Abstract
Osteoporotic fractures are associated with excess mortality and decreased functional capacity and quality of life. Age-standardized incidence rates of fragility fractures, particularly of the hip and forearm, have been noted to be decreasing in the last decade across many countries with the notable exception of Asia. The causes for the observed changes in fracture risk have not been fully identified but are likely the result of multiple factors, including birth cohort and period effects, increasing obesity, and greater use of anti-osteoporosis medications. Changing rates of fragility fractures would be expected to have an important impact on the burden of osteoporosis.
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Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010–8.
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–36.
Morin S, Lix LM, Azimaee M, et al. Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int. 2011;22:2439–48.
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9.
Abrahamsen B, van Staa T, Ariely R, et al. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21.
Ioannidis G, Papaioannou A, Hopman WM, et al. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. Can Med Assoc J. 2009;181:265–71.
Morin S, Lix LM, Azimaee M, et al. Institutionalization following incident non-traumatic fractures in community-dwelling men and women. Osteoporos Int. 2012;23:2381–6.
Penrod J, Litke A, Hawkes W, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007;55:407–13.
•• 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. Synthesis of temporal trends in hip and other osteoporotic fractures in the published literature up to 2010;also addressing reasons for the observed changes.
Auais M, Morin S, Nadeau L, et al. Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporos Int. 2013;[In press].
Gerber Y, Melton III LJ, McNallan SM, et al. Cardiovascular and noncardiovascular disease associations with hip fractures. Am J Med. 2013;126(169):e19–26.
Blume SW, Curtis JR. Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int. 2011;22:1835–44.
• Strom O, Borgstrom F, Kanis JA, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2011;6:59–155. A comprehensive review of osteoporosis and -related fractures burden in the European Union.
Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353:878–82.
Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–73.
Kanis J, Johnell O, Gullberg B, et al. Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int. 1999;9:45–54.
Levy AR, Mayo NE, Grimard G. Rates of transcervical and pertrochanteric hip fractures in the province of Quebec, Canada, 1981–1992. Am J Epidemiol. 1995;142:428–36.
Nikolaou VS, Papathanasopoulos A, Giannoudis PV. What's new in the management of proximal femoral fractures? Injury. 2008;39:1309–18.
Nieves JW, Bilezikian JP, Lane JM, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010;21:399–408.
Wang Z, Bhattacharyya T. Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996–2007. J Bone Miner Res. 2011;26:553–60.
Pulkkinen P, Gluer C, Jamsa T. Investigation of differences between hip fracture types: a worthy strategy for improved risk assessment and fracture prevention. Bone. 2011;49:600–4.
Baudoin C, Fardellone P, Sebert J. Effect of sex and age on the ratio of cervical to trochanteric hip fracture. A meta-analysis of 16 reports on 36,451 cases. Acta Orthop Scand. 1993;64:647–53.
Lu-Yao G, Baron J, Barrett J, Fisher E. Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health. 1994;84:1287–91.
Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2009;24:1095–102.
Arneson T, Melton Lr, Lewallen D, O'Fallon W. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965–1984. Clin Orthop Relat Res. 1988;188–94.
Ng AC, Drake MT, Clarke BL, et al. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984–2007. Osteoporos Int. 2012;23:1721–6.
•• Kanis JA, Oden A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56. A systematic review of hip fracture incidence in 62 countries and worldwide estimates of fracture burden.
Langsetmo L, Hanley DA, Kreiger N, et al. Geographic variation of bone mineral density and selected risk factors for prediction of incident fracture among Canadians 50 and older. Bone. 2008;43:672–8.
Adams AL, Shi J, Takayanagi M, et al. Ten-year hip fracture incidence rate trends in a large California population, 1997–2006. Osteoporos Int. 2013;24:373–6.
de Pina MF, Alves SM, Barbosa M, Barros H. Hip fractures cluster in space: an epidemiological analysis in Portugal. Osteoporos Int. 2008;19:1797–804.
King AB, Tosteson AN, Wong JB, et al. Interstate variation in the burden of fragility fractures. J Bone Miner Res. 2009;24:681–92.
Cheng SY, Levy AR, Lefaivre KA, et al. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int. 2011;22:2575–86.
Melton III LJ, Kearns AE, Atkinson EJ, et al. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009;20:687–94.
Wright NC, Saag KG, Curtis JR, et al. Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res. 2012;27:2325–32.
Leslie WD, O'Donnell S, Jean S, et al. Trends in hip fracture rates in Canada. JAMA. 2009;302:883–9.
Jaglal SB, Weller I, Mamdani M, et al. Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res. 2005;20:898–905.
Leslie WD, O'Donnell S, Lagace C, et al. Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int. 2010;21:1317–22.
