Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality

Abstract

In this international study, we examined the incidence of hip fractures, post-fracture 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%-11.9%) in Germany to 50.3% (95% CI 50.0%-50.7%) in the United Kingdom and all-cause mortality rates ranged from 14.4% (95% CI 14.0%-14.8%) in Singapore to 28.3% (95% CI 28.0%-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 post-fracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the ageing population.

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ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

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