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Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study

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Declining incidences of hip fractures are reported from western countries. Norway has among the highest rates in the world. The aim of this study was to investigate trends in total hip fracture rates in Norway between 1999 and 2008 and risk of second hip fractures. All hospitalizations given a hip fracture diagnosis code (International Classification of Diseases (ICD) 9 or ICD 10) (cervical, trochanteric or subtrochanteric) in Norwegian hospitals were retrieved with accompanying surgical procedure codes and additional diagnoses. A total of 93,123 hip fractures were identified between 1999 and 2008 in persons ≥50 years. Annual incidences of hip fractures were calculated and tested for trends. Rates of first and second hip fractures (2006–2008) were compared. The age-standardized total incidence of hip fracture decreased by 13.4 % (95 % confidence interval (CI): 11.0–15.6) in women and 4.8 % (95 % CI: 0.7, 8.7) in men. Age-adjusted rates of second hip fractures did not change in the observation period. In those with a prior hip fracture, the age-standardized risk of a subsequent hip fracture was 2.5-fold (95 % CI: 2.5, 2.6) in women, and 4.6-fold (95 % CI: 4.5, 4.7) in men. Total hip fracture rates declined in both genders during 1999–2008, whereas rates of second hip fractures did not change.

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  1. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005;16(Suppl 2):S3–7.

    Article  PubMed  Google Scholar 

  2. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.

    Article  PubMed  CAS  Google Scholar 

  3. Cooper C, Cole ZA, Holroyd CR, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011;22:1277–88.

    Article  PubMed  CAS  Google Scholar 

  4. Kannus P, Niemi S, Parkkari J, et al. Nationwide decline in incidence of hip fracture. J Bone Miner Res. 2006;21:1836–8.

    Article  PubMed  Google Scholar 

  5. Leslie WD, O’Donnell S, Jean S, et al. Trends in hip fracture rates in Canada. JAMA. 2009;302:883–9.

    Article  PubMed  CAS  Google Scholar 

  6. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9.

    Article  PubMed  CAS  Google Scholar 

  7. Abrahamsen B, Vestergaard P. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int. 2010;21:373–80.

    Article  PubMed  CAS  Google Scholar 

  8. Maravic M, Taupin P, Landais P, et al. Change in hip fracture incidence over the last 6 years in France. Osteoporos Int. 2011;22:797–801.

    Article  PubMed  CAS  Google Scholar 

  9. Hartholt KA, Oudshoorn C, Zielinski SM, et al. The epidemic of hip fractures: are we on the right track? PLoS One. 2011;6:e22227.

    Article  PubMed  CAS  Google Scholar 

  10. Adams AL, Shi J, Takayanagi M, et al. Ten-year hip fracture incidence rate trends in a large California population, 1997–2006. [published online ahead of print February 21, 2012] Osteoporos Int 2012. doi:10.1007/s00198-012-1938-5.

  11. Finsen VV. Hip fracture incidence in central Norway: a followup study. Clin Orthop Rel Res 2004;(419):173–178.

  12. Bjorgul K, Reikeras O. Incidence of hip fracture in southeastern Norway: a study of 1,730 cervical and trochanteric fractures. Int Orthop. 2007;31:665–9.

    Article  PubMed  CAS  Google Scholar 

  13. Lofthus CM, Osnes EK, Falch JA, et al. Epidemiology of hip fractures in Oslo, Norway. Bone. 2001;29:413–8.

    Article  PubMed  CAS  Google Scholar 

  14. Stoen RO, Nordsletten L, Meyer HE, et al. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. [Published online ahead of print January 14, 2012] Osteoporos Int 2012. doi: 10.1007/s00198-011-1888-3.

  15. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375–82.

    Article  PubMed  CAS  Google Scholar 

  16. Center JR, Bliuc D, Nguyen TV, et al. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297:387–94.

    Article  PubMed  CAS  Google Scholar 

  17. Melton LJ III, Kearns AE, Atkinson EJ, et al. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009;20:687–94.

    Article  PubMed  Google Scholar 

  18. Ryg J, Rejnmark L, Overgaard S, et al. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res. 2009;24:1299–307.

    Article  PubMed  Google Scholar 

  19. Hagino H, Sawaguchi T, Endo N, et al. The risk of a second hip fracture in patients after their first hip fracture. Calcif Tissue Int. 2012;90:14–21.