• Leslie W, Sadatsafavi M, Lix L, et al. Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int. 2011;2137–43. Population-based study documenting secular decreases in fractures rates over a 20-year period in Canada.
Johansson H, Clark P, Carlos F, et al. Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security. Osteoporos Int. 2011;22:2359–64.
Abrahamsen B, Vestergaard P. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int. 2009;21:373–80.
Nilson F, Moniruzzaman S, Gustavsson J, Andersson R. Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxf). 2013;35:125–31.
Korhonen N, Niemi S, Parkkari J, et al. Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int. 2013;24:1599–603.
Omsland TK, Holvik K, Meyer HE, et al. Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. Eur J Epidemiol. 2012;27:807–14.
Balasegaram S, Majeed A, Fitz-Clarence H. Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998. J Pub Health Med. 2001;23:11–7.
Wu TY, Jen MH, Bottle A, et al. Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxf). 2011;33:284–91.
McGowan B, Casey MC, Silke C, et al. Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis. Osteoporos Int. 2013;24:849–57.
Turkington P, McDonald S, Elliott J, Beringer T. Hip fracture in Northern Ireland, 1985–2010. Are age-specific fracture rates still rising? Ulster Med J. 2012;81:123–6.
Maravic M, Taupin P, Landais P, Roux C. Change in hip fracture incidence over the last 6 years in France. Osteoporos Int. 2011;22:797–801.
Arias LH, Treceno C, Garcia-Ortega P, et al. Hip fracture rates and bisphosphonate consumption in Spain. An ecologic study. Eur J Clin Pharmacol. 2013;69:559–64.
Lippuner K, Popp AW, Schwab P, et al. Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis. Osteoporos Int. 2011;22:2487–97.
Hartholt KA, Oudshoorn C, Zielinski SM, et al. The epidemic of hip fractures: are we on the right track? PLoS One. 2011;6:e22227.
Mann E, Icks A, Haastert B, Meyer G. Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr. 2008;8:35.
Lyritis GP, Rizou S, Galanos A, Makras P. Incidence of hip fractures in Greece during a 30-year period: 1977–2007. Osteoporos Int. 2013;24:1579–85.
Icks A, Haastert B, Wildner M, et al. Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int. 2008;19:1139–45.
El Maghraoui A, Ngbanda AR, Bensaoud N, et al. Age-adjusted incidence rates of hip fractures between 2006 and 2009 in Rabat, Morocco. Osteoporos Int. 2013;24:1267–73.
Crisp A, Dixon T, Jones G, et al. Declining incidence of osteoporotic hip fracture in Australia. Arch Osteoporos. 2012;7:179–85.
Boufous S, Finch CF, Lord SR. Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust. 2004;180:623–6.
Xia WB, He SL, Xu L, et al. Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res. 2012;27:125–9.
Hagino H, Furukawa K, Fujiwara S, et al. Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int. 2009;20:543–8.
Tuzun S, Eskiyurt N, Akarirmak U, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012;23:949–55.
Cheung E, Bow C, Loong C, et al. A secular increase in BMD in Chinese women. J Bone Miner Metab. 2013;[In press].
Egan M, Jaglal S, Byrne K, et al. Factors associated with a second hip fracture: a systematic review. Clin Rehabil. 2008;22:272–82.
Morin S, Rahme E, Behlouli H, et al. Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures. Osteoporos Int. 2007;18:1625–32.
Lonnroos E, Kautiainen H, Karppi P, et al. Incidence of second hip fractures. A population-based study. Osteoporos Int. 2007;18:1279–85.
Lee YK, Ha YC, Yoon BH, Koo KH. Incidence of second hip fracture and compliant use of bisphosphonate. Osteoporos Int. 2013;24:2099–104.
Shi N, Foley K, Lenhart G, Badamgarav E. Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone. 2009;45:1084–90.
Leslie W, Metge C, Azimaee M, et al. Direct costs of fractures in Canada and trends 1996–2006: a population-based cost-of-illness analysis. J Bone Miner Res. 2011;26:2419–29.
Ensrud KE, Schousboe JT. Clinical practice. Vertebral fractures. N Engl J Med. 2011;364:1634–42.
Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320–3.
Kelsey JL, Browner WS, Seeley DG, et al. Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. Am J Epidemiol. 1992;135:477–89.
Kanis JA, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001;12:417–27.
Center JR, Bliue D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297:387–94.
Cooper C, Atkinson EJ, Kotowicz M, et al. Secular trends in the incidence of postmenopausal vertebral fractures. Calcif Tissue Int. 1992;51:100–4.
Islam S, Liu Q, Chines A, Helzner E. Trend in incidence of osteoporosis-related fractures among 40- to 69-year-old women: analysis of a large insurance claims database, 2000–2005. Menopause. 2009;16:77–83.
