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Hip Fractures on the Decline in U.S.

Study Also Shows Death Rate From Hip Fractures Is Decreasing
By
WebMD Health News
Reviewed by Louise Chang, MD

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 researchers write.

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 write. 

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 1992-2005 period.

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 write.

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.

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