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Erschienen in: Osteoporosis International 3/2010

01.03.2010 | Original Article

Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006

verfasst von: B. Abrahamsen, P. Vestergaard

Erschienen in: Osteoporosis International | Ausgabe 3/2010

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Abstract

Summary

The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country.

Introduction

The purpose of this study is to clarify (1) if hip fracture rates decline in Denmark despite low treatment rates and (2) if changes in age-specific rates could be explained by anti-osteoporotic medications.

Methods

National registers were used to obtain incidence rates for hip fractures in men and women aged 60+ and aggregated national data on number of users of anti-osteoporotic medications for 1997–2006. The potential contribution of anti-osteoporotic treatment to prevented hip fractures was estimated.

Results

Incidence rates declined by 20% in men and 22% in women. Use of specific anti-osteoporotic medications had increased from 1.8% in 60+-year-old women and 0.2% in 60+-year-old men to 7.3% and 1.3%, respectively. The decrease risk in men was nearly the same as in women, despite a six times lower treatment prevalence. The number of prevented hip fractures that could be attributed to therapy was 1.3% in men and 3.7% in women.

Conclusions

The decrease in hip fractures is much too large to be explained by the extent of anti-osteoporotic medication. Interestingly, the decrease in fracture rates also applied to men, despite much lower treatment rates. Potential explanations include smoking habits, obesity, national home visit programmes, improved general health and vitamin D supplementation.
Literatur
1.
Zurück zum Zitat Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–93CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–93CrossRefPubMed
2.
Zurück zum Zitat Vestergaard P, Rejnmark L, Mosekilde L (2001) Hip fracture prevention: cost-effective strategies. Pharmacoeconomics 19:449–68CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2001) Hip fracture prevention: cost-effective strategies. Pharmacoeconomics 19:449–68CrossRefPubMed
3.
Zurück zum Zitat Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–75CrossRefPubMed Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–75CrossRefPubMed
4.
Zurück zum Zitat Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women's Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 288:321–33CrossRefPubMed Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women's Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 288:321–33CrossRefPubMed
5.
Zurück zum Zitat Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi JD (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905CrossRefPubMed Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi JD (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905CrossRefPubMed
6.
Zurück zum Zitat Guilley E, Chevalley T, Herrmann F, Baccino D, Hoffmeyer P, Rapin CH, Rizzoli R (2008) Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women. Osteoporos Int 19:1741–47CrossRefPubMed Guilley E, Chevalley T, Herrmann F, Baccino D, Hoffmeyer P, Rapin CH, Rizzoli R (2008) Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women. Osteoporos Int 19:1741–47CrossRefPubMed
7.
Zurück zum Zitat Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–45CrossRefPubMed Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–45CrossRefPubMed
8.
Zurück zum Zitat Rosengren BE, Ahlborg HG, Karlsson MK, Mellstrom D. Secular trends in Swedish hip fracture incidence 1987–2002. J Bone Miner Res 2008; S47 Rosengren BE, Ahlborg HG, Karlsson MK, Mellstrom D. Secular trends in Swedish hip fracture incidence 1987–2002. J Bone Miner Res 2008; S47
9.
Zurück zum Zitat Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–41CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–41CrossRefPubMed
10.
Zurück zum Zitat Roerholt C, Eiken P, Abrahamsen B (2009) Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteoporos Int 20:299–307CrossRefPubMed Roerholt C, Eiken P, Abrahamsen B (2009) Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteoporos Int 20:299–307CrossRefPubMed
12.
Zurück zum Zitat Hundrup YA, Hoidrup S, Obel EB, Rasmussen NK (2004) The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 32:136–43CrossRefPubMed Hundrup YA, Hoidrup S, Obel EB, Rasmussen NK (2004) The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 32:136–43CrossRefPubMed
14.
Zurück zum Zitat Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008; CD001155 Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008; CD001155
15.
Zurück zum Zitat Kanis JA, Adams J, Borgstrom F, Cooper C, Jonsson B, Preedy D, Selby P, Compston J (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15CrossRefPubMed Kanis JA, Adams J, Borgstrom F, Cooper C, Jonsson B, Preedy D, Selby P, Compston J (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15CrossRefPubMed
16.
Zurück zum Zitat Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–41CrossRefPubMed Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–41CrossRefPubMed
17.
Zurück zum Zitat Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. JAMA 282:637–45CrossRefPubMed Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. JAMA 282:637–45CrossRefPubMed
18.
Zurück zum Zitat Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–22CrossRefPubMed Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–22CrossRefPubMed
19.
Zurück zum Zitat Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–38CrossRefPubMed Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–38CrossRefPubMed
20.
Zurück zum Zitat Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–89CrossRefPubMed Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–89CrossRefPubMed
21.
Zurück zum Zitat Lokkegaard E, Lidegaard O, Moller LN, Agger C, Andreasen AH, Jorgensen T (2007) Hormone replacement therapy in Denmark, 1995–2004. Acta Obstet Gynecol Scand 86:1342–51CrossRefPubMed Lokkegaard E, Lidegaard O, Moller LN, Agger C, Andreasen AH, Jorgensen T (2007) Hormone replacement therapy in Denmark, 1995–2004. Acta Obstet Gynecol Scand 86:1342–51CrossRefPubMed
22.
