IOF urges action for prevention as study predicts global hip fractures to almost double by 2050
Of all osteoporosis-related fractures, hip fractures cause the most morbidity with reported mortality rates up to 20-24% in the first year after a hip fracture. Loss of function and independence among survivors is profound, with 40% unable to walk independently, and 60% requiring assistance a year later. Hip fractures represent a major global public health concern, which places a heavy burden on patients, and their families, and represents a significant cost burden to healthcare systems.
In the recently published study ‘Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality', an international group of researchers evaluated the secular trends in hip fracture incidence, post-fracture treatment, and all-cause mortality in 19 countries across five regions from 2005 to 2018. The study reveals that while the age- and sex-standardised hip fracture incidence rates decreased in most regions, the number of hip fractures worldwide is projected to nearly double by 2050 compared to 2018. A significant post-fracture treatment gap in fracture prevention was also observed for both sexes in all countries and regions, particularly in men. Males also had higher rates of all-cause mortality and a larger increase in the projected number of hip fractures by 2050.
Professor Cyrus Cooper, President of the International Osteoporosis Foundation (IOF) and a co-author of the global study, stated:
“The findings of this important study highlight the urgent need for improved strategies in hip fracture prevention and care. This should be seen as both a warning and a call to action for healthcare systems worldwide. Past studies have shown that five to 10 % of hip fracture patients go on to experience a recurrent hip fracture, and of these, as many as 23% occur in the year following their first hip fracture, and 70% within the first five years. Clearly, the enormous osteoporosis treatment gap, which the study found to be even higher in men than in women, is unacceptable. Healthcare systems must act. A first step is to prioritize the implementation of post-fracture care coordination programmes, such as Fracture Liaison Services, to ensure that any older adult who has sustained a first hip fracture receives the needed treatment and management to prevent further, potentially life-threatening fractures.”
The international study analysed data from a large representative cohort involving 19 countries in Oceania, Asia, Europe, and North- and South America. It examined the incidence of hip fractures, post-fracture treatment, and all-cause mortality following hip fractures, among patients aged 50 years and older, from 2005 to 2018. The study is unique in that, in contrast to previous reports on hip fracture incidence which are based on data with heterogeneity in data sources, study periods, and analytical approaches, it applied a standardised protocol and a common data model across all sites to provide comparable data. Age- and sex-standardised incidence rates of hip fracture were estimated using the 2020 United Nations world population as a standard. The number of hip fractures in 2030, 2040, and 2050 were projected based on the trends in the incidence rates and the World Bank data. Within 12 months following hip fractures, post-fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication), and the all-cause mortality rates were estimated.
The study identified 4,115,046 hip fracture cases in the cohort, with the following key findings:
- The reported age- and sex-standardized incidence rates of hip fractures ranged widely, from 95.1 (Brazil) to 315.9 (Denmark) per 100,000 population.
- Most countries and regions showed a decreasing trend in hip fracture incidence, with the most pronounced declines in Denmark (‐2.8% per year), Singapore (‐2.8%), and Hong Kong (‐2.4%). The largest increases were noted in the Netherlands (+2.1%), and South Korea (+1.2%).
- Despite the overall decline in hip fracture incidence, the total number of hip fractures is estimated to nearly double from 2018 to 2050.
- Within 1 year following a hip fracture, post-fracture treatment remained low, ranging from 11.5% in Germany to 50.3% in United Kingdom.
- One-year all-cause mortality rates following hip ranged from 14.4% (Singapore) to 28.3% (United Kingdom), while mortality trends varied from ‐5.3% to +18.4% per year.
- 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.
