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Changing trends in the epidemiology of hip fracture in Spain

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Abstract

Summary

Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years.

Introduction

The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist.

Methods

Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥65 years during a 14-year period (1997–2010). The analysis compares two periods of four years: 1997–2000 (P1) and 2007–2010 (P2).

Results

There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3 %/year in men and 1.4 % in women. After adjustment, the rate increased an average of 0.4 %/year in men (p < 0.0001), but decreased 0.2 %/year in women (p < 0.0001). In men, younger than 85, the decrease was not significant except in 70–74 years, and from 80 years, the adjusted rate increases significantly (p < 0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80–84 years, and the adjusted rate increased significantly in individuals 85 years and older (p < 0.0001). Mortality rates declined by 22 % in both sexes, and the index of overaging population rises 30.1 % in men and 25.2 % in women.

Conclusions

This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure.

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References

  1. Bessette L, Jean S, Lapointe-Garant MP, Belzile EL, Davison KS, Ste-Marie LG, Brown JP (2012) Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women. Osteoporos Int 23(6):1757–1768

    Article  CAS  PubMed  Google Scholar 

  2. Cummings SR, Melton LJ III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    Article  PubMed  Google Scholar 

  3. Pages A, Carbonell C, Fina F, Alzamora M, Baena JM, Martinez D et al (2012) Burden of osteoporotic fractures in primary health care in Catalonia (Spain): a population-based study. BMC Musculoskelet Disord 13:79

    Article  Google Scholar 

  4. Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E et al (2011) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 22(2):685–692

    Article  CAS  PubMed  Google Scholar 

  5. González López-Valcárcel B, Sosa Henríquez M (2013) Estimate of the 10-year risk of osteoporotic fractures in the Spanish population. Med Clin (Barc) 140(3):104–109

    Article  Google Scholar 

  6. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382

    Article  CAS  PubMed  Google Scholar 

  7. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521

    Article  CAS  PubMed  Google Scholar 

  8. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

    Article  CAS  PubMed  Google Scholar 

  9. Zwart M, Azagra R, Encabo G, Aguye A, Roca G, Güell S et al (2011) Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture. BMC Public Health 11:775

    Article  PubMed Central  PubMed  Google Scholar 

  10. Roux C, Wyman A, Hooven FH, Gehlbach SH, Adachi JD, Chapurlat RD et al (2012) Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). Osteoporos Int 23(12):2863–2871

    Article  CAS  PubMed  Google Scholar 

  11. Grønskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B (2012) Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int 23(6):1807–1811

    Article  PubMed  Google Scholar 

  12. Librero J, Peiró S, Leutscher E, Merlo J, Bernal-Delgado E, Ridao M et al (2012) Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System. BMC Health Serv Res 12:15

    Article  PubMed Central  PubMed  Google Scholar 

  13. Kanis JA, Johnell O, de Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17(7):1237–1244

    Article  PubMed  Google Scholar 

  14. Pfeilschifter J, Cooper C, Watts NB, Flahive J, Saag KG, Adachi JD et al (2012) Regional and age-related variations in the proportions of hip fractures and major fractures among postmenopausal women: the Global Longitudinal Study of Osteoporosis in Women. Osteoporos Int 23(8):2179–2188

    Article  CAS  PubMed  Google Scholar 

  15. Alvarez-Nebreda ML, Jimenez AB, Rodriguez P, Serra JA (2008) Epidemiology of hip fracture in the elderly in Spain. Bone 42(2):278–285

    Article  PubMed  Google Scholar 

  16. Urreizti R, Garcia-Giralt N, Riancho JA, González-Macías J, Civit S, Güerri R et al (2012) COL1A1 haplotypes and hip fracture. J Bone Miner Res 27(4):950–953

    Article  CAS  PubMed  Google Scholar 

  17. Larrosa M, Gomez A, Casado E, Moreno M, Vázquez I, Orellana C et al (2012) Hypovitaminosis D as a risk factor of hip fracture severity. Osteoporos Int 23(2):607–614

    Article  CAS  PubMed  Google Scholar 

  18. Pérez Durillo FT, Torío Durántez J, Villarejo Villar AB, Sánchez Vico AB, Cueto Camarero Mdel M, Durillo JP (2011) Comparative study of dietary intake and nutritional status in elderly women with and without hip fracture. Aten Primaria 43(7):362–368

