Incidence of hip fractures in Salamanca, Spain. Period: 1994–2002

Hip fractures in the elderly population are one of the most important health problems in this age group [1, 2, 10]. There are numerous studies that emphasize the importance of this pathology, and the exponential increase that is produced [11], though some recent studies have also shown a slowlevelling off of the increase within various countries either due to lessening in global incidence or statistical variance for one of the two sexes [6, 7, 12].

Various studies dealing with the incidence of hip fractures in our country are available [13, 14]. Serra et al. [8] have presented a study on the incidence of these types of fractures for the entire Spanish country, from data furnished by the central government (Ministry of Consumer and Health), thus contributing data on the incidence in middle-aged citizens, within each regions that forms Spain. Their data referring to our region differs from that found by our studies on the incidence of fractures. Here they are reported an the adjusted rate of 518/100,000 for the period 1996–1999. In our study, the maximum incidence was reached in the year 2002 with 495/100,000 65 years of age and older. This discrepancy could be explained by the different way data were collected. The data recounted by Serra et al.were obtained from the information sent by the hospitals to the central government. There are differences as for the codification between every hospital. On the other hand, we do not know if fractures due to tumor processes or to mechanisms of high energy were excluded. In the case of the middle-aged group, Serra et al. found evidence for all of Spain at 82 years of age, while in our study it corresponds to 83 years of age. Recently a study on osteoporotic hip fractures in Spain has been available [15]. The hip fracture rate was 694/100,000 in those 60 years and older. The information was obtained at 77 hospitals. The dates were requested by the hospitals’ departments of orthopedics. There is no information about the origin of the information. This work presents the effect only for the year 2002.

Other studies on the incidence of hip fractures in various regions of Spain are available, offering general results, for brief periods of time [13, 14, 16] (Table 7). In agreement with the study by Serra et al. [8], these studies show differences in the incidence, the highest being in northern regions like Barcelona and lower in southern regions like the Canary Islands. This distribution is similar to what is happening in the rest of the world.

Our study clearly shows an important increment in the incidence of hip fractures in the elderly in Salamanca. This increment is more accentuated if we also consider the published data of Fernandez et al. [9] from our region between 1977–1988. These authors found a total of 1,908 cases of fracture in the elderly (50 years and older), but the incidence of hip fracture in subjects aged under 65 were very low. In our study for the 1994–2002 period, we found 2,726 fracture cases, moreover in the elderly of 65 years of age and older. This supposes to provide data since 1977. From 1977 to 1994 the incidence of hip fractures increased 23%. From 1977 to 2002 the increase in the incidence in older people (65 years and older) was 93%. What this implies is that the increase was dramatically high. The increase is minor when we consider the standardized effect.

The increase in hip fracture cases is greater than expected due to an aging population, suggesting the existence of other factors influencing this higher incidence. What is more, we must assume a progressive increase in the following years with an expectation for the year 2015 of 668/100,000 (95% CI 516–819) in the elderly population (Figs. 4 and 5, Table 8).

With respect to other European countries, the incidence of hip fractures in our own region is situated at lower levels than those found in Scandinavian countries [17]. In Belgium, a country situated at a latitude closer to Spain, they have found a substantial increase in the number of fracture cases, achieving an incidence of 108/100,000 in 1984, and 141/100,000 in 1996 [18]. In the case of Greece [19], a country much more similar to Spain and in the south of Europe, the data of fracture incidence found in 1992 is very similar to that found in Spain. The average increase per year (9%), was closer than increased observed in Finland (10%) [20], and bigger than the increase reported in other countries [19, 21]. The same way, the estimation of incidence in the future (668/100,000) is similar than the estimation observed by Kannus et al. [20] for Finland (523/100,000).

The geographic differences in which the varied incidence of osteoporosis fracture cases are concerned are very well known. In whatever case this research study does not hope to establish the differences concerning the incidence of hip fractures, but more to the point shows these above-mentioned fractures as an important and growing health problem for our country, and that in our region a dramatic increase in hip fracture cases in the past decade has occurred. This new trend will likely continue to increase.

These increases in the incidence of hip fracture in the elderly population should and must motivate health authorities in our country, to promote the establishment of innovative and effective measures for the prevention of these geriatric concerns, with prevention programs and quality treatment for osteoporosis, as well as programs to help prevent falling and its subsequent consequences for the elderly. Together with these preventative healthcare measures, in agreement with Herrera et al., we should try to improve the health-watch system of the elderly and to establish useful clinical practice guidelines in the hospitals and extra hospital care programs that will lead to the obtaining of the best results in social and health terms.