Epidemiology and social costs of hip fracture

      Abstract

      Hip fracture is an important and debilitating condition in older people, particularly in women. The epidemiological data varies between countries, but it is globally estimated that hip fractures will affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually falling in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase from 1.26 million in 1990 to 4.5 million by the year 2050. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society.
      In this review, we show the most recent epidemiological data regarding hip fracture, indicating the well-known risk factors and conditions that seem relevant for determining this condition. A specific part is dedicated to the social costs due to hip fracture. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new co-morbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater.

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      References

        • Maggi S.
        • Kelsey J.L.
        • Litvak J.
        • Heyse S.P.
        Incidence of hip fractures in the elderly: a cross-national analysis.
        Osteoporos Int. 1991; 1: 232-241
        • Falaschi P.
        • Marsh D.R.
        Orthogeriatrics.
        Springer, 2017
        • Veronese N.
        • Maggi S.
        Epidemiology of Hip Fracture and Social Costs.
        Springer, 2017: 19-30https://doi.org/10.1007/978-3-319-43249-6_2 (Cham)
        • Seeman E.
        • Allen T.
        Risk factors for osteoporosis.
        Aust N Z J Med. 1989; 19: 69-75https://doi.org/10.1111/j.1445-5994.1989. tb01682.x
        • Cummings S.R.
        • ML
        Epidemiology and outcomes of osteoporotic fractures.
        Lancet. 2002; 359: 1-1761
        • Veronese N.
        • Solmi M.
        • Rizza W.
        • Manzato E.
        • Sergi G.
        • Santonastaso P.
        • et al.
        Vitamin D status in anorexia nervosa: a meta-analysis.
        Int J Eat Disord. 2015; 48: 803-813https://doi.org/10.1002/eat.22370
        • Solmi M.
        • Veronese N.
        • Correll C.U.
        • Favaro A.
        • Santonastaso P.
        • Caregaro L.
        • et al.
        Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.
        Acta Psychiatr Scand. 2016; 133: 341-351https://doi.org/10.1111/acps.12556
        • De Laet C.
        • Kanis J.A.
        • Odén A.
        • Johanson H.
        • Johnell O.
        • Delmas P.
        • et al.
        Body mass index as a predictor of fracture risk: a meta-analysis.
        Osteoporos Int. 2005; 16: 1330-1338https://doi.org/10.1007/s00198-005-1863-y
        • Haring B.
        • Crandall C.J.
        • Wu C.
        • LeBlanc E.S.
        • Shikany J.M.
        • Carbone L.
        • et al.
        Dietary patterns and fractures in postmenopausal women.
        JAMA Intern Med. 2016; https://doi.org/10.1001/jamainternmed.2016.0482
        • Cauley J.A.
        Osteoporosis: fracture epidemiologyupdate 2016.
        Curr Opin Rheumatol. 2017; 29: 150-156https://doi.org/10.1097/BOR.0000000000000365
        • Cooper C.
        • Campion G.
        • Melton L.J.
        Hip fractures in the elderly: a world-wide projection.
        Osteoporos Int. 1992; 2: 285-289https://doi.org/10.1007/BF01623184
        • Kanis J.A.
        • Odén A.
        • McCloskey E.V.
        • Johansson H.
        • Wahl D.A.
        • Cooper C.
        A systematic review of hip fracture incidence and probability of fracture worldwide.
        Osteoporos Int. 2012; 23: 2239-2256https://doi.org/10.1007/s00198-012-1964-3
        • Karagas M.R.
        • Lu-Yao G.L.
        • Barrett J.A.
        • Beach M.L.
        • Baron J.A.
        Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly.
        Am J Epidemiol. 1996; 143: 677-682
        • Cooper C.
        • Cole Z.A.
        • Holroyd C.R.
        • Earl S.C.
        • Harvey N.C.
        • Dennison E.M.
        • et al.
        Secular trends in the incidence of hip and other osteoporotic fractures.
        Osteoporos Int. 2011; 22: 1277-1288https://doi.org/10.1007/s00198-011-1601-6
        • Arakaki H.
        • Owan I.
        • Kudoh H.
        • Horizono H.
        • Arakaki K.
        • Ikema Y.
        • et al.
        Epidemiology of hip fractures in Okinawa, Japan.
        J Bone Miner Metab. 2011; 29: 309-314https://doi.org/10.1007/s00774-010-0218-8
        • Piscitelli P.
        • Tarantino U.
        • Chitano G.
        • Argentiero A.
        • Neglia C.
        • Agnello N.
        • et al.
        Updated incidence rates of fragility fractures in Italy: extension study 2002–2008.
        Clin Cases Miner Bone Metab. 2011; 8: 54-61
        • Mann E.
        • Meyer G.
        • Haastert B.
        • Icks A.
        Comparison of hip fracture incidence and trends between Germany and Austria 1995–2004: an epidemiological study.
