An international study that included researchers from Harvard Medical School indicates that while age- and sex-standardized hip fracture incidence rates have decreased in most regions around the globe, the number of hip fractures worldwide is projected to nearly double by 2050, compared to 2018.
- By MICHAEL CHMURA | Hebrew Senior LIfe
A significant treatment gap in patients sustaining a hip fracture and not receiving therapy to prevent future fractures was also observed in all countries and regions, particularly in men.
The study, recently published in the Journal of Bone and Mineral Research, reviewed more than 4 million cases and highlights an urgent need for better strategies in hip fracture prevention and care.
Hip fracture remains a global public health concern contributing to increased dependency, morbidity, and mortality and placing a burden on patients, their families, and health care systems.
A key message from the study is that the decline in hip fractures in many countries in recent years is not enough to offset the impact of the aging population. The burden of hip fracture is expected to continue to grow.
Given that hip fracture not only is a medical issue, but also a social issue that often requires institutionalization, the study indicated that government policy and multidisciplinary intervention should be considered to reduce the impact of hip fracture in the coming 30 years.
Global health concern
The researchers, including Douglas Kiel, HMS professor of medicine and director of the Musculoskeletal Research Center in the Marcus Institute for Aging Research at Hebrew SeniorLife, evaluated secular trends in hip fracture incidence, treatment patterns following a hip fracture, and all-cause mortality from 2005 to 2018.
In the study, researchers directly accessed the data from a large representative cohort involving 19 countries and regions to examine the incidence of hip fractures, treatment following a hip fracture, and all-cause mortality following hip fractures among patients aged 50 years and older.
Previous reports on hip fracture incidence have been based on data with heterogeneity in data sources, study periods, and analytical approaches. In contrast, this study applied a standardized protocol and a common data model across all sites to provide comparable data.
Age- and sex-standardized incidence rates of hip fracture were estimated using the 2020 United Nations world population as a standard. The number of hip fractures in 2030, 2040, and 2050 were projected based on the trends in incidence rates and World Bank data.
Within 12 months following hip fractures, the proportion of patients receiving anti-osteoporosis medication and all-cause mortality rates were estimated.
Research findings and significance
A total of 4,115,046 hip fracture cases were identified in the cohort. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (Brazil) to 315.9 (Denmark) per 100,000 population.
Most countries and regions showed a decreasing trend in hip fracture incidence, with the most pronounced declines in Denmark, ‐2.8 percent per year, Singapore, ‐2.8 percent, and Hong Kong, ‐2.4 percent.
The largest increases were noted in the Netherlands, +2.1 percent and South Korea, +1.2 percent.
Despite the overall decline in hip fracture incidence, the total number of hip fractures is estimated to nearly double from 2018 to 2050.
Within one year following a hip fracture, post-fracture treatment remained low throughout the years, ranging from 11.5 percent in Germany to 50.3 percent in the United Kingdom.
One-year all-cause mortality rates ranged from 14.4 (Singapore) to 28.3 percent (United Kingdom), while mortality trends varied from ‐5.3 to +18.4 percent per year.
Males had lower use of anti-osteoporosis medication than females, higher rates of all-cause mortality, and a larger increase in the projected number of hip fractures by 2050.
The study highlights substantial variations in the global epidemiology of hip fractures and the treatment after hip fracture across countries and regions.
Authorship, funding, disclosures
Co-authors included first author Chor-Wing Sing, corresponding author Ching‑Lung Cheung, and co-corresponding author Ian Chi Kei Wong, of HKUMed.
