Incidence of four major types of osteoporotic fragility fractures among elderly individuals in Sado, Japan, in 2015

National Surgical Trends in Distal Radius Fixation in Medicare Beneficiaries: Increased Utilization by Plastic Surgeons and Hand Surgeons

INTRODUCTION

Several randomized controlled trials have been published concerning the treatment of distal radius fracture interventions (DRFIs) in elderly patients. This study aims to investigate the surgical trends in the management of DRFs within the Medicare population.

METHODS

In this retrospective study, we collected data from the Centers for Medicare and Medicaid Services between 2013 and 2022 for claims for DRFIs identified using Current Procedural Terminology codes 25606, 25607, 25608, and 25609. Results were categorized by primary operator type (general orthopaedic surgeon, general plastics, general surgeon, subspecialty hand surgeon) and place of service (inpatient, outpatient, other).

RESULTS

A total of 101,857 DRFIs were identified. The overall rate of DRFIs declined by 12% (29.5 to 26.1 per 100,000 individuals). The utilization of closed reduction percutaneous pinning experienced a 63% decrease (4.8 to 1.8 per 100,000). Conversely, open treatment for distal radial intra-articular fractures saw an 11% increase in utilization (10.0 to 11.1 per 100,000). Orthopaedic surgeons and general surgeons experienced a notable decrease in utilization of DRFIs of 22% and 6%, respectively, whereas plastic surgeons and hand surgeons saw an increase in utilization of 74% and 13%, respectively, over the same 10-year period. Outpatient DRFIs increased by 11%, whereas inpatient and other decreased by 17% and 36%, respectively.

CONCLUSION

There has been a notable decline in DRFIs within the Medicare population. We observed a diminishing procedure share among general orthopaedic surgeons and general surgeons, accompanied by a rising utilization of plastic surgeons and hand surgeons in addressing DRFIs.

LEVEL OF EVIDENCE

NA, Database Review.

Incidence of four major osteoporotic fragility fractures among older individuals in Sado, Japan, in 2020

INTRODUCTION

This study compared the 2020 incidence of fragility fractures in Sado City with those from 2004 to 2015.

MATERIALS AND METHODS

Data from patients aged ≥ 60 years living in Sado City with fragility fractures in the hip, vertebral, distal radius, and proximal humerus between January 1 and December 31, 2020, were collected. We examined the number and incidence of four types of osteoporotic fractures in the older population aged ≥ 60 years living in Sado City in 2020. We compared the results with those of the 2004, 2010, and 2015 surveys, examining the temporal change and trend in the incidence of the four fracture types in this population. We investigated the use rate of anti-osteoporotic medications and the relationship between their administration and the occurrence of fragility fractures.

RESULTS

The age-specific incidence of hip fractures slightly decreased from 2015. However, the incidence of the other three fractures slightly increased, although the difference was not statistically significant. The incidence of hip fractures markedly increased in the 80 s. In 2020, the percentage of patients taking anti-osteoporotic agents before the occurrence of fractures decreased to 12.4% from 14.5% in 2015; it increased from 4% in 2004 to 7.6% in 2010.

CONCLUSION

The 2020 incidence of the four fractures did not decrease, and the percentage of patients receiving anti-osteoporotic agents did not increase. A higher frequency of osteoporosis treatment is necessary to reduce the incidence of fragility fractures. We recommend using anti-osteoporotic agents to prevent hip fractures among individuals in their mid-70 s and above.

Incidence of fragility hip fracture across the Asia-pacific region: A systematic review

PURPOSE

This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions.

METHOD

A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518).

RESULTS

Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China.

CONCLUSION

Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning.

The total number of patients with any of four major fragility fractures decreased during the first wave of the COVID-19 epidemic in Japan, commencing before the state of emergency declaration, which was not as enforceable as lockdown

Durin g the first wave of the COVID-19 epidemic, the total number of patients with any of the four major fragility fractures, including both inpatients and first-visit outpatients, began to decline shortly before the state of emergency was declared, rather than immediately after it was declared.

PURPOSE

This study aimed to investigate the impact of public health measures in the first wave of the COVID-19 epidemic on the occurrence of major fragility fractures (MFFs).

METHODS

Patients aged 50 years or older who were hospitalized or had an initial visit as an outpatient for an MFF, defined as a proximal femoral fracture (PFF), vertebral fragility fracture (VFF), distal radius fracture (DRF), or a proximal humeral fracture (PHF), were included in this study. Three-phase interrupted time-series analyses were performed to evaluate the impact of the voluntary event cancellation request in late February 2020 and the emergency declaration in early April 2020 on changes in the total number of patients, including inpatients and first-visit outpatients.

