Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality


Chor Wing Sing, The University of Hong Kong Li Ka Shing Faculty of Medicine
Tzu Chieh Lin, Amgen Incorporated
Sharon Bartholomew, Public Health Agency of Canada
J. Simon Bell, Monash University
Corina Bennett, Amgen Incorporated
Kebede Beyene, University of Health Sciences and Pharmacy
Pauline Bosco-Levy, Université de Bordeaux
Brian D. Bradbury, Amgen Incorporated
Amy Hai Yan Chan, The University of Auckland
Manju Chandran, Singapore General Hospital
Cyrus Cooper, University of Southampton
Maria de Ridder, Erasmus MC
Caroline Y. Doyon, Public Health Agency of Canada
Cécile Droz-Perroteau, Université de Bordeaux
Ganga Ganesan, Ministry of Health, Government of Singapore
Sirpa Hartikainen, Itä-Suomen yliopisto
Jenni Ilomaki, Monash University
Han Eol Jeong, Sungkyunkwan University
Douglas P. Kiel, Harvard Medical School
Kiyoshi Kubota, NPO Drug Safety Research Unit Japan
Edward Chia Cheng Lai, National Cheng Kung University College of Medicine
Jeff L. Lange, Amgen Incorporated
E. Michael Lewiecki, UNM School of Medicine
Julian Lin, Itä-Suomen yliopisto
Jiannong Liu, Chronic Disease Research Group
Joe Maskell, Amgen Incorporated
Mirhelen Mendes de Abreu, Universidade Federal do Rio de Janeiro
James O'Kelly, Amgen Incorporated
Nobuhiro Ooba, Nihon University
Alma B. Pedersen, Aarhus Universitetshospital
Albert Prats-Uribe, University of Oxford Medical Sciences Division
Daniel Prieto-Alhambra, University of Oxford Medical Sciences Division
Simon Xiwen Qin, The University of Hong Kong Li Ka Shing Faculty of Medicine

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Journal of Bone and Mineral Research


In this international study, we examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age- and sex-standardized incidence rates of hip fractures, post-hip fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all-cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databases. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (95% confidence interval [CI] 94.8–95.4) in Brazil to 315.9 (95% CI 314.0–317.7) in Denmark per 100,000 population. Incidence rates decreased over the study period in most countries; however, the estimated total annual number of hip fractures nearly doubled from 2018 to 2050. Within 1 year following a hip fracture, post-hip fracture treatment ranged from 11.5% (95% CI 11.1% to 11.9%) in Germany to 50.3% (95% CI 50.0% to 50.7%) in the United Kingdom, and all-cause mortality rates ranged from 14.4% (95% CI 14.0% to 14.8%) in Singapore to 28.3% (95% CI 28.0% to 28.6%) in the United Kingdom. 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. Substantial variations exist in the global epidemiology of hip fractures and postfracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the aging population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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