Burden of fractures in France: incidence and severity by age, gender, and site in 2016

Benjamin Bouyer,Jérémie Rudant,Alain Weill,Joël Coste,Fanny Leroy

doi:10.1007/s00264-020-04492-2

Abstract

PurposeFractures are common events, but the exact incidence and severity of fractures have not been clearly determined for most anatomical sites. We estimated the incidence and severity of fractures in France regardless of the anatomical site.MethodsObservational cross-sectional study in France in 2016 based on the national health data system. All incident fractures in patients 20 years and older were included. We determined the anatomical fracture site (12 sites) and the severity using a 4-point scale (outpatient care, hospitalization, surgery, and in-hospital death).ResultsWe identified 562,094 incident fractures, predominantly occurring in women (319,858: 56.9%); with a mean age of 63.6 years, and an exponential increase after the age of 70 years. Distal upper limb (172,591: 30.7%), distal lower limb (84,602: 15.1%), and femoral neck (78,766: 14.0%) accounted for more than one-half of all fractures. Sex and age of onset distributions varied widely according to fracture sites, with earlier onset for distal lower limb fractures (mean age: 54.2 years) and distal upper limb fractures (mean age: 55.2 years) with a men predominance for skull fractures. Only 105,165 (18.7%) fractures were treated on an outpatient basis; 11,913 (2.1%) in-hospital deaths occurred in patients with a mean age of 79.5 years. High mortality was observed for skull (12.9%), rib (4.9%), and femoral fractures (femoral neck 4.3% and proximal lower limb 4.2%).ConclusionWe estimated the incidence of fractures in France by sex and anatomical site. We also showed that fractures remain common and serious life events, especially in older people.

Highlights

IntroductionOsteoporotic or low-trauma fractures are the most extensively
Fractures are frequent events in a subject’s lifetime [1]
Hip fractures have been studied in particular detail, as they are associated with a high mortality rate, but the burden of all fractures is constantly growing in all countries as a result of aging of the populations [7]

Summary

Introduction

Osteoporotic or low-trauma fractures are the most extensively. Université de Paris, Paris, France 3 Caisse Nationale de l’Assurance Maladie, Paris, France 4 Groupement d’Intérêt Scientifique EPI-PHARE, Saint-Denis, France 5 Unité de Biostatistique et d’Epidémiologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France studied types of fractures and have become a worldwide subject of interest [2, 3]. The incidence of fractures increases dramatically with age in all countries [4,5,6]. Hip fractures have been studied in particular detail, as they are associated with a high mortality rate, but the burden of all fractures is constantly growing in all countries as a result of aging of the populations [7]. Low-trauma fractures, primarily hip fractures, are responsible for loss of healthy life-years or increased mortality [8, 9]

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