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Fragility fractures of the hip and femur: incidence and patient characteristics

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Abstract

Summary

Using national discharge and medical claims data, we studied the epidemiology of femoral fractures from 1996 to 2006. The annual hip fracture incidence declined from 600/100,000 to 400/100,000, without decline in the more rare femur fractures. Incidence rates for subtrochanteric and femoral shaft fractures were each below 20 per 100,000.

Introduction

This study’s purpose is to describe the site-specific epidemiology of femur fractures among people aged 50 and older.

Methods

Using the National Hospital Discharge Survey from 1996 to 2006 and a large medical claims database (MarketScan®), we studied epidemiology of all femur fractures. Hip fractures were grouped together; subtrochanteric, shaft, and distal femur fractures were kept separate.

Results

In females, the overall hospital discharge rates of hip fracture decreased from about 600/100,00 to 400/100,000 person-years from 1996 to 2006. Subtrochanteric, femoral shaft, and lower femur rates remained stable, each approximately 20 per 100,000 person-years. Similar trends but lower rates existed in males. No significant trends were found in any of these fractures during the more recent years of 2002–2006 (MarketScan data). Using MarketScan, the overall incidence of hip fracture was <300/100,000 person-years; incidence of subtrochanteric and femoral shaft fractures combined was <25/100,000 person-years and distal femur fracture incidence was <18/100,000 person-years in females; rates were lower in males. The incidence of hip and other femur fractures increased exponentially with age.

Conclusions

We found no evidence of an increasing incidence of any femoral fracture. Hip fracture incidence is declining but the incidence of each of the more rare femur fractures (distal to the lesser trochanter) is stable over time.

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Acknowledgement

We thank the following people for their help in preparing this manuscript: David Cahall from Sanofi-aventis, Karen Driver, Didier Huber, Andrea Klemes, Jeff L. Lange, Darrel Russell, Richard Sheer, J. Mike Sprafka, and Diane Vonderheide from Procter and Gamble, and Barbara McCarty Garcia.

Conflicts of interest and financial disclosures

Dr. Nieves has attended advisory meetings for Merck and Bayer and is a member of the Speakers Bureau for Sciele Pharma, Inc.

Dr. Bilezikian is a consultant to the Alliance for Better Bone Health (a Procter & Gamble and Sanofi-aventis partnership), Merck, Lilly, Novartis, and Johnson & Johnson, has received research grants from the Alliance for Better Bone Health and Radius, and is on the Speakers Bureau for the Alliance for Better Bone Health, Novartis, and Lilly.

Dr. Lane is a consultant to BioMimetics, DFine, Innovative Clinical Solutions, Orthovita, Osteotech, Soteira, Zelos, and Zimmer, has received research grants from The Charles Cohn Foundation, and is on the Speakers Bureau for Lilly, Novartis, Procter & Gamble, and Sanofi-aventis.

Dr. Einhorn is a consultant to Eli Lilly, Novartis, Zelos, Amgen, and Pfizer and has received grants from Zelos.

Dr. Wang is an employee of Procter and Gamble.

Dr. Steinbuch is an employee of Procter and Gamble and holds company stock.

Dr. Cosman is a consultant or on an advisory board for Novartis, Eli Lilly, Merck, Amgen, Procter and Gamble, Pfizer, and Zosano and on the Speakers Bureau for Novartis and Eli Lilly.

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Authors and Affiliations

  1. Departments of Epidemiology and Medicine, Columbia University, New York, NY, USA

    J. W. Nieves, J. P. Bilezikian & F. Cosman

  2. Clinical Research Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY, 10994, USA

    J. W. Nieves & F. Cosman

  3. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    J. M. Lane

  4. Boston University Orthopaedic Surgical Associates, 720 Harrison Avenue, Suite 805, Boston, MA, 02118, USA

    T. A. Einhorn

  5. Epidemiology and Health Outcomes, Procter & Gamble Pharmaceuticals, Mason, OH, 45040, USA

    Y. Wang & M. Steinbuch

Authors
  1. J. W. Nieves
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  2. J. P. Bilezikian
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  3. J. M. Lane
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  4. T. A. Einhorn
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  5. Y. Wang
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  6. M. Steinbuch
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  7. F. Cosman
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Corresponding author

Correspondence to J. W. Nieves.

Appendices

Appendix 1

Table 4 Hospital discharge rates of closed femoral fractures, NHDS 1996-2006
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Appendix 2:

Table 5 Incidence rates of fragility fractures, MarketScan 2002–2006
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Appendix 3:

Table 6 Fitted model parameters for Poisson rate parameters a
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Nieves, J.W., Bilezikian, J.P., Lane, J.M. et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int 21, 399–408 (2010). https://doi.org/10.1007/s00198-009-0962-6

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  • DOI: https://doi.org/10.1007/s00198-009-0962-6

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