Newswise — An international team of researchers, led by the Department of Pharmacology and Pharmacy, LKS Faculty of Medicine at the University of Hong Kong (HKUMed), and including Douglas P Kiel, MD, MPH, Director of the Musculoskeletal Research Center at the Marcus Institute for Aging Research, Hebrew SeniorLife, and Professor of Medicine at Harvard Medical School, assessed hip fracture trends, treatment patterns, and all-cause mortality in 19 countries and regions between 2005 and 2018. While hip fracture incidence rates declined in most areas, projections indicate a near doubling of global hip fractures by 2050 compared to 2018. The study, recently published in the Journal of Bone and Mineral Research, reveals a significant treatment gap for individuals who sustain a hip fracture and do not receive preventive therapy for future fractures, especially among men. It emphasizes the pressing need for improved strategies in hip fracture prevention and care.
Background
Hip fracture continues to pose a worldwide public health issue, leading to heightened dependence, morbidity, and mortality, and imposing significant challenges on patients, families, and healthcare systems. In this global investigation, scientists gained direct access to data from a substantial and diverse cohort encompassing 19 countries and regions. Their objective was to analyze the occurrence of hip fractures, the subsequent treatment received, and the overall mortality rates among individuals aged 50 years and above, spanning the period from 2005 to 2018.
Past studies regarding hip fracture incidence have relied on data characterized by variations in data sources, study durations, and analytical methods. In contrast, this particular study implemented a standardized protocol and employed a uniform data model across all participating sites. This approach ensured the generation of comparable data, enabling more reliable and meaningful comparisons.
Using the 2020 United Nations world population as a standard, the study estimated age- and sex-standardized incidence rates of hip fracture. By analyzing the trends in these rates and utilizing data from the World Bank, projections were made for the number of hip fractures expected in 2030, 2040, and 2050. Furthermore, the study assessed the proportion of patients receiving anti-osteoporosis medication within a 12-month period following hip fractures, as well as the all-cause mortality rates during this timeframe.
Research findings and significance
Within the cohort, a total of 4,115,046 cases of hip fractures were identified. The age- and sex-standardized incidence rates varied across countries and regions, ranging from 95.1 (Brazil) to 315.9 (Denmark) per 100,000 population. The majority of countries and regions displayed a downward trend in hip fracture incidence, with the most significant declines observed in Denmark (-2.8% per year), Singapore (-2.8%), and Hong Kong (-2.4%). Conversely, the Netherlands (+2.1%) and South Korea (+1.2%) experienced the largest increases. Despite the overall decrease in hip fracture incidence, projections indicate that the total number of hip fractures will nearly double from 2018 to 2050.
During the one-year period following a hip fracture, the percentage of individuals receiving post-fracture treatment remained consistently low across the years. The range of treatment rates spanned from 11.5% in Germany to 50.3% in the United Kingdom. One-year all-cause mortality rates exhibited variability, ranging from 14.4% in Singapore to 28.3% in the United Kingdom. Trends in mortality rates also varied, with annual changes ranging from -5.3% to +18.4%. In terms of gender differences, males demonstrated lower utilization of anti-osteoporosis medication compared to females. Additionally, males exhibited higher rates of all-cause mortality, and the projected number of hip fractures in males was projected to increase more significantly by 2050 compared to females.
The study underscores significant disparities in the global epidemiology of hip fractures and the subsequent treatment received across various countries and regions. One crucial takeaway from the research is that the decline in hip fractures observed in several nations in recent times is insufficient to counterbalance the impact of an aging population. Consequently, the burden of hip fractures is projected to persistently increase. As hip fractures not only pose medical challenges but also frequently necessitate institutionalization, it is imperative to consider governmental policies and implement multidisciplinary interventions to mitigate the consequences of hip fractures in the next three decades. Recognizing the social implications associated with hip fractures, a comprehensive approach involving healthcare systems, public policies, and various disciplines is crucial for reducing the overall impact of hip fractures.
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