Annual Number Of Hip Fractures Research Articles

The impact of an ageing population on future increases in hip fracture burden.

Current levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care. Historical data from the Scottish Hip Fracture Audit (2017 to 2021) were used to identify monthly incidence rates. Established time series forecasting techniques (Exponential Smoothing and Autoregressive Integrated Moving Average) were then used to predict the annual number of hip fractures from 2022 to 2029, including adjustment for predicted changes in national population demographics. Predicted differences in service-level outcomes (length of stay and discharge destination) were analyzed, including the associated financial cost of any changes. Between 2017 and 2021, the number of annual hip fractures increased from 6,675 to 7,797 (15%), with a rise in incidence from 313 to 350 per 100,000 (11%) for the at-risk population. By 2029, a combined average projection forecast the annual number of hip fractures at 10,311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. Based upon these projections, assuming discharge rates remain constant, the total overall length of hospital stay following hip fracture in Scotland will increase by 60,699 days per annum, incurring an additional cost of at least £25 million per year. Approximately five more acute hip fracture beds may be required per hospital to accommodate this increased activity. Projection modelling demonstrates that hip fracture burden and incidence will increase substantially by 2029, driven by an ageing population, with substantial implications for health and social care services.

THE HISTORIC AND PROJECTED HIP FRACTURE BURDEN AND INCIDENCE IN SCOTLAND: 2017 – 2029

Hip fracture represents a significant challenge, placing increasing pressure on health and social care services in Scotland. This study establishes the ‘historic’ hip fracture burden, namely, the annual number of hip fractures in Scotland, and respective incidence, between 2017 – 2021. Furthermore, the ‘projected’ hip fracture burden and incidence from 2022 – 2029 was estimated, to inform future capacity and funding of health and social care services.The number of individuals with a hip fracture in Scotland between 2017 and 2021 was identified through the Scottish Hip Fracture Audit, enabling the annual number of hip fractures and respective incidence between 2017 – 2021 to be calculated. Projection modelling was performed using Exponential Smoothing and Auto Regressive Integrated Moving Average to estimate the number of hip fractures occurring annually from 2022 – 2029. A combined average projection was employed to provide a more accurate forecast. Accounting for predicted changes within the population demographics of Scotland, the projected hip fracture incidence up to 2029 was calculated.Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797 (15%), with an increase in incidence from 313 to 350 per 100,000 (11%) of the at-risk population. Hip fracture was observed to increase across all groups, notably males, and the 70–79 and 80–89 age cohorts. By 2029, the combined average projection estimated the annual number of hip fractures at 10311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. The largest percentage increase in hip fracture by 2029 occurs in the 70–79 and 80–89 age cohorts (57% and 53% respectively). Based upon these projections, overall length of hospital stay following hip fracture will increase by 60699 days per annum by 2029, incurring an additional cost of at least £25 million.Projection modelling demonstrates the annual number of hip fractures in Scotland will increase substantially by 2029, with significant implications for health and social care services. This increase in hip fracture burden and incidence is influenced strongly by changing population demographics, primarily an ageing population.

Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality.

In this international study, we examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age- and sex-standardized incidence rates of hip fractures, post-hip fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all-cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databases. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (95% confidence interval [CI] 94.8-95.4) in Brazil to 315.9 (95% CI 314.0-317.7) in Denmark per 100,000 population. Incidence rates decreased over the study period in most countries; however, the estimated total annual number of hip fractures nearly doubled from 2018 to 2050. Within 1 year following a hip fracture, post-hip fracture treatment ranged from 11.5% (95% CI 11.1% to 11.9%) in Germany to 50.3% (95% CI 50.0% to 50.7%) in the United Kingdom, and all-cause mortality rates ranged from 14.4% (95% CI 14.0% to 14.8%) in Singapore to 28.3% (95% CI 28.0% to 28.6%) in the United Kingdom. Males had lower use of anti-osteoporosis medication than females, higher rates of all-cause mortality, and a larger increase in the projected number of hip fractures by 2050. Substantial variations exist in the global epidemiology of hip fractures and postfracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the aging population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

