Hip Fractures on the Decline in U.S.
Study Also Shows Death Rate From Hip Fractures Is Decreasing
Oct. 12, 2009 -- Hip fracture rates and deaths related to such injuries are
decreasing in the U.S. among people aged 65 and older, a new study shows.
Scientists reporting in the Oct. 14 issue of The Journal of the American
Medical Association say the reasons for the declining fracture and death
rates aren't entirely clear, but they credit lifestyle changes and possibly
medications as probable contributors.
Lifestyle changes include increased societal attention on the importance of
calcium and vitamin D supplementation, avoidance of smoking, and more emphasis
on the benefits of weight-bearing exercise and moderate alcohol intake, the
Moreover, "public and physician education and awareness of osteoporosis and
fragility fractures has also increased since 1995," which has likely
contributed to the declining hip fracture rate, the researchers
Hip fracture research is critical because about 30% of people with hip
fractures die in the following year, many experience long-term significant
functional loss, and the financial cost is enormous, the researchers say.
A typical hit fracture patient in the U.S. spends $40,000 in the first year
after injury in direct medical costs, say Brauer and colleagues.
The team analyzed data on 786,717 hip fractures, obtained from Medicare data
from 1985 to 2005. The researchers also obtained medication data for the
Most of the decreases in death rate related to hip fracture that occurred
before 1998, with a larger decrease in men than women. After that year, "very
little change occurred in mortality for either sex," according to the study,
whose lead author is Carmen A. Brauer, MD, MSc, of the division of orthopaedic
surgery at the University of Calgary, Canada.
The majority of fractures -- 77% -- occurred in women; most hip fractures in
both men and women were found in people ages 75 to 84.
"The age adjusted incidence of hip fracture increased for both sexes from
1986 to 1995 and then steadily decreased from 1995 to 2005," the researchers
Although the researchers write that it's not entirely clear why the decline
has occurred, medication statistics suggest the use of bisphosphonates (such as
Fosamax and Actonel) may have played a role.
Bisphosphohates are a class of drugs that are used to prevent and treat bone
loss from osteoporosis.
"Why these trends have occurred is not entirely clear," the researchers
write. "The decrease in incidence that occurred after 1995 corresponds
temporally with the market release of several bisphosphonates."
Surgical and medical management of hip fracture patients also has improved
over the past 20 years -- possible factors in mortality reduction. "Better use
of prophylactic antibiotics, aggressive medical management and increased rates
of discharge to non-acute health care settings also may have contributed to the
mortality improvements," the researchers write. But more research is needed,
they say, to determine more clearly the improved outcomes.
The researchers also report that the common medical problems of people with
hip fracture in the years studied were congestive heart failure, chronic
pulmonary disease, and diabetes. And in patients with hip fracture, the number
of other medical problems has increased.