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The incidence of fragility fractures is increasing rapidly, although age-adjusted rates seem to be declining.
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Poor outcomes are related both to fractures and their comorbidities and to the frailty of the patients who sustain fractures.
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Identifying individuals who are at highest risk, using a prediction tool such as the FRAX, can allow for targeted primary prevention.
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A person who sustains one fracture is at 50% to 100% higher risk of having another one; fractures, therefore, provide important
Epidemiology of Fragility Fractures
Section snippets
Key points
Prevalence/Incidence
For each decade after age 50, the risk of hip fracture doubles.7 At age 50, an American white woman has a 17% lifetime risk of sustaining a hip fracture,8, 9 and a woman who lives to age 90 has a 1 in 3 chance of sustaining a hip fracture.10 The increased risk with age combined with a rapidly expanding older adult population translates to a projected increase in worldwide hip fracture incidence, from 1.7 million in 1990 to 6.3 million in 2050.11
The incidence of hip fractures has been
Outcomes
A hip fracture can be a life-changing, or life-ending, event (Box 1). The surgery itself carries a 4% mortality overall,13 and within a year, approximately 20% die.14, 15, 16, 17 Patients with hip fracture experience a 5- to 8-fold increase in all-cause mortality in the first 3 months after the fracture, with men experiencing particularly high risk.18 This excess risk declines over time but never resolves completely, likely reflective of the frail population who sustain the fractures in the
Clinical correlation
As primary prevention efforts improve, the onset of first fracture is delayed. The age of hip fracture patients has increased over time,4 and, as a concomitant phenomenon, patients have more comorbidities.4 Fragility fractures are, therefore, not only an outcome of frailty but also a marker of frailty.
Perioperative risk is increased in the face of comorbidities, with a higher burden of chronic conditions leading to an elevated risk of postoperative complications32, 33 and mortality.32, 34 The
Predictors of fragility fracture
Because fragility fractures are common and lead to significant morbidity and mortality, identifying those at risk provides opportunity for both prevention and care planning (Box 3).12 The FRAX score, developed by the World Health Organization, is a tool to determine 10-year risk of hip fracture and other fragility fractures.36 The FRAX score is available on line at http://www.shef.ac.uk/FRAX/.
FRAX uses data from cohort studies from Europe, North America, Asia, and Australia, incorporating
Summary
Fragility fractures are on the rise due to the rapidly growing elderly population around the world. These fractures may be both markers of frailty as well as sentinel events leading to functional decline and other morbidity. Because of their serious consequences, efforts to prevent fragility fractures and to optimize treatment when they occur are becoming increasingly important.
References (41)
- et al.
Changes in population demographics and the future incidence of hip fracture
Injury
(2009) - et al.
Epidemiology and outcomes of osteoporotic fractures
Lancet
(2002) - et al.
Diagnosis and management of vertebral fractures in elderly adults
Am J Med
(2002) - et al.
Comorbidity risk-adjustment strategies are comparable among persons with hip fracture
J Clin Epidemiol
(2008) - et al.
Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture
J Am Acad Orthop Surg
(2004) - Statistics FIFoA-R. Older Americans 2012: key indicators of well-being. 2012. Available at:...
- et al.
A universal pattern of mortality decline in the G7 countries
Nature
(2000) - et al.
Incidence and mortality of hip fractures in the United States
JAMA
(2009) - et al.
Trends in hip fracture rates in Canada
JAMA
(2009) - et al.
Epidemiology of fractures of the proximal femur in Rochester, Minnesota
Clin Orthop Relat Res
(1980)
Epidemiology of osteoporotic fractures
Osteoporos Int
Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women
Arch Intern Med
Hip fractures in the elderly: a world-wide projection
Osteoporos Int
Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009
Int J Gen Med
National consensus conference on improving the continuum of care for patients with hip fracture
J Bone Joint Surg Am
Survival experience of aged hip fracture patients
Am J Public Health
Estimating hip fracture morbidity, mortality and costs
J Am Geriatr Soc
Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study
J Am Geriatr Soc
The 1-year mortality of patients treated in a hip fracture program for elders
Geriatr Orthop Surg Rehabil
Meta-analysis: excess mortality after hip fracture among older women and men
Ann Intern Med
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