Good News, Bad News for Global Hip Fracture Rates

AUSTIN, Texas — The incidence of hip fractures has dropped in many parts of the world, but an aging population is likely to put a damper on that positive trajectory, a researcher reported.

Based on an assessment of 20 healthcare databases from 19 regions and countries, the rate of hip fractures declined by as much as 2.8% a year in 11 global regions, according to Douglas Kiel, MD, MPH, of Beth Israel Deaconess Medical Center/Harvard Medical School in Boston.

Still, the number of these fractures is estimated to double by 2050, particularly with a 4.5-fold increase in the global population of people who are ages ≥85 (based on an analysis of years 2010-2050), Kiel and colleagues, including Chor-Wing Sing, PhD, of Hong Kong University, reported at the American Society for Bone and Mineral Research (ASBMR) meeting.

In addition, there was a “large post-fracture treatment gap in fracture prevention across all countries through the study period” of 2005-2018, they stated “Many potential reasons for this gap include concerns about adverse events associated with antiresorptive therapies, Kiel’s group noted.

He also pointed out that the burden of hip fractures was more pronounced in men than in women, and there was a higher mortality rate among men. For the latter, the authors reported that all-cause mortality within a year of experiencing a hip fracture ranged from 19.2% to 35.8% among men versus 12.1% to 25.4% among women.

In terms of the treatment gap, Kiel explained that in a U.K. database, 50.3% of surveyed patients, who were within 1-year of a having had a hip fracture, reported that they were getting preventive treatment, and that was the best result of any region included in the study. In the U.S., 35% of patients reported the same. In other countries, the post-fracture treatment rate was as low as 11%.

The databases used in the retrospective, cohort study included electronic health records from hospital or primary care practice, billing claims, and national data. In some nations, data from up to 100% of the population was available; in other nations, the data represented anywhere from 5% to 70% of the population, according to the authors. Kiel’s group looked at the incidence of hip fractures in the population of people ages >50. The study protocol was described in a 2021 BMJ Open article.

The authors reported that in the Medicare database, the incidence of hip fractures during the study period came in at 487.9 per 100,000 population (ages >65). In other countries, the incidence was 315.9/100,000 people in Denmark, 95.1 in Brazil, and 54.8 in Japan (ages <75).

And the hip fracture incidence rates in people ages >85 were over two-fold greater versus rates in ages 80-84, they said.

“The message from this epidemiological study is this: We have to figure out why there is such a treatment gap, with only 50% of patients with a history of fracture being treated to prevent osteoporosis and further fractures,” said ASBMR session co-moderator Radhika Narla, MD, of the University of Washington/Puget Sound Veterans Affairs in Seattle.

“We have a lot of work to do,” she told MedPage Today, suggesting that most of the people in the study who had already experienced a hip fracture should have been treated with newer medications, such as biologics or bisphosphonates, yet the study showed poor uptake of those medications in this population.