Explaining declining hip fracture rates in Norway: a population-based modelling study

A Modeling Study for Hip Fracture Rates in Romania

Background and Objectives: As the population ages, the number of hip fractures is expected to increase. Developing prevention policies requires knowledge of the factors that lead to the incidence of hip fractures. In this study, we aimed to quantify how much variation in hip fracture incidence can be explained by osteoporosis treatment and temporal trends in the main risk factors. Methods: We used the HIP-IMPACT method for a national study in Romania. This method has been validated nationally in Norway, based on the validated IMPACT models for coronary heart disease. The model uses numerical data from 2008 to 2018 on fractures stratified by sex, the prevalence of pharmacological treatments, and risk and prevention factors. Results: The HIP-IMPACT model explained 90.1% (4287/4760) of the variation in hip fracture rates recorded during the period of 2008-2018. The increase in the number of fractures was explained by the increase in body mass index (1750/4760; 36.8%), the decrease in the intensity of physical activities (1396/4760; 29.3%), the increase in the prevalence of smoking (1387/4760; 29.1%), the increased prevalence of type 2 diabetes (334/4760; 7.0%), and users of z-drugs (381/4760; 8.0%), glucorticoids (491/4760; 10.3%), and opioids (331/4760; 7.0%). These effects were partially compensated by change over time in the uptake of osteoporosis medication (733/4760; 15.4%), increased prevalence of total hip replacements (491/4760; 10.2%), and reduced benzodiazepine use (559/4760; 11.8%). Conclusions: From 2008 to 2018, osteoporosis medication contributed to a decrease in hip fractures by one-eighth, while changes in risk factors and prevention contributed to an increase in hip fractures by three-quarters. There is high potential for fracture prevention through pharmacological treatments but also through national policies to increase physical activity, reduce smoking, and lower body mass index (BMI).

Evaluation of proanthocyanidins in treating Type 2 diabetic osteoporosis via SIRT6/Nrf2/GPX4 pathways

This study investigates the therapeutic potential of proanthocyanidins (PAC) in addressing Type 2 diabetic osteoporosis (T2DOP) by activating the SIRT6/Nrf2/GPX4 signaling pathways. T2DOP is characterized by compromised bone structure and heightened oxidative stress, where ferroptosis plays a pivotal role. Utilizing a T2DOP mouse model and MC3T3-E1 cells under high glucose conditions, we evaluated the impact of PAC on bone health and iron homeostasis. Our results, obtained through micro-CT, histological staining, Western blot, and immunofluorescence analyses, revealed reductions in bone density and decreased GPX4 expression in T2DOP conditions, indicating ferroptosis and oxidative stress. However, PAC treatment improved trabecular bone structure, reduced bone marrow adipocytes, decreased oxidative stress, and enhanced expression of key osteogenic proteins. These findings highlight PAC's potential in mitigating T2DOP through the SIRT6/Nrf2/GPX4 pathways, offering promising therapeutic insights for managing diabetic osteoporosis.

Forecasting the burden of hip fracture in Norway towards 2050 by educational level: The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

AIMS

Hip fracture burden is expected to increase due to the ageing population. Given that hip fracture incidence differs by educational attainment, and that a shift in the older population's educational level will manifest itself in coming decades, we investigated future hip fracture trends in Norway and their variation by attained educational level.

METHODS

Estimated annual hip fracture numbers in the population aged 50+ years in 2020-2050 were based on information from the Norwegian Epidemiologic Osteoporosis Studies hip fracture database and official population projections from Statistics Norway. Projected educational attainment was obtained from the Wittgenstein Centre for Demography and Global Human Capital. We explored two scenarios: first, assuming that the observed 2019 rates remain constant until 2050, and second, assuming a continuing rate of decline corresponding to that observed during 1999-2019.

RESULTS

The projections showed that the annual number of hip fractures will increase by 91% in women and 131% in men given constant sex- and age-specific rates, and by 27% in women and 66% in men given declining rates. The majority of hip fractures are expected in the group with secondary education, however, the numbers will increase steeply in people with tertiary education due to the temporal shift in educational attainment.

CONCLUSIONS

The annual number of hip fractures may double by 2050, placing high demands on the healthcare services. The majority of hip fractures are projected to occur in people with secondary and tertiary education. It is vital to intensify preventive efforts, not least in the high-risk populations.

Falling rates but projected rising numbers of fractures in elderly Norwegians: a study of fracture rates in the Norwegian patient registry from 2010 to 2021, extrapolated to 2041

PURPOSE

 Our aim was to calculate rates of major fractures by fracture location in elderly Norwegians over the years 2010 to 2021 and thereby estimate the volume of fractures in this population by 2041.