RESULTS

A total of 166,560 patients with MFFs were included (92,767 PFFs, 26,158 VFFs, 33,869 DRFs, and 13,766 PHFs). From the end of February, in seven prefectures with high proportions of urbanization, decreasing trends were estimated for level changes and slope changes in the total number of patients with any of the four MFFs (level change: PFF; point estimate; - 13.5 (95% CI; - 43.4, 16.5), VFF; - 15.3 (- 32.2, 1.5), DRF; - 16.1 (- 39.9, 7.6), PHF; - 1.9 (- 13.6, 9.8), slope change: PFF; - 4.8 (- 14.0, 4.4), VFF; - 3.0 (- 8.1, 2.2), DRF; - 0.6 (- 7.9, 6.7), PHF; - 2.4 (- 6.0, 1.2)).

CONCLUSION

The findings suggested that the total number of patients with any of the four MFFs did not begin to decline from early April 2020 after the state of emergency was declared but earlier, in late February 2020.

Epidemiology of distal radius fracture: a regional population-based study in Japan

BACKGROUND

Distal radius fracture (DRF) is very common worldwide. In particular, aging countries have numerous patients with DRF, resulting in an urgent need for active preventive measures. As few epidemiological studies have investigated DRF in Japan, we aimed to identify the epidemiological characteristics of patients of all ages with DRF in Japan.

METHODS

This descriptive epidemiologic study analyzed data obtained from clinical information of patients diagnosed with DRF from January 1, 2011, to December 31, 2020, at a prefectural hospital in Hokkaido, Japan. We calculated the crude and age-adjusted annual incidences of DRF and described the age-specific incidence, injury characteristics (injury location and cause, seasonal differences, and fracture classification), and 1- and 5-year mortality rates.

RESULTS

A total of 258 patients with DRF were identified, of which 190 (73.6%) were female and the mean age (standard deviation) was 67.0 (21.5) years. The crude annual incidence of DRF ranged from 158.0 to 272.6 per 100,000 population/year, and the age-adjusted incidence among female patients demonstrated a significant decreasing trend during 2011-2020 (Poisson regression analysis; p = 0.043). The age-specific incidence differed by sex, with peaks at 10-14 years for males and 75-79 years for females. The most common cause of injury was a simple fall in patients > 15 year of age and sports injuries in patients ≤ 15 years of age. DRFs were most frequently sustained outdoors and were more common in the winter season. In patients > 15 years of age, the proportions of AO/OTA fracture types A, B, and C were 78.7% (184/234), 1.7% (4/234), and 19.6% (46/234), respectively, and 29.1% (68/234) of patients received surgical treatment for DRF. The 1- and 5-year mortality rates were 2.8% and 11.9%, respectively.

CONCLUSIONS

Our findings were mostly consistent with previous global studies. Although the crude annual incidence of DRF was relatively high because of recent population aging, the age-adjusted annual incidence among female patients showed a significant decreasing trend during this decade.

Trends in incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fractures in people aged 50 years and above: retrospective cohort study using UK primary care data

This study used primary care data to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK during 2000-2018 accounting for age, sex, calendar year and social deprivation. More than 3 million people aged 50-99 years were included. We found that men living in the most deprived areas had a 45% higher risk of being diagnosed with osteoporosis and 50% higher risk of fragility fracture compared to men living in the least deprived areas.

PURPOSE

a) To estimate the incidence trends of a recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK over time; b) to describe differences according to age, sex, and social deprivation.

METHODS

This is a longitudinal population-based cohort study using routinely collected primary care data obtained via IQVIA Medical Research Database (IMRD). All patients aged 50-99 years registered with a practice participating in THIN (The Health Improvement Network) between 2000-2018 were included. The first recorded diagnosis of osteoporosis, osteopenia, or fragility fracture was used to estimate incidence rates (IR) per 10,000 person-years at risk. Poisson regression was used to provide Incidence Rate Ratios (IRR) adjusted by age, sex, social deprivation, calendar year, and practice effect.

