Changes in number and incidence of hip fractures over 12 years in France

Highlights

• This study assessed the incidence of hip fractures in men and women aged 60 years and over, from 2002 to 2013 in France.

• The number of hip fractures increased in women (+ 5%; from 49,287 in 2002 to 50,215) and in men (+ 22%, from 12,716 to 15,482).

• Over the last 12 years, the incidence of hip fractures decreased in France in women and men aged over 60 years.

• This decrease is important in the subjects > 85 years old in both genders (− 29% and − 24% in women and men respectively).

Abstract

The incidence of hip fractures decreased in France in both genders, especially in the elderly, from 2002 to 2008, in parallel with availability of bone densitometry and effective anti-osteoporotic treatments. However prescriptions of these treatments are decreasing, since 2008, and recent studies show declining of osteoporosis management after fragility fractures. The aim of this study was to assess the incidence of hip fractures in men and women aged 60 years and over, from 2002 to 2013 in France.

Data were drawn from the French Hospital National Database which includes all hospitalizations of the country. Hospital data for hip fractures between 2002 and 2013 were numbered and the incidence rates per 1,000,000 adjusted on age (60–74; 74–84, and ≥ 85 years), and gender was calculated using the data of the French population.

The number of hip fractures increased in women (+ 5%; from 49,287 in 2002 to 50,215) and in men (+ 22%, from 12,716 to 15,482) aged over 60 years. Between 2002 and 2013, the French population increased by 21 and 29% in women and men of this age group; thus, incidence of hip fractures decreased by 14% in women (6929 and 5987 per million in 2002 and 2013, respectively) and a slight decrease of − 1% was observed in men (2344 and 2316). The decrease in incidence is also confirmed in the very elderly (≥ 85 years), with a decrease of − 29% and − 24% in women and men respectively.

Over the last 12 years, the incidence of hip fractures decreased in France in women and men aged over 60 years. This decrease is also observed in the subjects (≥ 85 years and older in both genders). Further studies are needed to assess potential changes in risk factors of hip fractures during the last decade.

Introduction

Hip fractures are a major public health concern because of their consequences in morbidity, costs and mortality. They are associated with a reduction of expected survival of 10–20% in the first year following the fracture, and a greater risk of dying persisting for at least 5 years afterwards [1], [2], [3]. The number of hip fractures is increasing worldwide, because of the increase in the number of frail elderly people at high risk of falls and fractures. But hip fracture incidence varies among countries [4], [5]. During the past decade, hip fracture incidence has declined in most Western countries and Oceania [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], reached a plateau [15], [16] and increased in some countries in Asia and South America [5], [17]. In France, we previously showed that the incidence of hip fractures decreased in both genders from 2002 to 2008 [18]. This observation was associated with different factors, including the availability of bone densitometry and effective anti-osteoporotic treatments [18], although no causal association has been demonstrated.

However, recent studies show declining of osteoporosis management after fragility fractures. In a retrospective analysis of 96,887 men and women aged 50 years or more, hospitalized for hip fracture over a period of 1 year, the estimated probability of receiving osteoporosis medication within 12 months after discharge from hospital significantly declined over a 10-year period from 40.2% in 2002, to 20.5% in 2011 [19]. Antiosteoporotic treatment uptake decreased progressively in Europe since 2008 including in France [20]. According to a retrospective analysis conducted in patients hospitalized in 2010–2011 for a major osteoporotic fracture (59% were hip fractures) in a tertiary hospital in Paris, France, only 4% and 10% of patients discharged to home and admitted to a rehabilitation center respectively received an antiosteoporotic treatment [21].

Thus, our hypothesis was that the decrease in hip fracture incidence observed between 2002 and 2008 could wane thereafter, because of the recent changes in management of osteoporotic patients and prescriptions of antiosteoporotic drugs. The aim of this study was to assess the trends of occurrence of hip fractures, numbers, and incidences from 2002 to 2013, in women and men aged 60 years and over in France.