Professor Nicholas Harvey, Chair of the IOF Committee of Scientific Advisors, concluded:
“One of the study's key takeaways is that the decrease in age-and sex-specific hip fracture incidence observed in numerous countries over the past few years will not compensate for the global impact of aging populations. The burden of hip fracture will thus continue to grow, leading to increased dependency, morbidity, and mortality, and resulting in immense socio-economic costs for resource-strapped healthcare services worldwide. The time for action is now. IOF urges healthcare care systems to address the treatment gap through targeted policy and multidisciplinary intervention to reduce the impact of the hip fracture in the coming decades.”
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References:
Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, Bosco-Levy P, Bradbury BD, Chan AHY, Chandran M, Cooper C, de Ridder M, Doyon CY, Droz-Perroteau C, Ganesan G, Hartikainen S, Ilomaki J, Jeong HE, Kiel DP, Kubota K, Lai EC, Lange JL, Lewiecki EM, Lin J, Liu J, Maskell J, de Abreu MM, O'Kelly J, Ooba N, Pedersen AB, Prats-Uribe A, Prieto-Alhambra D, Qin SX, Shin JY, Sørensen HT, Tan KB, Thomas T, Tolppanen AM, Verhamme KMC, Wang GH, Watcharathanakij S, Wood SJ, Cheung CL, Wong ICK. Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality. J Bone Miner Res. 2023 Apr 29. doi: 10.1002/jbmr.4821. Epub ahead of print. PMID: 37118993.
Details for the study and the research team may be found at https://www.bone.hku.hk/
Facts and Statistics on Osteoporosis: https://www.osteoporosis.foundation/facts-statistics
About IOF
The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as more than 320 patient, medical and research organizations, work together to make fracture prevention and healthy mobility a worldwide heath care priority.
www.osteoporosis.foundation @iofbonehealth
JOURNAL
Journal of Bone and Mineral Research
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality
Hip fracture burden to nearly double worldwide by 2050
Researchers call for urgent action in hip fracture prevention
An international group of researchers led by the Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, the University of Hong Kong (HKUMed), and including Douglas P Kiel, MD, MPH, Director Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife, and Professor of Medicine, Harvard Medical School, evaluated the secular trends in hip fracture incidence, treatment patterns following a hip fracture, and all-cause mortality in 19 countries and regions from 2005 to 2018. While the age- and sex-standardised hip fracture incidence rates decreased in most regions, the number of hip fractures worldwide are projected to nearly double by 2050 compared to 2018. A significant treatment gap of patients sustaining a hip fracture not receiving therapy to prevent future fractures was also observed in all countries and regions, particularly in men. The study, recently published in Journal of Bone and Mineral Research, highlights an urgent need for better strategies in hip fracture prevention and care.
Background
Hip fracture remains a global public health concern contributing to increased dependency, morbidity, and mortality, and placing a burden on patients, their families, and healthcare systems. In this international study, researchers directly accessed to the data from a large representative cohort involving 19 countries and regions to examine the incidence of hip fractures, treatment following a hip fracture, and all-cause mortality following hip fractures, among patients aged 50 years and older, from 2005 to 2018.
Previous reports on hip fracture incidence have been based on data with heterogeneity in data sources, study periods, and analytical approaches. In contrast, this study applied a standardised protocol and a common data model across all sites to provide comparable data.
Age- and sex-standardised incidence rates of hip fracture were estimated using the 2020 United Nations world population as a standard. The number of hip fractures in 2030, 2040, and 2050 were projected based on the trends in the incidence rates and the World Bank data. Within 12 months following hip fractures, the proportion of patients receiving anti-osteoporosis medication, and the all-cause mortality rates were estimated.
Research findings and significance
A total of 4,115,046 hip fracture cases were identified in the cohort. The reported age- and sex-standardised incidence rates of hip fractures ranged from 95.1 (Brazil) to 315.9 (Denmark) per 100,000 population. Most countries and regions showed a decreasing trend in hip fracture incidence, with the most pronounced declines in Denmark (‐2.8% per year), Singapore (‐2.8%), and Hong Kong (‐2.4%). The largest increases were noted in the Netherlands (+2.1%), and South Korea (+1.2%). Despite the overall decline in hip fracture incidence, the total number of hip fractures is estimated to nearly double from 2018 to 2050.