RESULTS

The year-specific adjusted IRR of recorded osteoporosis was highest in 2009 in women [IRR 1.44(95%CI 1.38-1.50)], whereas in men it was highest in 2013-2014 [IRR 1.94(95%CI 1.72-2.18)] compared to 2000. The year-specific adjusted IRR of fragility fracture was highest in 2012 in women [IRR 1.77(95%CI 1.69-1.85)], whereas in men it was highest in 2013 [IRR 1.64(95%CI 1.51-1.78)] compared to 2000. Men in the most deprived areas had a higher risk of being diagnosed with osteoporosis [IRR 1.45(95%CI 1.38-1.53)], osteopenia [IRR 1.17(95%CI 1.09-1.26)], and fragility fracture [IRR 1.50(95%CI 1.44-1.56)] compared to those living in the least deprived areas, but smaller differences were seen in women.

CONCLUSION

Use of fracture risk assessment tools may enhance the detection of osteoporosis cases in primary care. Further research is needed on the effect of social deprivation on diagnosis of osteoporosis and fractures.

Diagnostic Criteria and Treatment of Atypical Ulnar Fractures Associated With Prolonged Bisphosphonate Therapy: Multicenter Case Analysis

PURPOSE

Atypical ulnar fracture (AUF) related to prolonged bisphosphonate therapy is a rare complication. We propose diagnostic criteria of AUFs and present a treatment algorithm.

METHODS

Twelve AUFs in 10 patients were studied. The diagnosis of AUF was based on the case definition of atypical femoral fracture (AFF). We investigated clinical and radiographic characteristics of AUFs according to major and minor features of AFFs, and modified the case definition of an AFF to fit the characteristics of AUFs. All AUFs were treated surgically. The radiographic union of fractures was investigated, and delayed fracture healing was defined as a delay of 6 months or more.

RESULTS

The average point at which AUFs occurred was at a point 35.1% along the proximal diaphysis of the total ulnar length. All major features of AFFs were identified in the 12 AUFs. Among the minor features, generalized cortical thickening was observed in 6 AUFs, prodromal symptoms in 2 AUFs, bilateral involvement in 2 patients, and delayed fracture healing in 10 AUFs (5 delayed union, 5 nonunion). Initially, 11 of 12 AUFs were treated with plating, and 1 was treated with intramedullary nailing. Two nonunions were revised with sclerotic bone resections, bone grafts, and plate fixation. Finally, union was achieved in 9 AUFs.

CONCLUSIONS

The case definition of AFFs can be used for the diagnosis of AUFs, although some modifications must be included in the case definition. Plating is useful in managing AUFs, although sclerotic bone resections and bone grafts may be required. Atypical ulnar fractures occurred in patients who took bisphosphonates longer than AFFs or those whose bisphosphonates were discontinued a few years earlier. Therefore, physicians should be aware of AUFs in those patients and, if necessary, perform a screening test to look for atypical fractures in other bones.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic V.

Incidence of different types of subsequent fractures and related mortality in Taiwan

Hip fracture is the most common type of fracture to occur within 2 years after an initial fracture. Mortality risk increases when a subsequent fracture occurs. The occurrence of subsequent fracture is significantly higher in patients with hip fractures than others. Prevention of subsequent fracture is of paramount important.

PURPOSE

Osteoporotic fracture significantly increases risk of subsequent fracture. In this retrospective cohort study, we used the Taiwan National Health Insurance Database (NHIRD) to analyze data on fractures in a group at high risk of osteoporosis. We aimed to distinguish differences in subsequent fracture types and their relationship with mortality.

METHODS

We enrolled patients aged ≥ 50 years old who were diagnosed with an initial fracture classified as hip, vertebral, upper end of the humerus, or wrist. Data from 2 years of follow-up were analyzed. Risks of subsequent fracture events and mortality were calculated by Kaplan-Meier estimation and assessed with Cox proportional hazards models.

RESULTS

We included 375,836 patients from the 2011-2015 NHIRD. Patients with initial hip fracture had the highest incidence of subsequent fracture at both 1- and 2-year follow-up (7.0% and 10.9%). Subsequent fractures occurred mainly at the hip. Conversely, other patients had a higher proportion of subsequent vertebral fracture. Patients with subsequent fracture classified as hip, vertebral, and upper end of the humerus had significantly higher cumulative mortality rates than that of patients who had no subsequent fracture, with adjusted hazard ratios of 1.64 (95% CI = 1.57-1.71, p < 0.01), 1.06 (95% CI = 1.00-1.12, p = 0.04), 1.31 (95% CI = 1.17-1.46, p < 0.01), respectively.

CONCLUSION

Patients who experienced an initial hip fracture are at greatest risk of subsequent fracture, most commonly the hip. Occurrence of subsequent fractures was associated with an increased mortality risk. Thus, there is a need for early intervention following initial hip fractures.