    Article  PubMed  CAS  Google Scholar 

  20. StatBank Norway. 2012. Accessed 23 Feb 2012.

  21. Alvaer K, Meyer HE, Falch JA, et al. Outdoor air pollution and bone mineral density in elderly men—the Oslo health study. Osteoporos Int. 2007;18:1669–74.

    Article  PubMed  CAS  Google Scholar 

  22. Joakimsen RM, Fonnebo V, Sogaard AJ, et al. The Tromso study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int. 2001;12:1001–5.

    Article  PubMed  CAS  Google Scholar 

  23. Dimai HP, Svedbom A, Fahrleitner-Pammer A, et al. Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 2011; 22:685–692.

    Google Scholar 

  24. De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–8.

    Article  PubMed  Google Scholar 

  25. Meyer HE, Tverdal A. Development of body weight in the Norwegian population. Prostaglandins Leukot Essent Fatty Acids. 2005;73:3–7.

    Article  PubMed  CAS  Google Scholar 

  26. Droyvold WB, Nilsen TI, Kruger O, et al. Change in height, weight and body mass index: longitudinal data from the HUNT Study in Norway. Int J Obes (Lond). 2006;30:935–9.

    Article  CAS  Google Scholar 

  27. Midthjell K. Public health development. The HUNT study, Norway. HUNT1 (1984–1986)—HUNT 2 (1995–1997)—HUNT 3 (2006–2008). 2011;60–64.

  28. Fisher AA, O’Brien ED, Davis MW. Trends in hip fracture epidemiology in Australia: possible impact of bisphosphonates and hormone replacement therapy. Bone. 2009;45:246–53.

    Article  PubMed  CAS  Google Scholar 

  29. Meyer HE, Lofthus CM, Sogaard AJ, et al. Change in the use of hormone replacement therapy and the incidence of fracture in Oslo. Osteoporos Int. 2009;20:827–30.

    Article  PubMed  CAS  Google Scholar 

  30. StatBank Norway. Percentage daily smokers and occasional smokers, by sex and age. Accessed 23 Feb 2012.

  31. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005;16:155–62.

    Article  PubMed  CAS  Google Scholar 

  32. van Geel TA, Huntjens KM, van den Bergh JP, et al. Timing of subsequent fractures after an initial fracture. Curr Osteoporos Rep. 2010;8:118–22.

    Article  PubMed  Google Scholar 

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The authors are deeply grateful to system architect monitoring Tomislav Dimoski at The Norwegian Knowledge Centre for the Health Services who developed the system that enabled extraction and transfer of data from PAS. He and his team also carried through the collection of the hip fracture data. Senior advisor Dominic Hoff at the Norwegian Institute of Public Health helped with data processing. The authors thank the staff at the Department of Pharmacoepidemiology (Norwegian Institute of Public Health), and Sverre Bjarte Johnsen (Statistics Norway) for assisting in transferring the data to the Norwegian Institute of Public Health and in the encryption process. Hip fracture data for validation of the NOREPOS Hip Fracture Database were obtained from local fracture registries in Tromsø and Oslo, and the authors thank the study investigators for their permission to use these data. This study was supported by a grant from the Research Council of Norway.

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The authors declare that they have no conflict of interest.

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Correspondence to Tone K. Omsland.

Additional information

NOREPOS (The NORwegian EPidemiologic Osteoporosis Studies) is a collaboration between epidemiologic osteoporosis studies, which are sub-studies within large population-based surveys in four districts of Norway (Tromsø, Nord-Trøndelag, Hordaland, Oslo). The NOREPOS Hip fracture Database includes all hospitalizations for hip fracture in Norway.

Electronic supplementary material

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Supplementary table Total number of hip fractures1999–2008 in five year age groups in women and men. The NOREPOS Hip Fracture Database 1999–2008 (DOC 35 kb)

Supplementary material 2 (PDF 213 kb)

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Omsland, T.K., Holvik, K., Meyer, H.E. et al. Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study. Eur J Epidemiol 27, 807–814 (2012).

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