PROJECTED HIP FRACTURE INCIDENCE IN SCOTLAND

The hip fracture burden on health and social care services in Scotland is anticipated to increase significantly, primarily driven by an ageing population. This study forecasts future hip fracture incidence and the annual number of hip fractures in Scotland until 2029.The monthly number of patients with hip fracture aged ≥ 50 admitted to a Scottish hospital between 01/01/2017 and 31/12/2021 was identified through data collected by the Scottish Hip Fracture Audit. This data was analysed using Exponential Smoothing and Auto Regressive Integrated Moving Average forecast modelling to project future hip fracture incidence and the annual number of hip fractures until 2029. Adjustments for population change were accounted for by integrating population projections published by National Records of Scotland.Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797, with a respective increase in hip fracture incidence from 313 to 350 per 100,000. By 2029, the averaged projected annual number of hip fractures is 10311, with an incidence rate of 463 per 100,000. The largest percentage increase in hip fracture occurs in the 70-79 age group (57%), with comparable increases in both sexes (30%). Based upon these projections, overall length of stay following hip fracture will increase from 142713 bed days per annum in 2021, to 203412 by 2029, incurring an additional cost of over £25 million.Forecast modelling demonstrates that the annual number of hip fractures in Scotland will rise substantially by 2029, with considerable implications for health and social care services.

Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050.

A better understanding of the burden of fragility fractures in sub-Saharan Africa is needed to inform healthcare planning. We aimed to use recent hip fracture incidence data from South Africa (SA) to estimate the future burden of hip fracture for the country over the next three decades. Hip fracture incidence data within the Gauteng, KwaZulu-Natal and Western Cape provinces of SA were obtained from patients aged ≥ 40years with a radiograph-confirmed hip fracture in one of 94 included hospitals. Age-, sex- and ethnicity-specific incidence rates were generated using the 2011 SA census population for the study areas. Incidence rates were standardised to United Nations (UN) population projections, for the years 2020, 2030, 2040 and 2050, and absolute numbers of hip fractures derived. The 2767 hip fracture patients studied had mean (SD) age 73.7 (12.7) years; 69% were female. Estimated age- and ethnicity-standardised incidence rates (per 100,000 person-years) for the overall SA population in 2020 were 81.2 for females and 43.1 for males. Overall projected incidence rates were discernibly higher by the year 2040 and increased further by the year 2050 (109.0 and 54.1 for females and males, respectively). Estimates of the overall annual number of hip fractures for SA increased from approximately 11,000 in 2020 to approximately 26,400 by 2050. The hip fracture burden for SA is expected to more than double over the next 30years. Significant investment in fracture prevention services and inpatient fracture care is likely to be needed to meet this demand.

Sex differences in incidence rate, and temporal changes in surgical management and adverse events after hip fracture surgery in Denmark 1997–2017: a register-based study of 153,058 hip fracture patients

Background and purpose — Extensive research and national multidisciplinary programs have striven to introduce uniform standards of treatment and mitigate mortality and adverse events after hip fracture surgery over the past decades. A large-scale overview of temporal developments in hip fracture surgery and care is warranted. Patients and methods — We studied Danish patients aged ≥ 60 years, sustaining their first ever hip fracture between 1997 and 2017. Patients were identified from the Danish National Patient Registry (DNPR). Incidence rates of first hip fracture were calculated per 1,000 patient-years and stratified by age group and sex. Information on pre-injury living settings, comorbidities, and medications were obtained from national administrative registers. Type of fracture and treatment choice were recorded, and patients were followed for 1 year to observe mortality, readmission, and surgical complications. Results — Data from 153,058 patients was analyzed. Incidence rate decreased in both sexes, but only led to a reduction in the annual number of hip fractures in the female population. Choice of surgery shifted away from sliding hip screws and parallel implants (SHS-PI), towards intramedullary nailing and hemi-/arthroplasties for trochanteric and femoral neck fractures, respectively. Pre-injury diagnosed morbidity and 1-year readmissions increased contrary to mortality. Median age remained stable around 83 (IQR 77–88) for women and 80 (IQR 73–86) for men. Interpretation — Over the past 2 decades important aspects of hip fracture management have improved. However, sex differences were observed, and men remain more vulnerable than women in terms of morbidity, mortality, and incidence rate.