Zurück zum Zitat Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T (2003) Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 51:306–13CrossRefPubMed Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T (2003) Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 51:306–13CrossRefPubMed
23.
Zurück zum Zitat Vetter NJ, Lewis PA, Ford D (1992) Can health visitors prevent fractures in elderly people? BMJ 304:888–90CrossRefPubMed Vetter NJ, Lewis PA, Ford D (1992) Can health visitors prevent fractures in elderly people? BMJ 304:888–90CrossRefPubMed
24.
Zurück zum Zitat Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y (2002) Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 136:733–41PubMed Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y (2002) Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 136:733–41PubMed
25.
Zurück zum Zitat Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19:370–378CrossRefPubMed Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19:370–378CrossRefPubMed
26.
Zurück zum Zitat Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M, Llorca J, Gonzalez-Macias J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–70CrossRefPubMed Hernandez JL, Olmos JM, Alonso MA, Gonzalez-Fernandez CR, Martinez J, Pajaron M, Llorca J, Gonzalez-Macias J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–70CrossRefPubMed
27.
Zurück zum Zitat Mann E, Icks A, Haastert B, Meyer G (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr 8:35CrossRefPubMed Mann E, Icks A, Haastert B, Meyer G (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr 8:35CrossRefPubMed
28.
Zurück zum Zitat Hoidrup S, Prescott E, Sorensen TI, Gottschau A, Lauritzen JB, Schroll M, Gronbaek M (2000) Tobacco smoking and risk of hip fracture in men and women. Int J Epidemiol 29:253–59CrossRefPubMed Hoidrup S, Prescott E, Sorensen TI, Gottschau A, Lauritzen JB, Schroll M, Gronbaek M (2000) Tobacco smoking and risk of hip fracture in men and women. Int J Epidemiol 29:253–59CrossRefPubMed
29.
Zurück zum Zitat Vestergaard P, Mosekilde L (2003) Fracture risk associated with smoking: a meta-analysis. J Intern Med 254:572–83CrossRefPubMed Vestergaard P, Mosekilde L (2003) Fracture risk associated with smoking: a meta-analysis. J Intern Med 254:572–83CrossRefPubMed
30.
Zurück zum Zitat Mukamal KJ, Robbins JA, Cauley JA, Kern LM, Siscovick DS (2007) Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study. Osteoporos Int 18:593–602CrossRefPubMed Mukamal KJ, Robbins JA, Cauley JA, Kern LM, Siscovick DS (2007) Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study. Osteoporos Int 18:593–602CrossRefPubMed
31.
Zurück zum Zitat Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, Lopes VA, Lyritis G (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–15CrossRefPubMed Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, Lopes VA, Lyritis G (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–15CrossRefPubMed
32.
Zurück zum Zitat Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P (2000) Predictors of fractures in elderly women. Osteoporos Int 11:134–40CrossRefPubMed Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P (2000) Predictors of fractures in elderly women. Osteoporos Int 11:134–40CrossRefPubMed
33.
Zurück zum Zitat de Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ III, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338CrossRefPubMed de Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ III, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338CrossRefPubMed
34.
Zurück zum Zitat Grisso JA, Kelsey JL, O'Brien LA, Miles CG, Sidney S, Maislin G, LaPann K, Moritz D, Peters B, Hip Fracture Study Group (1997) Risk factors for hip fracture in men. Am J Epidemiol 145:786–793PubMed Grisso JA, Kelsey JL, O'Brien LA, Miles CG, Sidney S, Maislin G, LaPann K, Moritz D, Peters B, Hip Fracture Study Group (1997) Risk factors for hip fracture in men. Am J Epidemiol 145:786–793PubMed
35.
Zurück zum Zitat Ekholm O, Kjøller M, Davidsen M, Hesse U, Eriksen L, Christensen A.I., Grønbæk M. Sundhed og sygelighed i Danmark 2005. Report, National Institute of Public Health, Copenhagen 2006; ISBN 87-7899-112-9 Ekholm O, Kjøller M, Davidsen M, Hesse U, Eriksen L, Christensen A.I., Grønbæk M. Sundhed og sygelighed i Danmark 2005. Report, National Institute of Public Health, Copenhagen 2006; ISBN 87-7899-112-9
36.
Zurück zum Zitat Diamond T, Smerdely P, Kormas N, Sekel R, Vu T, Day P (1998) Hip fracture in elderly men: the importance of subclinical vitamin D deficiency and hypogonadism. Med J Aust 169:138–41PubMed Diamond T, Smerdely P, Kormas N, Sekel R, Vu T, Day P (1998) Hip fracture in elderly men: the importance of subclinical vitamin D deficiency and hypogonadism. Med J Aust 169:138–41PubMed
37.
Zurück zum Zitat Thiebaud D, Burckhardt P, Costanza M, Sloutskis D, Gilliard D, Quinodoz F, Jacquet AF, Burnand B (1997) Importance of albumin, 25(OH)-vitamin D and IGFBP-3 as risk factors in elderly women and men with hip fracture. Osteoporos Int 7:457–62CrossRefPubMed Thiebaud D, Burckhardt P, Costanza M, Sloutskis D, Gilliard D, Quinodoz F, Jacquet AF, Burnand B (1997) Importance of albumin, 25(OH)-vitamin D and IGFBP-3 as risk factors in elderly women and men with hip fracture. Osteoporos Int 7:457–62CrossRefPubMed
38.
Zurück zum Zitat Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, Ragi-Eis S, Chandler J (2006) The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med 260:245–54CrossRefPubMed Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, Ragi-Eis S, Chandler J (2006) The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med 260:245–54CrossRefPubMed
39.
Zurück zum Zitat Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip Fracture Patients at Risk of Second Hip Fracture-A Nationwide Population-Based Cohort Study of 169,145 Cases During 1977–2001. J Bone Miner Res 2009 (published online). Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip Fracture Patients at Risk of Second Hip Fracture-A Nationwide Population-Based Cohort Study of 169,145 Cases During 1977–2001. J Bone Miner Res 2009 (published online).
Metadaten
Titel
Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006
verfasst von
B. Abrahamsen
P. Vestergaard
Publikationsdatum
01.03.2010
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 3/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-0957-3

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