30-year trends of hip and vertebral fracture incidence in Japan: a systematic review and meta-analysis

INTRODUCTION

A previous review study showed the trends of declining age- and sex-adjusted incidence of hip fractures in almost all the countries, except Austria and Japan, in the most recent of the periods studied. However, the expansion of devices for diagnosis and drugs for fracture prevention in Japan was roughly the same as in the other countries. This study aimed to conduct a comprehensive systematic review and meta-analyses of incidence rates (IRs) of osteoporotic fractures reported over 30-years in multiple communities in Japan and to evaluate secular trends.

MATERIALS AND METHODS

We searched MEDLINE for observational studies reporting IRs of osteoporotic fractures in the general population. Additional studies were identified by hand searches of reference lists of published studies. Two reviewers and 1 expert independently assessed study eligibility. Pooled analyses of IRs were conducted by a random-effect model. Data from 3 periods (1985-1999, 2000-2009, and from 2010) were compared.

RESULTS

Of 47 eligible studies, 21 with IRs or information enabling recalculation of IRs in the population aged 50 years and older were included. IRs of hip fractures per 100,000 person-years significantly increased over time in men: 1985-1999, 0.79 (95% CI 0.71-0.87); 2000-2009, 1.18 (95% CI 1.09-1.28); and 2010 onwards, 1.31 (95% CI 1.17-1.45). They also significantly increased in women: 2.23 (95% CI 1.89-2.58); 3.99 (95% CI 3.70-4.28); and 4.39 (95% CI 4.00-4.78), respectively.

CONCLUSION

IRs of hip fractures continuously increased in the past 30-years in men and women despite improved the diagnosis, treatment, and care. Such data from Japan, a leading aging society, provide important information for other countries.

Current and Future Burden of Hip and Vertebral Fractures in Asia

The increase in the incidence of hip fractures over time disappeared in Northern European and North American Caucasians after 2000, while an increase was observed in Asian countries including Japan until 2010. However, a decrease in the incidence was observed after 2010. The prevalence of vertebral fractures in Asians, Europeans, and American Caucasians is similar, and the incidences of clinical and morphometric vertebral fractures are higher in Asians compared with European Caucasians. The decrease in the incidence of vertebral fractures over time has been observed in Japan. Although the stabilization or decrease over time in the incidence of hip and vertebral fractures have been observed, the number of patients with these fractures is expected to increase rapidly with increases in the elderly population. Multidisciplinary measures to prevent fragility fractures are an urgent issue in Asia at this time. This narrative review outlines the recent trends in incidence and future burdens of hip fracture and vertebral fracture in Asia.

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Hypothesis

This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants.

Methods

Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs).

Results

Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants.

Conclusion

Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.

Incidence of fractures among patients receiving medications for type 2 diabetes or chronic obstructive pulmonary disease and glucocorticoid users according to the National Claims Database in Japan

According to information from the National Health Insurance and Claims database, the risk for hip, radius, and clinical vertebral fractures was higher among patients receiving medication for type 2 diabetes, COPD, or glucocorticoids than among the whole Japanese population after middle age.

PURPOSE

The aim of this study was to determine the incidence of fractures among patients receiving medications for type 2 diabetes or chronic obstructive pulmonary disease (COPD) and using glucocorticoids (GC) according to the National Database of Health Insurance Claims (NDB) in Japan.

METHODS

We obtained data on the number of fractures and patients receiving medications for type 2 diabetes, COPD, or GC from the NDB. The claims data included sex, age group, injury/illness name, hospitalization, outpatient, surgery/medical treatment, and drugs used between January and December 2017.

RESULTS

The risk of hip fracture was higher among patients receiving medications for diabetes or COPD and GC users than in the Japanese population, with standardized incidence ratios (SIRs) of 1.71 (95% confidence interval [CI]1.6-1.75), 1.35 (95% CI 1.28-1.42), and 1.62 (95% CI 1.53-1.71) in men and 1.81 (95% CI 1.79-1.84), 1.67 (95% CI 1.54-1.80), and 1.71 (95% CI 1.66-1.76) in women, respectively. There was also a significantly higher incidence of radial fractures in women and clinical vertebral fractures in both men and women. A greater risk of hip fracture was found among diabetic patients starting in their late 40 s.

CONCLUSIONS

Real-world data revealed that the incidence of hip, radius, and clinical vertebral fractures was significantly higher among patients receiving medications for diabetes or COPD and GC users than in the Japanese population after middle age.

