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      The annual number of hip fractures in Sweden will double from year 2002 to 2050 : Projections based on local and nationwide data

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      Acta Orthopaedica
      Informa Healthcare

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          Abstract

          Background and purpose

          The incidence and annual number of hip fractures have increased worldwide during the past 50 years, and projections have indicated a further increase. During the last decade, however, a down-turn in the incidence of hip fracture has been seen in the western world. We predicted the development of hip fractures in Sweden until the year 2050.

          Methods

          We reviewed surgical records for the period 2002–2012 in the city of Malmö, Sweden, and identified patients aged 50 years or more with a hip fracture. We estimated incidence rates by using official population figures as denominator and applied the rates to population projections each year until 2050. We also made projections based on our previously published nationwide Swedish hip fracture rates for the period 1987–2002. Since the projections are based on estimates, no confidence limits are given.

          Results

          During the period 2002–2012, there were 7,385 hip fractures in Malmö. Based on these data, we predicted that there would be approximately 30,000 hip fractures in Sweden in the year 2050. Use of nationwide rates for 2002 in the predictive model gave similar results, which correspond to an increase in the number of hip fractures by a factor of 1.9 (1.7 for women and 2.3 for men) compared to 2002.

          Interpretation

          The annual number of hip fractures will almost double during the first half of the century. Time trends in hip fractures and also changes in population size and age distribution should be continuously monitored, as such changes will influence the number of hip fractures in the future. Our results indicate that we must optimize preventive measures for hip fractures and prepare for major demands in resources.

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          Most cited references17

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          Hip fractures in Finland between 1970 and 1997 and predictions for the future.

          Hip fractures in elderly people are common worldwide, and the predicted ageing of populations is increasing the burden of these fractures on health-care systems. However, prediction of the true increases in number of patients needing treatment requires exact knowledge of whether the number of hip fractures is rising more rapidly than can be accounted for by demographic changes alone. We aimed to make such a prediction for people aged 50 years or more in Finland. All patients aged 50 years or more, who were admitted to hospitals in Finland during 1970-97 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. The age-specific and age-adjusted fracture incidences were expressed as the number of patients per 100,000 individuals per year, and prediction of the number, and incidence of hip fractures in Finland (population 5 million) until the year 2030 was calculated with a regression model. The number of hip fractures in Finnish people aged 50 or more rose during the study period, from 1857 in 1970 to 7122 in 1997. The corresponding fracture incidence (per 100,000 people) increased from 163 to 438. The age-adjusted incidence of hip fractures also showed a steady increase from 1970 to 1997: in women, from 292 to 467, and in men, from 112 to 233. If this trend continues, the number of hip fractures in Finland will be almost three-fold higher in the year 2030 than in 1997. The number of hip fractures in elderly Finnish men and women is increasing at a rate that cannot be explained merely by demographic changes. The precise reasons for this are not known, but deterioration in age-adjusted bone-mineral density and strength, with accompanying increase in the age-adjusted incidence of injurious falls of the elderly, could partly account for the development.
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            Incidence of hip fractures in Malmö, Sweden, 1992-1995. A trend-break.

            The incidence of hip fractures in Malmö, Sweden, has been studied since 1924. Predictions based on material from the 1950s to the 1980s have shown an almost exponential increase in incidence. During 1992-1995, 2,268 patients aged 50 and older, with hip fractures, were admitted to Malmö University Hospital, the only hospital in the city treating hip fractures. 76% were women with a mean age of 81 (SD 8) years, and the mean age of men was 78 (SD 9) years. 47% of the fractures were cervical. The annual incidences per 10,000 inhabitants were 36 in men and 85 in women. The corresponding numbers of subjects over 80 years were 170 men and 297 women. These findings show that the incidence is no longer increasing. The causes of such a trend-break could be successful osteoporosis prevention, an increasing proportion of non-Scandinavian immigrants with a lower genetic risk of osteoporotic fractures, or a healthier elderly population. Increasing number of the population at risk already have two operated hips, due to previous fractures or arthrosis. Other causes may be fewer prescriptions of sedatives and higher winter temperatures.
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              Trends in hip fracture incidence rates among the elderly in Sweden 1987-2009.

              Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied. Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates. The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.
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                Author and article information

                Journal
                Acta Orthop
                Acta Orthop
                ORT
                Acta Orthopaedica
                Informa Healthcare
                1745-3674
                1745-3682
                June 2014
                16 June 2014
                : 85
                : 3
                : 234-237
                Affiliations
                Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics , Malmö University Hospital, Lund University, Sweden.
                Author notes
                Article
                ORT_A_916491_O
                10.3109/17453674.2014.916491
                4062788
                24786906
                480bdfc7-be32-4acd-ad86-ce005eb679d9
                Copyright: © Nordic Orthopaedic Federation

                This is an open-access article distributed under the terms of the CC-BY-NC-ND 3.0 License which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is credited.

                History
                : 22 October 2013
                : 15 February 2014
                Categories
                Hip and Femur

                Orthopedics
                Orthopedics

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