Oudshoorn C, Hartholt KA, Zillikens MC, et al. Emergency department visits due to vertebral fractures in the Netherlands, 1986–2008: steep increase in the oldest old, strong association with falls. Injury. 2012;43:458–61.
Melton III LJ, Amadio PC, Crowson CS, O'Fallon WM. Long-term trends in the incidence of distal forearm fractures. Osteoporos Int. 1998;8:341–8.
Jonsson B, Bengner U, Redlund-Johnell I, Johnell O. Forearm fractures in Malmo, Sweden. Changes in the incidence occurring during the 1950s, 1980s, and 1990s. Acta Orthop Scand. 1999;70:129–32.
Oskam J, Kingma J, Klasen HJ. Fracture of the distal forearm: epidemiological developments in the period 1971–1995. Injury. 1998;29:353–5.
Boufous S, Finch C, Lord S, et al. The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia. Bone. 2006;39:1144–8.
Dimai HP, Svedbom A, Fahrleitner-Pammer A, et al. Epidemiology of proximal humeral fractures in Austria between 1989 and 2008. Osteoporos Int. 2013;[In press].
Palvanen M, Kannus P, Niemi S, Parkkari J. Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone. 2010;46:1355–8.
Kannus P, Palvanen M, Niemi S, et al. Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970–2006 and prediction for the future. Bone. 2008;43:340–2.
Kannus P, Niemi S, Parkkari J, et al. Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006. Osteoporos Int. 2009;20:43–6.
Palvanen M, Kannus P, Niemi S, Parkkari J. Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int. 2004;15:649–53.
Kanis JA, Oden A, Johnell O, et al. The components of excess mortality after hip fracture. Bone. 2003;32:468–73.
Maravic M, Taupin P, Landais P, Roux C. Decrease of inpatient mortality for hip fracture in France. Joint Bone Spine. 2011;78:506–9.
Rosengren BE, Ahlborg HG, Mellstrom D, et al. Secular trends in Swedish hip fractures 1987–2002: birth cohort and period effects. Epidemiology. 2012;23:623–30.
Jean S, O'Donnell S, Lagace C, et al. Trends in hip fracture rates in Canada: an age-period-cohort analysis. J Bone Miner Res. 2013;28:1283–9.
Goodfellow LR, Earl S, Cooper C, Harvey NC. Maternal diet, behaviour and offspring skeletal health. Int J Environmen Res Pub Health. 2010;7:1760–72.
Langley J, Samaranayaka A, Davie G, Campbell AJ. Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007. Osteoporos Int. 2011;22:105–11.
•• Looker AC, Melton III LJ, Borrud LG, Shepherd JA. Changes in femur neck bone density in US adults between 1988–1994 and 2005–2008: demographic patterns and possible determinants. Osteoporos Int. 2012;23:771–80. Report of the last National Health and Nutrition Examination Survey documenting increases in femoral neck BMD in Americans over 10 years.
• Johansson H, Kanis JA, Oden A, et al. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res. 2013;[In press]. A recent meta-analysis exploring the association between body mass index, BMD, and fragility fractures.
Nielson CM, Marshall LM, Adams AL, et al. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res. 2011;26:496–502.
Melton III LJ, Kanis JA, Johnell O. Potential impact of osteoporosis treatment on hip fracture trends. J Bone Miner Res. 2005;20:895–7.
O'Donnell S. Canadian Chronic Disease Surveillance System Osteoporosis Working G: use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study. Arch Osteoporos. 2013;8:143.
Acknowledgements
The authors would like to thank Ms. Tamara Rader, of the Cochrane Musculoskeletal Group, for her assistance with the literature search strategy.
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Conflict of Interest
S.N. Morin discloses that she is a researcher-clinician scholar of the Fonds de Recherche du Québec en Santé. She has received research grants from Amgen and has served as a consultant for Amgen, Novartis, Eli Lilly, and Merck. L.M. Lix discloses that she holds a position as Manitoba Research Chair from the Manitoba Health Research Council. She has received research grants from Amgen.
S.R. Majumdar discloses that he holds the position of Endowed Chair in Patient Health Management (Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta) and receives salary support as a Health Scholar of the Alberta Heritage Foundation for Medical Research and Alberta Innovates-Health Solutions. He declares no conflicts of interest.
W.D. Leslie has received research grants from Novartis, Amgen, and Genzyme, and is a part of the speaker bureau for Amgen, Eli Lilly, and Novartis.
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Morin, S.N., Lix, L.M., Majumdar, S.R. et al. Temporal Trends in the Incidence of Osteoporotic Fractures. Curr Osteoporos Rep 11, 263–269 (2013). https://doi.org/10.1007/s11914-013-0168-x
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DOI: https://doi.org/10.1007/s11914-013-0168-x