Trends in hip fracture rates in Canada
Hip fractures are a public health concern because they are associated with significant morbidity, excess mortality, and the majority of the costs directly attributable to osteoporosis. The objective of this study [1] was to examine trends in hip fracture rates in Canada. This was an ecologic trend study using nationwide hospitalization data for 1985 to 2005 from a database at the Canadian Institute for Health Information. Data for all patients with a hospitalization for which the primary reason was a hip fracture (570 872 hospitalizations) were analyzed. The main outcome measures were age-specific and age-standardized hip fracture rates.
There was a decrease in age-specific hip fracture rates (all P for trend <.001). Over the 21-year period of the study, age-adjusted hip fracture rates decreased by 31.8% in females (from 118.6 to 80.9 fractures per 100 000 person-years) and by 25.0% in males (from 68.2 to 51.1 fractures per 100 000 person-years). Regression analysis identified a change in the linear slope around 1996. For the overall population, the average age-adjusted annual percentage decrease in hip fracture rates was 1.2% per year from 1985 to 1996 and 2.4% per year from 1996 to 2005 (P<.001 for difference in slopes). Similar changes were seen in both females and males, with greater slope reductions after 1996 (P<.001 for difference in slopes for each sex).
In conclusion, although absolute numbers of hip fractures are still increasing, the age-standardized rates of hip fracture have steadily declined in Canada since 1985 and more rapidly during the later study period. This decrease was evident in both females and males, with an onset that precedes large-scale use of diagnostic testing for osteoporosis or modern pharmacotherapy.
- Leslie WD et al. JAMA. 2009;302:883-889.
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