Within 1 year following a hip fracture, post-fracture treatment remained low throughout the years, ranging from 11.5% in Germany to 50.3% in United Kingdom. One-year all-cause mortality rates ranged from 14.4% (Singapore) to 28.3% (United Kingdom), while mortality trends varied from ‐5.3% to +18.4% per year. 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.
The study highlights substantial variations in the global epidemiology of hip fractures and the treatment after hip fracture across countries and regions. A key message from the study is that decline in hip fractures in many countries in recent years is not enough to offset the impact of the aging population. The burden of hip fracture is expected to continue to grow. Given that hip fracture is not only a medical issue, but also a social issue that often requires institutionalisation, government policy and multidisciplinary intervention should be considered to reduce the impact of the hip fracture in the coming 30 years.
About the research team
The research was led by
- Dr. Chor-Wing Sing, Research Assistant Professor Department of Pharmacology and Pharmacy, HKUMed (First author)
- Dr. Ching‑Lung Cheung, Associate Professor, Department of Pharmacology and Pharmacy, HKUMed (Co-corresponding author)
- Professor Ian Chi Kei Wong, Lo Shiu Kwan Kan Po Ling Professorship in Pharmacy,
Head of Department of Pharmacology and Pharmacy, HKUMed (Co-corresponding author)
Other co-authors include (in alphabetical order)
Sharon Bartholomew, MHSc | J Simon Bell, PhD | Corina Bennett, MS |
Kebede Beyene, PhD | Pauline Bosco-Levy, MD | Brian D Bradbury, DSc |
Amy Hai Yan Chan, PhD | Manju Chandran, MD | Cyrus Cooper, FMedSci |
Maria de Ridder, PhD | Caroline Y Doyon, MSc | Cécile Droz‑Perroteau, PhD |
Ganga Ganesan, MSc | Sirpa Hartikainen, PhD | Jenni Ilomaki, PhD |
Han Eol Jeong, PhD | Douglas P Kiel, MD, MPH | Kiyoshi Kubota, PhD |
Edward Chia-Cheng Lai, PhD | Jeff L Lange, PhD | E Michael Lewiecki, MD |
Julian Lin, PhD | Tzu-Chieh Lin, PhD | Jiannong Liu, PhD |
Joe Maskell, MSc | Mirhelen Mendes de Abreu, MD | James O’Kelly, PhD |
Nobuhiro Ooba, PhD | Alma B Pedersen, PhD | Albert Prats-Uribe, MD |
Daniel Prieto‑Alhambra, MD | Simon Xiwen Qin, PhD | Ju-Young Shin, PhD |
Henrik T Sørensen, DMSc | Kelvin Bryan Tan, PhD | Tracy Thomas, MSc |
Anna-Maija Tolppanen, PhD | Katia MC Verhamme, MD | Grace Hsin-Min Wang, PhD |
Sawaeng Watcharathanakij, PhD | Stephen J Wood, Bpharm |
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Douglas P Kiel, MD, MPH, is Professor of Medicine, Harvard Medical School; Director Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife; and Associate Member, Broad Institute of Harvard and MIT.
Details for the study and the research team may be found at https://www.bone.hku.hk/
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $63 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website at https://www.hebrewseniorlife.org/ or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.
JOURNAL
Journal of Bone and Mineral Research
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality
ARTICLE PUBLICATION DATE
29-Apr-2023
COI STATEMENT
DPK, EML, and the institutions in which ICKW, SW, KMCV, A-MT, HTS, J-YS, JnL, DP-A, MMdA, EC-CL, KK, CD-P, AHYC, KB, and JSB were employed received financial support from Amgen Inc. for the submitted work. DPK also receives support from Amgen, Inc. in the form of an investigator-initiated grant. All other authors declare no competing interests.
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