Epidemiology of fractures in England and Wales

Abstract

Records from the General Practice Research Database were used to derive age- and gender-specific fracture incidence rates for England and Wales during the period 1988–1998. In total, 103,052 men and 119,317 women in the sample of 5 million adults sustained a fracture over 10.4 million and 11.2 million person-years (py) of follow-up. Among women, the most frequent fracture sites were the radius/ulna (30.2 cases per 10,000 py) and femur/hip (17.0 per 10,000 py). In men, the most common fracture was that of the carpal bones (26.2 per 10,000 py); the incidence of femur/hip fracture was 5.3 per 10,000 py. Varying patterns of fracture incidence were observed with increasing age; whereas some fractures became more common in later life (vertebral, distal forearm, hip, proximal humerus, rib, clavicle, pelvis), others were more frequent in childhood and young adulthood (tibia, fibula, carpus, foot, ankle). The lifetime risk of any fracture was 53.2% at age 50 years among women, and 20.7% at the same age among men. Whereas fractures of the proximal femur and vertebral body were associated with excess mortality over a 5 year period following fracture diagnosis among both men and women, fractures of the distal forearm were associated with only slight excess mortality in men. This study provides robust estimates of fracture incidence that will assist health-care planning and delivery.

Introduction

Osteoporotic fractures represent an enormous public health burden. Worldwide, there were an estimated 1.66 million hip fractures in 1990, about 1,197,000 in women and 463,000 in men.8 Epidemiological studies from North America have estimated the lifetime risk of common fragility fractures to be 17.5% for hip fracture, 15.6% for clinically diagnosed vertebral fracture, and 16% for distal forearm fracture among white women aged 50 years.16 Corresponding risks among men are 6%, 5%, and 2.5%. Fracture incidence data relating to the British population are, however, more scarce. In Cardiff, Wales, a recent study reported an all-fracture incidence rate of 235/10,000 per year among men and of 188/10,000 per year among women.14 An earlier study based in Leicester11 suggested substantially lower rates: annual incidence of fractures at all sites of around 100/10,000 per year in men and 81/10,000 per year among women. Robust estimates of fracture incidence are required to plan healthcare delivery, as well as to characterize geographic and temporal variation. In this study, we utilize records from the General Practice Research Database to report age- and gender-specific fracture incidence rates for the adult population of England and Wales as a whole, during the period 1988 to 1998.