Introduction.

INTRODUCTION Hip fractures rank in the top 10 of all-cause disability worldwide, and the number of hip fractures is expected to rise to more than 6 million per year by 2050.1,2 Demographic projections by Statistics Canada indicate that, by the year 2036, 1 in 4 Canadians will be older than 653 years and that the annual number of hip fractures is likely to exceed 88,000 in Canada and 500,000 in the United States.1,4–6 Over half of hip fractures (54%) are femoral neck fractures, two-thirds of which are typically displaced and treated with arthroplasty, whereas one-third are undisplaced and treated with internal fixation. We conducted 2 multicenter, randomized controlled trials focusing on the management options for fractures of the femoral neck. The FAITH (Fixation using Alternative Implants for the Treatment of Hip fractures) trial compared the intervention of cancellous screws with a sliding hip screw in 1079 patients 50 years of age or older with a low-energy displaced or undisplaced femoral neck fracture, while the HEALTH (Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty vs. Hemiarthroplasty) trial compared the intervention of total hip arthroplasty with hemiarthroplasty in 1441 patients 50 years of age or older with low-energy displaced femoral neck fractures.7,8 Please refer to the Study Summaries portion of the supplement for further details on these 2 trials. The data collected as part of the FAITH and HEALTH trials provide a unique opportunity to answer highly relevant clinical questions in this fracture population. The following supplement is dedicated to addressing 12 highly relevant clinical questions using data from the FAITH and HEALTH trials.

CURRENT EFFORTS TO UNDERSTAND AND IMPROVE OLDER ADULTS’ FUNCTIONAL RECOVERY AFTER HIP FRACTURE

The annual number of hip fractures in the US is projected to increase from 258,000 in 2010 to 458,000 by 2050. Globally, annual hip fractures are projected to reach 4.5 million by 2050. Yet the majority of older adults experience long-term mobility disability following hip fracture and do not return to pre-fracture functional capacity. Published reviews have concluded there is insufficient evidence regarding effectiveness of interventions designed to reduce residual disability and enhance mobility post-hip fracture. This Symposium features current efforts to understand and improve functional recovery post-hip fracture. Dr. Magaziner will present results from the recently-completed Community Ambulation Project (CAP), a multi-site randomized trial in which two in-home physical therapy interventions were compared: PUSH, which included aerobic conditioning, strengthening, balance and functional training; and PULSE, which included transcutaneous electrical nerve stimulation, flexibility and active range of motion exercises. Dr. Fortinsky will present CAP data examining the role of psychological resilience, optimism, depression, and balance confidence on mobility measures. Dr. Gruber-Baldini will present CAP data examining differences between PUSH and PULSE on study participants’ cognition and the impact of cognition on community ambulation. Dr. Binder will present the study design and early results from the STEP-HI study, a multi-site randomized trial evaluating whether structured exercise and topical testosterone therapy can improve function post-hip fracture among older women. Discussant Dr. Latham will comment on design, results, and implications of these two studies for research, policy, and practice intended to improve older adults’ recovery after hip fracture.

Continued decline in hip fracture incidence in Norway: a NOREPOS study.

