Global epidemiology of hip fractures: A study protocol using a common analytical platform among multiple countries


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, The University of Auckland
Pauline Bosco-Lévy, Université de Bordeaux
Amy Hai Yan Chan, The University of Auckland
Manju Chandran, Singapore General Hospital
Ching Lung Cheung, The University of Hong Kong Li Ka Shing Faculty of Medicine
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
Jeff Lange, Amgen Incorporated
E. Michael Lewiecki, UNM School of Medicine
Jiannong Liu, Chronic Disease Research Group
Kenneth K.C. Man, UCL School of Pharmacy
Mirhelen Mendes De Abreu, Universidade Federal do Rio de Janeiro
Nicolas Moore, Université de Bordeaux
James O'Kelly, Amgen Incorporated
Nobuhiro Ooba, Nihon University
Alma B. Pedersen, Aarhus Universitetshospital
Daniel Prieto-Alhambra, University of Oxford Medical Sciences Division
Ju Young Shin, Sungkyunkwan University
Henrik T. Sørensen, Aarhus Universitetshospital
Kelvin Bryan Tan, Ministry of Health, Government of Singapore
Anna Maija Tolppanen, Itä-Suomen yliopisto

Document Type


Publication Title

BMJ Open


Introduction Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. Methods and analysis This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. Ethics and dissemination Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences.



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