.pdf. Accessed 2 Oct 2012
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767
Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320(7231):341–346
Polinder S, Meerding WJ, van Baar ME, Toet H, Mulder S, van Beeck EF, EUROCOST Reference Group (2005) Cost estimation of injury-related hospital admissions in 10 European countries. J Trauma 59(6):1283–1291
Kanis J, on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health care level. http://www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf. Accessed Nov 2012
Mann E, Meyer G, Haastert B, Icks A (2010) Comparison of hip fracture incidence and trends between Germany and Austria 1995–2004: an epidemiological study. BMC Public Health 10:46
Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M, Llorca J, Gonzalez-Macias J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17(3):464–470
Lyritis GP, Rizou S, Galanos A, Makras P (2013) Incidence of hip fractures in Greece during a 30-year period: 1977–2007. Osteoporos Int 24:1579–1585
Korhonen N, Niemi S, Parkkari J, Sievanen H, Palvanen M, Kannus P (2013) Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int 24:1599–1603
Lakatos P, Balogh A, Czerwinski E, Dimai HP, Hans D, Holzer G, Lorenc RS, Palicka V, Obermayer-Pietsch B, Stepan J, Takacs I, Resch H (2011) New considerations on the management of osteoporosis in central and eastern Europe (CEE): summary of the “3rd summit on osteoporosis-CEE”, November 2009, Budapest, Hungary. Arch Osteoporos 6(1–2):1–12
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288
Abbing-Karahagopian V, Kurz X, de Vries F, van Staa T, Alvarez Y, Hesse U, et al (2013) Bridging differences in outcomes of pharmacoepidemiological studies: design and first results of the PROTECT project. Curr Clin Pharmacol, in press
Balasegaram S, Majeed A, Fitz-Clarence H (2001) Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Public Health Med 23(1):11–17
Lalmohamed A, Welsing PM, Lems WF, Jacobs JW, Kanis JA, Johansson H, de Boer A, de Vries F (2012) Calibration of FRAX® 3.1 to the Dutch population with data on the epidemiology of hip fractures. Osteoporos Int 23(3):861–869
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733
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(4):552–564
Wu TY, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A (2011) Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxf) 33(2):284–291
Pages-Castella A, Carbonell-Abella C, Aviles FF, Alzamora M, Baena-Diez JM, Laguna DM, Nogues X, Diez-Perez A, Prieto-Alhambra D (2012) Burden of osteoporotic fractures in primary health care in Catalonia (Spain): a population-based study. BMC Musculoskelet Disord 13:79
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(2):166–172
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(8):1139–1145
Dhanwal DK, Dennison EM, Harvey NC, Cooper C (2011) Epidemiology of hip fracture: worldwide geographic variation. Indian J Orthop 45(1):15–22
Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18(3):333–337
Elffors I, Allander E, Kanis JA, Gullberg B, Johnell O, Dequeker J, Dilsen G, Gennari C, Lopes Vaz AA, Lyritis G et al (1994) The variable incidence of hip fracture in southern Europe: the MEDOS study. Osteoporos Int 4(5):253–263
Fretland S, Kruger O (1998) Femoral neck fractures in Nord-Trondelag 1988–95. Incidence differences between winter and summer months [in Norwegian]. Tidsskr Nor Laegeforen 118(1):34–36
Gronskag AB, Forsmo S, Romundstad P, Langhammer A, Schei B (2010) Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT study. Bone 46(5):1294–1298
Poole KE, Compston JE (2006) Osteoporosis and its management. BMJ 333(7581):1251–1256
De Laet CE, van Hout BA, Burger H, Hofman A, Pols HA (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ 315(7102):221–225
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(6):298–302
Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8(6):611–617
Tafuri S, Martinelli D, Balducci MT, Fortunato F, Prato R, Germinario C (2008) Epidemiology of femoral neck fractures in Puglia (Italy): an analysis of existing data. Ig Sanita Pubbl 64(5):623–636
Nilson F, Moniruzzaman S, Gustavsson J, Andersson R (2012) Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxf) 35(1):125–131
Adams AL, Shi J, Takayanagi M, Dell RM, Funahashi TT, Jacobsen SJ (2012) Ten-year hip fracture incidence rate trends in a large California population, 1997–2006. Osteoporos Int 24(1):373–376
Pasco JA, Brennan SL, Henry MJ, Nicholson GC, Sanders KM, Zhang Y, Kotowicz MA (2011) Changes in hip fracture rates in southeastern Australia spanning the period 1994–2007. J Bone Miner Res 26(7):1648–1654
Leslie WD, Sadatsafavi M, Lix LM, Azimaee M, Morin S, Metge CJ, Caetano P (2011) Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22(7):2137–2143
Holt G, Smith R, Duncan K, Hutchison JD, Reid D (2009) Changes in population demographics and the future incidence of hip fracture. Injury 40(7):722–726
Greene D, Dell RM (2010) Outcomes of an osteoporosis disease-management program managed by nurse practitioners. J Am Acad Nurse Pract 22(6):326–329
EU Commission, Executive Agency for Health and Consumers (EAHC) (2009) PASEO (physical activity among sedentary older people). http://www.paseonet.org/the_project.html. Accessed Nov 2012
Huerta CA-KV, Requena G, Oliva B, Alvarez Y, et al (2013) Prevalence of use of benzodiazepines and related drugs in seven European databases: a cross-national descriptive study from the PROTECT-EU project. Presented at the 29th international conference on pharmacoepidemiology and therapeutic risk management, Montreal, 25–28 August 2013
Garcia Rodriguez LA, Ruigomez A (2010) Case validation in research using large databases. Br J Gen Pract 60(572):160–161
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(4):424–429
Schilcher J, Michaelsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364(18):1728–1737
The research leading to these results was conducted as part of the PROTECT consortium (Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium; www.imi-protect.eu) 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 (www.tipharma.nl), 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; www.imi.europa.eu) 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.
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
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). https://doi.org/10.1007/s00223-014-9850-y
- Hip fracture
- Incidence rate
- Electronic health-care record
- European country