The previously reported decline in age-adjusted hip fracture rates in Norway during 1999-2008 continued after 2008. The annual number of hip fractures decreased in women and increased in men. Norway has among the highest hip fracture incidence rates ever reported despite previously observed declining rates from 1999 through 2008. The aim of the present study was to investigate whether this downward trend continued through 2013, and to compare gender-specific trends in 5year age-groups during three time periods: 1999-2003, 2004-2008, and 2009-2013. All hip fractures (cervical, trochanteric, and sub-trochanteric) admitted to Norwegian hospitals were retrieved. Annual age-standardized incidence rates of hip fracture per 10,000 person-years by gender were calculated for the period 1999-2013. Time trends were tested by age-adjusted Poisson regression. From 1999 through 2013 there were 140,136 hip fractures in persons aged 50years and above. Age-adjusted hip fracture incidence rates declined by 20.4% (95% CI: 18.6-20.1) in women and 10.8% (95% CI: 7.8-13.8) in men, corresponding to an average annual age-adjusted decline of 1.5% in women and 0.8% in men. Except for the oldest men, hip fracture rates declined in all age-groups 70years and older. The average annual number of fractures decreased in women (-0.3%) and increased in men (+1.1%). During the past 15years, hip fracture rates have declined in Norway. The forecasted growing number of older individuals might, however, cause an increase in the absolute number of fractures, with a substantial societal economic and public health burden.

Épidémiologie, morbidité, mortalité, coût pour la société et pour l’individu, principales causes de la chute

Falls are the leading cause of accidental death among the elderly, accounting for about 12 000 deaths per year. The risk of falls increases with age: one-third of subjects over 65 years old living in the community and half of those over 85 fall at least once a year. Despite their frequency, falls should not be trivialized, as they are associated with significant morbidity and care expenditure: 10% of falls have severe traumatic consequences, and30 % of hospital admissions for traumatic injury among elderly individuals are due to falls. Even when they have no physical repercussions, falls can have psychological effects (anxiety while walking, fear of falling), and can be complicated by a psychomotor disadaptation syndrome with voluntary restriction of activities of daily living in 30% of cases. Risk factors for falls are numerous, and falls are rarely due a single, precise reason. Recurrent falls are associated with balance and gait impairment and decreased muscle strength, sometimes due to a latent pathological condition. Factors that may favor falls in the home must be taken into account through targeted prevention actions. Among institutionalized populations, the risk of falls increases with the severity of dementia, the use of certain drugs (particularly psycho tropics) and the existence of wasting, which leads to a decline in quadriceps strength. About 1.5% of all health expenditure is related to falls. The majority of these costs are due to hospitalization, fractures of the proximal femur being the most costly complication. In recent years, thanks to the prevention of both osteoporosis and falls, the annual number of hip fractures has been stable at about 79,500 cases per year, standardized hospitalization rates have declined, and the average length of stay has decreased. With the increasing number of elderly people, one priority to reduce healthcare costs is to identify and correct factors of frailty in midlife, using a preventive approach.

The annual number of hip fractures in Sweden will double from year 2002 to 2050

Background and purpose — The incidence and annual number of hip fractures have increased worldwide during the past 50 years, and projections have indicated a further increase. During the last decade, however, a down-turn in the incidence of hip fracture has been seen in the western world. We predicted the development of hip fractures in Sweden until the year 2050.Methods — We reviewed surgical records for the period 2002–2012 in the city of Malmö, Sweden, and identified patients aged 50 years or more with a hip fracture. We estimated incidence rates by using official population figures as denominator and applied the rates to population projections each year until 2050. We also made projections based on our previously published nationwide Swedish hip fracture rates for the period 1987–2002. Since the projections are based on estimates, no confidence limits are given.Results — During the period 2002–2012, there were 7,385 hip fractures in Malmö. Based on these data, we predicted that there would be approximately 30,000 hip fractures in Sweden in the year 2050. Use of nationwide rates for 2002 in the predictive model gave similar results, which correspond to an increase in the number of hip fractures by a factor of 1.9 (1.7 for women and 2.3 for men) compared to 2002.Interpretation — The annual number of hip fractures will almost double during the first half of the century. Time trends in hip fractures and also changes in population size and age distribution should be continuously monitored, as such changes will influence the number of hip fractures in the future. Our results indicate that we must optimize preventive measures for hip fractures and prepare for major demands in resources.