    Article  PubMed  Google Scholar 

  19. Freemantle N, Cooper C, Roux C, Díez-Pérez A, Guillemin F, Jonsson B et al (2010) Baseline observations from the POSSIBLE EU® study: characteristics of postmenopausal women receiving bone loss medications. Arch Osteoporos 5(1–2):61–72

    Article  PubMed Central  PubMed  Google Scholar 

  20. Khong TP, de Vries F, Goldenberg JS, Klungel OH, Robinson NJ, Ibáñez L et al (2012) Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int 91(1):24–31

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Khalili H, Huang ES, Jacobson BC, Camargo CA Jr, Feskanich D, Chan AT (2012) Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ 344:e372

    Article  PubMed Central  PubMed  Google Scholar 

  22. Hernández JL, Olmos JM, Alonso MA, González-Fernández CR, Martínez J, Pajarón M et al (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17(3):464–470

    Article  PubMed  Google Scholar 

  23. Guerra-García MM, Rodríguez-Fernández JB, Puga-Sarmiento E, Charle-Crespo MÁ, Gomes-Carvalho CS, Prejigueiro-Santás A (2011) Incidence of hip fractures due to osteoporosis in relation to the prescription of drugs for their prevention and treatment in Galicia, Spain. Aten Primaria 43(2):82–88

    Article  PubMed  Google Scholar 

  24. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579

    Article  CAS  PubMed  Google Scholar 

  25. Vanasse A, Orzanco MG, Dagenais P, Ouarda T, Courteau J, Asghari S et al (2012) Secular trends of hip fractures in Québec, Canada. Osteoporos Int 23(6):1665–1672

    Article  CAS  PubMed  Google Scholar 

  26. Wu TY, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A (2011) Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxford) 33(2):284–291

    Article  Google Scholar 

  27. Korhonen N, Niemi S, Parkkari J, Sievänen H, Palvanen M, Kannus P (2013) Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int 24(5):1599–1603

    Article  CAS  PubMed  Google Scholar 

  28. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Nilson F, Moniruzzaman S, Gustavsson J, Andersson R (2013) Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxford) 35(1):125–131

    Article  Google Scholar 

  30. Kanis JA, on behalf of the World Health Organization Scientific Group: Assessment of osteoporosis at the primary healthcare level. Technical Report. WHO Collaborating Centre 2007. University of Sheffield, Sheffield. UK. Available in http://www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf

  31. Kanis J, Burlet N, Cooper D, Delmas C, Reginster J, Borgstrom F et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19(4):399–428

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Azagra-Ledesma R, Prieto-Alhambra D, Encabo-Duró G, Casado-Burgos E, Aguyé-Batista A, Díez-Pérez A et al (2011) Usefulness of FRAX® tool for the management of osteoporosis in the Spanish female population. Med Clin (Barc) 136(14):613–619

    Article  Google Scholar 

  33. Naranjo A, Ojeda-Bruno S, Francisco-Hernández F, Erausquin C, Rúa-Figueroa I, Rodríguez-Lozano C (2011) Application of guidelines for secondary prevention of fracture and the FRAX® index in patients with fragility fracture. Med Clin (Barc) 136(7):290–292

    Article  Google Scholar 

  34. Azagra R, Roca G, Encabo G, Aguyé A, Zwart M, Güell S et al (2012) FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort. BMC Musculoskelet Disord 13(1):204

    Article  PubMed Central  PubMed  Google Scholar 

  35. Serra JA, Garrido G, Marañón E, Ortiz J (2002) Epidemiology of hip fracture in elderly in Spain. An Med Interna (Madrid) 19(8):389–395

    Article  CAS  Google Scholar 

  36. Imaz-Iglesia I, Rubio-González B, López-Delgado ME, Amate-Blanco JM, Gómez-Pajuelo P, González-Enriquez J (2010) Análisis coste-utilidad de los tratamientos farmacológicos para la prevención de fracturas en mujeres con osteoporosis en España: IPE 63/2010. Madrid: AETS - Instituto de Salud Carlos III. Available in http://gesdoc.isciii.es/gesdoccontroller?action=download&id=14/09/2012-3fdd17b5be

  37. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370 (9596):1453–1457.

