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Hip fracture trends in the United States, 2002 to 2015

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Michael Lewiecki E1, Wright NC2, Curtis JR3, Siris E4, Gagel RF5, Saag KG3, Singer AJ6,7, Steven PM8, Adler RA9,10. Osteoporos Int. 2018 Mar;29(3):717-722. doi: 10.1007/s00198-017-4345-0. Epub 2017 Dec 27.

Abstract

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1 New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA. mlewiecki@gmail.com.

2 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.

3 Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.

4 Department of Medicine, Columbia University Medical Center, New York, NY, USA.

5 Department of Endocrine Neoplasia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

6 Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA.

7 Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.

8 International Society for Clinical Densitometry, Hartford, CT, USA.

9 Endocrinology Section, McGuire Veterans Affairs Medical Center, Richmond, VA, USA.

10 Virginia Commonwealth University School of Medicine, Richmond, VA, USA.

Abstract An analysis of United States (US) Medicare claims data from 2002 to 2015 for women aged ≥ 65 years found that age-adjusted hip fracture rates for 2013, 2014, and 2015 were higher than projected, resulting in an estimated increase of more than 11,000 hip fractures.

INTRODUCTION: Hip fractures are a major public health concern due to high morbidity, mortality, and healthcare expenses. Previous studies have reported a decrease in the annual incidence of hip fractures in the US beginning in 1995, coincident with the introduction of modern diagnostic tools and therapeutic agents for osteoporosis. In recent years, there has been less bone density testing and fewer prescriptions for osteoporosis treatments. The large osteoporosis treatment gap raises concern of possible adverse effects on hip fracture rates.

METHODS: We assessed hip fracture incidence in the US to determine if the previous decline in hip fracture incidence continued. Using 2002 to 2015 Medicare Part A and Part B claims for women ≥ 65 years old, we calculated age-adjusted hip fracture rates, weighting to the 2014 population.

RESULTS: We found that hip fracture rates declined each year from 2002 to 2012 and then plateaued at levels higher than projected for years 2013, 2014, and 2015.

CONCLUSIONS: The plateau in age-adjusted hip fracture incidence rate resulted in more than 11,000 additional estimated hip fractures over the time periods 2013, 2014, and 2015. We recommend further study to assess all factors contributing to this remarkable change in hip fracture rate and to develop strategies to reduce the osteoporosis treatment gap.