Incidence of clinical vertebral fractures and hip fractures of the elderly (65 years or over) population-large-scale data analysis using claim database in Kure City, Hiroshima, Japan

Using the claim database, we investigated the incidence rate of clinical vertebral fractures per 1,000 in the elderly residents, over 65 years of age, in Kure city. The incidence rate, of clinical vertebral fractures, was 15.58 (7.29 male, 21.17 female, 2.90 female/male ratio).

PURPOSE

To elucidate the incidence of clinical vertebral and hip fractures using the claim database, in those over 65 years of age in Kure city, and to compare with the previous reports.

METHODS

We used, for residents in 2015, the medical care information of the National Health Insurance or Senior Elderly Care System in Kure City (Hiroshima Prefecture, Japan). Those with vertebral fractures as disease name, and either treatment/operation/hospitalization were defined as clinical vertebral fractures. Among the claim database, we extracted the clinical vertebral fracture and investigated the number of occurrences and the incidence rate per 1,000. We also investigated the incidence rate of hip fractures and compared those to the clinical vertebral fractures.

RESULT

The incidence rate of clinical vertebral fractures of the elderly population (65 years or over) per 1,000 was 15.58 (7.29 male, 21.17 female, 2.90 female/male ratio). In both men and women, the incidence rate increased with aging. The incidence rate of hip fractures per 1,000 was 9.17 (3.55 male, 12.96 female, 3.65 male/female ratio). Clinical vertebral fractures were more frequent than hip fractures, and the ratio of incidence rate of vertebral fractures to hip fractures was 1.70 (male, 2.05, female, 1.63). For both fractures, the incidence rate increases with age, apart from the women where the incidence of vertebral fracture reduces slightly in the older age group CONCLUSION: This is the first report that investigated the incidence rate of the clinical vertebral fractures using the claim database, which covered almost the whole number of 230,000 population area.

Fragility fractures and delayed wound healing after tooth extraction in Japanese older adults

INTRODUCTION

Fragility fractures can cause delayed wound healing after tooth extraction, which contributes to an increased risk of osteomyelitis of the jaw. We evaluated whether a history of fragility fracture was associated with increased risk of delayed wound healing after tooth extraction in older adults in Japan.

MATERIALS AND METHODS

Of 5352 people aged 50-89 years in the 2014 basic resident registry of the town of Obuse, the present study included 376 subjects (190 men and 186 women) who completed a structured questionnaire and measurement of the bone mineral densities (BMDs) of the bilateral femoral neck. Delayed wound healing after tooth extraction was self-reported. Fragility fractures were confirmed via examination of hospital medical records. Logistic regression analyses adjusted for age and gender were used to evaluate association of clinical variables with delayed would healing after tooth extractions. Odds ratios (ORs) and the 95% confidence intervals (CIs) of all possible associated variables for the presence of delayed wound healing were calculated.

RESULTS

Subjects with a history of fragility fractures had a significantly higher risk of delayed wound healing compared with those without previous fragility fractures (OR 2.68; 95% CI 1.11-6.46, p = 0.028). This association still remained after adjusted for all other variables (OR 2.70; 95% CI 1.10-6.60, p = 0.030). Delayed wound healing was not significantly associated with the BMD of the femoral neck.

CONCLUSIONS

History of fragility fracture may be associated with increased risk of delayed wound healing after tooth extraction in Japanese men and women aged 50-89 years.

Fragility Fractures in Older People in Japan Based on the National Health Insurance Claims Database

Fragility fractures associated with age-related bone loss are of urgent concern worldwide because they reduce QOL and pose financial burdens for health care services. Currently, national data in Japan are limited. This study provides quantitative data for older patients throughout Japan who, although otherwise relatively healthy, sustained fragility fractures and were hospitalized for them. The National Database of Health Insurance Claims and Specific Health Checkups of Japan was accessed to target patients aged 65 years or older who sustained fractures between May 2013 and September 2014 and were not hospitalized for at least 13 months prior to fracture. We investigated whether the first fracture sustained was fragility related at any of four locations (proximal humerus, distal radius, vertebra, or femoral neck) and whether it necessitated hospitalization. Fragility fractures were identified in 490138 of 1188754 patients (41.2%, 345980 patients/year; 1 : 4 male-to-female ratio). Regardless of gender, vertebral fractures were most common across the age cohorts studied (43286 males and 162767 females/year), and femoral neck fractures increased markedly with increased patient age. Approximately 80% of patients with femoral neck fractures were hospitalized (62.3% of males, 71.1% of females) compared with up to 10.4% of patients with other fragility fractures. Data provided in this study can be used as a baseline for evaluating the health economy and establishing health policy in Japan.