METHODS

 We identified fractures in persons aged 65 years and over from the Norwegian Patient Registry. We summarized age- and sex-specific numbers of fractures and incidence rates by fracture location. Extrapolating adjusted incidence rates combined with population projections from Statistics Norway, we estimated the expected numbers of fracture cases for the following 20 years.

RESULTS

 The total number of major fractures rose from 22,581 in 2010 to 27,596 in 2021. While the number of hip fractures was relatively stable (8,164 to 8,194 over the period), there were substantial increases in the number of fractures in the upper extremities, spine and pelvis, and lower extremities. Annual changes in incidence rates adjusted for age and sex were 0.6% (95% confidence interval [CI] 0.4-0.7), 1.2% (CI 0.9-1.4), 0.4% (CI 0.1-0.7), and -1.9% (CI -2.0 to -1.7) for upper extremity, spine and pelvis, lower extremity, and hip respectively. Extrapolating trends in incidence rates, we estimate a 64% (95% prediction interval 48-70) overall increase in the number of major fractures by 2041 compared with 2021, primarily due to the aging of the population.

CONCLUSION

 Incidence rates of hip fractures decreased over the period, while rates of other major fractures increased. We can expect a substantial increase in the number of fractures over the coming years, primarily due to the expected aging of the population.

The hip fracture incidence in the high-risk area Oslo continues to decline

Oslo in Norway has had the highest incidence of hip fractures in the world. The incidence in Oslo has been thoroughly described every decade since the late 1970s. The incidence in Oslo has previously been higher compared to the rest of Norway but has now decreased to a level below the country average.

PURPOSE

The purpose of this study was to report the incidence of hip fractures in Oslo in 2019 and compare it with the incidence rates from the previous four decades.

METHODS

Patients residing in Oslo in 2019 with a new hip fracture identified by searching the Oslo hospital's patient administrative systems and protocols from the operating theaters. The diagnosis was verified through medical records and/or radiographs. To compare with previous studies, the direct standardization method was used with the population of Oslo in 2019 as the standard.

RESULTS

A total of 758 hip fractures, 70% women, were identified in 2019. The age-standardized incidence rates per 10,000 person-years in 2019 (95% CI) were 45 (41.1-48.8) for women and 30 (25.8-33.8) for men. In women, there has been a continuous decline in age-standardized rates the last three decades and in men the last two decades. The most pronounced decline was seen in the oldest age groups over 70 years. There has been a secular decline in both cervical and trochanteric fractures; however, the decrease in trochanteric fractures was most distinct for males, with more than two times higher risk in 1996/1997 compared to 2019.

CONCLUSION

Incidence rates for hip fractures in Oslo in 2019 were the lowest rate reported since 1978. The decrease was significant for both men and women. For the first time, the incidence rates are below the national rates of Norway. However, the rates are still among the highest worldwide.

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.

Decrease in incidence of distal radius fractures in Oslo, Norway

This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high compared to other regions in Norway and some of the other Nordic countries.

PURPOSE

We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999.

METHODS

Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated.

RESULTS

The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71-0.84) and 0.77 (95% CI 0.66-0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71-0.86) and 0.78 (95% CI 0.63-0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40-0.80) for women and 0.77 (95% CI 0.44-1.37) for men.

CONCLUSIONS

The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.

The impact of an ageing population on future increases in hip fracture burden

Aims

Current levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care.

Methods

Historical data from the Scottish Hip Fracture Audit (2017 to 2021) were used to identify monthly incidence rates. Established time series forecasting techniques (Exponential Smoothing and Autoregressive Integrated Moving Average) were then used to predict the annual number of hip fractures from 2022 to 2029, including adjustment for predicted changes in national population demographics. Predicted differences in service-level outcomes (length of stay and discharge destination) were analyzed, including the associated financial cost of any changes.

Results

Between 2017 and 2021, the number of annual hip fractures increased from 6,675 to 7,797 (15%), with a rise in incidence from 313 to 350 per 100,000 (11%) for the at-risk population. By 2029, a combined average projection forecast the annual number of hip fractures at 10,311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. Based upon these projections, assuming discharge rates remain constant, the total overall length of hospital stay following hip fracture in Scotland will increase by 60,699 days per annum, incurring an additional cost of at least £25 million per year. Approximately five more acute hip fracture beds may be required per hospital to accommodate this increased activity.

Conclusion

Projection modelling demonstrates that hip fracture burden and incidence will increase substantially by 2029, driven by an ageing population, with substantial implications for health and social care services.