Secular Trends in Swedish Hip Fractures 1987–2002

Recently, a leveling off in hip-fracture incidence has been reported in several settings, but the annual number is nonetheless predicted to increase due to the growing elderly population. Using Swedish national data for 1987-2002 for all inpatients 50 years or older, we examined the annual number and incidence of hip fractures and explored age, period, and cohort effects. Age adjustment was done by direct standardization, time-trend analysis by linear regression, changes in linear trends by joinpoint regression, and age-period-cohort effects by log-likelihood estimates in Poisson regression models. Before 1996, the age-standardized hip fracture incidence was stable (0.1% per year [95% confidence interval = -0.2% to 0.5%]), and the annual number of hip fractures increased (2.1% per year [1.8% to 2.4%]). After 1996, both the age-standardized hip fracture incidence (-2.2% per year [-2.8% to -1.6%]) and the number of hip fractures (-0.9% per year [-1.5% to -0.4%]) decreased. The period + cohort effects were more marked among women than men, with a major reduction in hip fracture incidence in subsequent birth cohorts (estimated incidence rate ratio = 2.2 comparing women born 1889-1896 with 1945-1952) or periods (estimated incidence rate ratio = 1.1 comparing women living 1987-1990 with 1999-2002). The age-standardized hip fracture incidence has decreased since 1996, more than counteracting the effects of the aging population and resulting in a decline in the annual number of hip fractures through 2002. The magnitude of the combined period and cohort effects in women seems to be of biologic importance. If this persists into older age, the annual number of hip fractures will be lower than has been projected.

Age-adjusted incidence rates of hip fractures between 2006 and 2009 in Rabat, Morocco

This study, characterizing the incidence of hip fracture in the province of Rabat, showed that age- and sex-specific rates remained stable between 2006 and 2009. The demographic projections estimated for Morocco indicate that between 2010 and 2030, the expected annual number of hip fractures would increase about twofold. No data on hip fracture incidence trends exist from Africa. The aim of the study was to determine time trends in hip fracture rates for the province of Rabat and to forecast the number of hip fractures expected in Morocco up to 2030. All hip fracture cases registered during the years 2006-2009 were collected at all the public hospitals and private clinics with a trauma unit and/or a permanent orthopedic surgeon across the province. Over the 4-year period, 723 (54.3%) hip fractures were recorded in women and 607 (45.6%) in men. The age- and gender-specific incidence of hip fracture rose steeply with advancing age. Hip fractures occurred later in women 75.0 (10.7) years than in men 73.3 (11.0) years (p=0.014), and its incidence was higher in women than in men [85.9 (95% CI 79.7-92.2) per 100,000 person-years vs. 72.7 (95% CI 66.9-78.5)]. The incidence remained globally stable over the period study, and the linear regression analysis showed no significant statistical difference. For the year 2010, there were 4,327 hip fractures estimated in Morocco (53.3% in women). Assuming no change in the age- and sex-specific incidence of hip fracture from 2010 to 2030, the number of hip fractures in men is expected to increase progressively from 2,019 to 3,961 and from 2,308 to 4,259 in women. The age-specific incidence of hip fracture between the years 2006 and 2009 remained stable in Morocco, and the number of expected hip fractures would double between 2010 and 2030.

Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007)

To examine the secular trend of hip fracture incidence in Belgium between 2000 and 2007 and the concomitant change in the prescriptions of antiosteoporosis medications. The incidence of hip fractures and the number of prescriptions were determined using national databases. A logistic regression including years and 5-year age range was performed to assess the secular trend of hip fracture incidence, and Pearson's correlation coefficient was calculated to examine the relationship between hip fracture incidence and the prescriptions of antiosteoporosis medications. The annual number of hip fractures increased in Belgium from 13,512 in 2000 to 14,744 in 2007, with a more marked increased in men (20.4%) than in women (5.7%). The age-adjusted incidence of hip fractures was significantly decreased by 1.12% per year in women, but declined nonsignificantly by 0.34% per year in men. An increase in the prescriptions of antiosteoporosis medications in women was observed during the same time period. Despite an increase in the number of hip fractures in Belgium between 2000 and 2007, there was a significant decrease in age-adjusted incidence in women but not in men. Although our results suggest that the decrease may be related to the extent of antiosteoporosis medications, a causal relationship cannot be ascertained and many other factors may have contributed to the decrease in age-adjusted incidence.

Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican institute of social security

This study, characterising the incidence of hip fracture in Mexico, showed that age- and sex-specific rates increased between 2000 and 2006. The demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 in 2050. If the age-specific incidence of hip fracture continues, the number of hip fractures would increase by a further 46%. The aim of the present study was to determine time trends, if any, in hip fracture rates for Mexico and to forecast the number of hip fractures expected in Mexico over the coming years up to 2050. All hip fracture cases registered during the years 2000-2006 were collected at all the second and tertiary-care hospitals across the country from one of the largest health systems in Mexico, The Instituto Mexicano del Seguro Social (IMSS). Between the years 2000 and 2006, the age-specific incidence of hip fracture increased significantly both for men and women by 1% per year (p = 0.016 and p < 0.001, respectively). In 2005, there were there were 29,732 hip fractures estimated in Mexico, 68% of which were found in women. Assuming no change in the age- and sex-specific incidence of hip fracture, the number of hip fractures was expected to increase markedly with time to 155,874 in 2050. Assuming that the age-specific incidence continues, the number of hip fractures in men and women would increase by a further 46% to 226,886 in 2050. Demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 expected in 2050. If the age-specific incidence of hip fracture continues to rise, the number of hip fractures would increase by a further 46%.

Hip fracture management and outcomes in Finland

Hip fracture is a common, devastating, and often fatal trauma in older people. In Finland, the incidence of hip fractures increased steadily until the late 1990's. Thereafter signs of declining incidence trend have been observed. Currently, the annual number of hip fractures is over 7000. The hip fracture patients are predominantly women (70%) aged 80 years and over, and most (76%) are community-dwelling. All patients with a hip fracture are referred to hospital for surgical assessment, and nearly all are operated on. One third of the hip fracture patients aged 70 and over die during the first post fracture year. Hip fractures have also negative long-term effects on morbidity and hospitalizations. Substantial mortality, utilization of inpatient care and rate of institutionalization following hip fractures poses the question: could we do better? Adherence with the up-to-date and evidence-based national practice guideline for treating hip fracture patients is suboptimal. There is room for improvement in the perioperative management, postoperative care and rehabilitation of these patients.

Rising Incidence of Hip Fracture in Gwangju City and Chonnam Province, Korea

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.

Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types.

After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures treated in the county of Ostergötland, Sweden (approximately 400,000 inhabitants) 1982-96. A total of 11,517 hip fractures in men and women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression model, considering both age and year of fracture in every single year 1982-96 for the respective fracture type and gender, and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100,000 and of trochanteric fractures from 138 to 170/100,000. In women the incidence of cervical fractures decreased from 462/100,000 to 418/100,000 and of trochanteric fractures from 407/100,000 to 361/100,000. Cervical/trochanteric fracture incidence rate ratio leveled off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue as during 1982-96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other hip fractures in both genders will decrease by 4-32% resulting in a total reduction of 11%.

Optimal treatment of hip fractures

At the orthopedic departments in Sweden, the hip fracture patients continuously occupy up to one third of the bed resources. Hip fractures in Sweden consume more hospital days than all the cancer patients together. In the middle of the 1980s, the annual number of hip fractures amounted to 6,500 in Denmark, 4,500 in Finland, 260 in Iceland, 6,000 in Norway and 14,000 in Sweden. The calculated number of hip fractures in the year 2000 is dependent on if the prognosis is based solely on the increasing number of elderly in the population or if also the increasing incidence during the last decades is included. An increase up to the year 2000 of 50-100 percent is prognosticated for Scandinavia. The proportions cervical/trochanteric fractures varies. In Norway and Sweden it is close to 1/1, whereas Iceland and Finland have more cervical than trochanteric fractures. In Iceland, however, trochanteric fractures are increasing. Finally, in all of Scandinavia, 3 out of 4 hip fracture patients are women.