        BMC Public Health. 2010; 10: 46https://doi.org/10.1186/1471-2458-10-46
        • Tuzun S.
        • Eskiyurt N.
        • Akarirmak U.
        • Saridogan M.
        • Senocak M.
        • Johansson H.
        • et al.
        Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study.
        Osteoporos Int. 2012; 23: 949-955https://doi.org/10.1007/s00198-011-1655-5
        • Langley J.
        • Samaranayaka A.
        • Davie G.
        • Campbell A.J.
        Age, cohort and period effects on hip fracture incidence: analysis and predictions from New Zealand data 1974–2007.
        Osteoporos Int. 2011; 22: 105-111https://doi.org/10.1007/s00198-010-1205-6
        • Nymark T.
        • Lauritsen J.M.
        • Ovesen O.
        • Röck N.D.
        • Jeune B.
        Decreasing incidence of hip fracture in the Funen County, Denmark.
        Acta Orthop. 2006; 77: 109-113https://doi.org/10.1080/17453670610045777
        • Leslie W.D.
        • O’Donnell S.
        • Jean S.
        • Lagacé C.
        • Walsh P.
        • Bancej C.
        • et al.
        Trends in hip fracture rates in Canada.
        JAMA. 2009; 302: 883-889https://doi.org/10.1001/jama.2009.1231
        • Cassell E.
        • Clapperton A.
        A decreasing trend in fall-related hip fracture incidence in Victoria, Australia.
        Osteoporos Int. 2013; 24: 99-109https://doi.org/10.1007/s00198-012-1937-6
        • Adams A.L.
        • Shi J.
        • Takayanagi M.
        • Dell R.M.
        • Funahashi T.T.
        • Jacobsen S.J.
        Ten-year hip fracture incidence rate trends in a large California population, 1997–2006.
        Osteoporos Int. 2013; 24: 373-376https://doi.org/10.1007/s00198-012-1938-5
        • Wu T.-Y.
        • Jen M.-H.
        • Bottle A.
        • Liaw C.-K.
        • Aylin P.
        • Majeed A.
        Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study.
        J Public Health (Oxf). 2011; 33: 284-291https://doi.org/10.1093/pubmed/fdq074
        • Hernández J.L.
        • Olmos J.M.
        • Alonso M.A.
        • González-Fernández C.R.
        • Martínez J.
        • Pajarón M.
        • et al.
        Trend in hip fracture epidemiology over a 14-year period in a Spanish population.
        Osteoporos Int. 2006; 17: 464-470https://doi.org/10.1007/s00198-005-0008-7
        • Rosengren B.E.
        • Ahlborg H.G.
        • Gärdsell P.
        • Sernbo I.
        • Nilsson J-Å.
        • Daly R.M.
        • et al.
        Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987–2002.
        Scand J Public Health. 2012; 40: 102-108https://doi.org/10.1177/1403494811425604
        • White S.M.
        • Griffiths R.
        Projected incidence of proximal femoral fracture in england: a report from the NHS hip fracture anaesthesia network (HIPFAN).
        Injury. 2017; 42: 1230-1233https://doi.org/10.1016/j.injury.2010.11.010
        • Iqbal M.M.
        Osteoporosis: epidemiology, diagnosis, and treatment.
        South Med J. 2000; 93: 2-18
        • Emaus N.
        • Olsen L.R.
        • Ahmed L.A.
        • Balteskard L.
        • Jacobsen B.K.
        • Magnus T.
        • et al.
        Hip fractures in a city in Northern Norway over 15 years: time trends, seasonal variation and mortality: the Harstad Injury Prevention Study.
        Osteoporos Int. 2011; 22: 2603-2610https://doi.org/10.1007/s00198-010-1485-x
        • Ettinger B.
        • Black D.M.
        • Dawson-Hughes B.
        • Pressman A.R.
        • Melton L.J.
        Updated fracture incidence rates for the US version of FRAX.
        Osteoporos Int. 2010; 21: 25-33https://doi.org/10.1007/s00198-009-1032-9
        • Wong P.C.
        Fracture epidemiology in a mixed southeastern Asian community (Singapore).
        Clin Orthop Relat Res. 2008; 45: 55-61
        • Chalmers J.
        • Ho K.C.
        Geographical variations in senile osteoporosis: the association with physical activity.
        J Bone Joint Surg Br. 1970; 52: 667-675
        • Chen F.-P.
        • Shyu Y.-C.
        • Fu T.-S.
        • Sun C.-C.
        • Chao A.-S.
        • Tsai T.-L.
        • et al.
        Secular trends in incidence and recurrence rates of hip fracture: a nationwide population-based study.
        Osteoporos Int. 2017; 28: 811-818https://doi.org/10.1007/s00198-016-3820-3
        • Kannus P.
        • Parkkari J.
        • Sievänen H.
        • Heinonen A.
        • Vuori I.
        • Järvinen M.
        Epidemiology of hip fractures.
        Bone. 1996; 18: 57S-63S
        • Cummings S.R.