    Google Scholar 

  38. Hiligsmann M, Bruyère O, Roberfroid D, Dubois C, Parmentier Y, Carton J et al (2012) Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007). Arthritis Care Res 64(5):744–750

    Article  Google Scholar 

  39. Azagra R, López-Expósito F, Aguye A, Encabo G, GROIMAP group (2013) Prediction of frailty fractures or prediction of densitometric osteoporosis. Med Clin (Barc) 141(1):43–44

    Article  Google Scholar 

  40. Gonzalez-Macias J, Marin F, Vila J, Diez-Perez A (2012) Probability of fractures predicted by FRAX® and observed incidence in the Spanish ECOSAP Study cohort. Bone 50(1):373–377

    Article  PubMed  Google Scholar 

  41. Azagra R, Encabo G, Aguyé A, Iglesias M, on behaf of GROIMAP group (2012) New evidence on the discriminant and predictive capacity of the FRAX® tool in a Spanish female population. Aten Primaria 44(5):297–299

    Article  PubMed  Google Scholar 

  42. Piscitelli P, Chitano G, Johannson H, Brandi ML, Kanis JA, Black DM (2013) Updated fracture incidence rates for the Italian version of FRAX®. Osteoporos Int 24(3):859–866

    Article  CAS  PubMed  Google Scholar 

  43. Icks A, Arend W, Becker C, Rapp K, Jungbluth P, Haastert B (2013) Incidence of hip fractures in Germany, 1995–2010. Arch Osteoporos 8(1–2):140

    Article  PubMed  Google Scholar 

  44. Omsland TK, Holvik K, Meyer HE, Center JR, Emaus N, Tell GS et al (2012) Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. Eur J Epidemiol 27(10):807–814

    Article  PubMed  Google Scholar 

  45. Maravic M, Taupin P, Landais P, Roux C (2011) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int 22(3):797–801

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

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Authors and Affiliations

  1. Department of Medicine, Universitat Autònoma de Barcelona, ps/ Vall d’ Hebron 119, 08135, Barcelona, Spain

    R. Azagra, F. López-Expósito & A. Díez-Pérez

  2. Health Center Badia del Valles (ICS), GROIMAP-USR MN-IDIAP Jordi Gol, c/ Bética s/n, Badia del Vallès, Barcelona, Spain

    R. Azagra

  3. Idc-Hospital General de Catalunya, Universitat Internacional de Catalunya, c/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain

    R. Azagra

  4. Health Center Bon Pastor (ICS), c/ Mollerussa s/n, 08030, Barcelona, Spain

    F. López-Expósito

  5. Biostatistics Unit, Departament of Basic Sciences, Universitat Internacional de Catalunya, c/ Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain

    J. C. Martin-Sánchez

  6. Health Center Granollers Centre (ICS), c/ Museu 19, 08400, Granollers, Barcelona, Spain

    A. Aguyé

  7. Secretaria Tècnica, DAP Gerència Territorial Metropolitana Nord, Institut Català de la Salut (ICS), Ctra/ Barcelona, 473, 08203, Sabadell, Barcelona, Spain

    N. Moreno

  8. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK

    C. Cooper & E. M. Dennison

  9. Botnar Research Centre, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK

    C. Cooper

  10. Department of Internal Medicine, URFOA, IMIM, Parc de Salut Mar, Barcelona, Spain

    A. Díez-Pérez

  11. Red Temática de Envejecimiento y Fragilidad RETICEF, Instituto de Salud Carlos III-FEDER, Madrid, Spain

    A. Díez-Pérez

  12. Victoria University, PO Box 600, Wellington, 6140, New Zealand

    E. M. Dennison

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  1. R. Azagra
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  2. F. López-Expósito
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  3. J. C. Martin-Sánchez
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  4. A. Aguyé
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  6. C. Cooper
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  7. A. Díez-Pérez
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Correspondence to R. Azagra.

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Azagra, R., López-Expósito, F., Martin-Sánchez, J.C. et al. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int 25, 1267–1274 (2014). https://doi.org/10.1007/s00198-013-2586-0

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  • DOI: https://doi.org/10.1007/s00198-013-2586-0

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