        • Rubin S.M.
        • Black D.
        The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen.
        Clin Orthop Relat Res. 1990; : 163-166
        • Haentjens P.
        • Autier P.
        • Barette M.
        • Boonen S.
        The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group.
        J Bone Joint Surg Am. 2001; 83–A: 493-500
        • Hoerger T.J.
        • Downs K.E.
        • Lakshmanan M.C.
        • Lindrooth R.C.
        • Plouffe L.
        • Wendling B.
        • et al.
        Healthcare use among U.S. women aged 45 and older: total costs and costs for selected postmenopausal health risks.
        J Womens Health Gend Based Med. 1999; 8: 1077-1189https://doi.org/10.1089/jwh.1.1999.8.1077
        • Lawrence T.M.
        • White C.T.
        • Wenn R.
        • Moran C.G.
        The current hospital costs of treating hip fractures.
        Injury. 2005; 36 (discussion 92): 88-91https://doi.org/10.1016/j.injury.2004.06.015
        • Piscitelli P.
        • Iolascon G.
        • Gimigliano F.
        • Muratore M.
        • Camboa P.
        • Borgia O.
        • et al.
        Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey.
        Osteoporos Int. 2007; 18: 211-219https://doi.org/10.1007/s00198-006-0224-9
      1. National Hospital Discharge Survey. Health Data Interactive, Health Care Use and Expenditures.
        2010
        • Nordstrom P.
        • Gustafson Y.
        • Michaelsson K.
        • Nordstrom A.
        Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden.
        BMJ. 2015; 350: h696https://doi.org/10.1136/bmj.h696
        • Nikkel L.E.
        • Kates S.L.
        • Schreck M.
        • Maceroli M.
        • Mahmood B.
        • Elfar J.C.
        Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study.
        BMJ. 2015; 351: h6246
        • Maggi S.
        • Siviero P.
        • Wetle T.
        • Besdine R.W.
        • Saugo M.
        • Crepaldi G.
        A multicenter survey on profile of care for hip fracture: predictors of mortality and disability.
        Osteoporos Int. 2010; 21: 223-231https://doi.org/10.1007/s00198-009-0936-8
        • De Rui M.
        • Veronese N.
        • Manzato E.
        • Sergi G.
        Role of comprehensive geriatric assessment in the management of osteoporotic hip fracture in the elderly: an overview.
        Disabil Rehabil. 2013; 35: 758-765https://doi.org/10.3109/09638288.2012.707747
        • Braithwaite R.S.
        • Col N.F.
        • Wong J.B.
        Estimating hip fracture morbidity, mortality and costs.
        J Am Geriatr Soc. 2003; 51: 364-370https://doi.org/10.1046/j.1532-5415.2003.51110.x
        • Kramer A.M.
        • Steiner J.F.
        • Schlenker R.E.
        • Eilertsen T.B.
        • Hrincevich C.A.
        • Tropea D.A.
        • et al.
        Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings.
        JAMA. 1997; 277: 396-404
        • Ward D.
        • Severs M.
        • Dean T.
        • Brooks N.
        Care home versus hospital and own home environments for rehabilitation of older people (Cochrane Review).
        Cochrane Database Syst Rev. 2003; (Art. No.: CD003164. 10.1002/14651858. CD003164. pub2. www.cochranelibrary.com)
        • Huusko T.M.
        Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia.
        BMJ. 2000; 321: 1107-1111https://doi.org/10.1136/bmj.321.7269.1107
        • Cooper C.
        The crippling consequences of fractures and their impact on quality of life.
        Am J Med. 1997; 103: S12-S19https://doi.org/10.1016/S0002-9343(97)90022-X
        • Cristancho P.
        • Lenze E.J.
        • Avidan M.S.
        • Rawson K.S.
        Trajectories of depressive symptoms after hip fracture.
        Psychol Med. 2016; 46: 1413-1425https://doi.org/10.1017/S0033291715002974
        • Iaboni A.
        • Seitz D.P.
        • Fischer H.D.
        • Diong C.C.
        • Rochon P.A.
        • Flint A.J.
        Initiation of antidepressant medication after hip fracture in community-dwelling older adults.
        Am J Geriatr Psychiatry. 2015; 23: 1007-1015https://doi.org/10.1016/j.jagp.2014.10.002
        • Veronese N.
        • Stubbs B.
        • Crepaldi G.
        • Solmi M.
        • Cooper C.
        • Harvey N.C.
        • et al.
        Relationship between low bone mineral density and fractures with incident cardiovascular disease: a systematic review and meta-analysis.
        J Bone Miner Res. 2017; 32: 1126-1135https://doi.org/10.1002/jbmr.3089
        • Smith T.O.
        • Dainty J.R.
        • MacGregor A.
        Trajectory of social isolation following hip fracture: an analysis of the English Longitudinal Study of Ageing (ELSA) cohort.
        Age Ageing. 2017; 72: 1-6https://doi.org/10.1093/ageing/afx129