Trends in incidence, health care consumption, and costs for proximal femoral fractures in the Netherlands between 2000 and 2019: a nationwide study

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Abstract

Summary

This study evaluated the incidence rates and societal burden of hip fractures in The Netherlands. Although incidence in the elderly population is decreasing and hospital stay is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population.

Purpose

The aim of this nationwide study was to provide an overview of the incidence rate and economic burden of acute femoral neck and trochanteric fractures in The Netherlands.

Methods

Data of patients who sustained acute proximal femoral fractures in the period January 1, 2000, to December 31, 2019, were extracted from the National Medical Registration of the Dutch Hospital Database. The incidence rate, hospital length of stay (HLOS), health care and lost productivity costs, and years lived with disability (YLD) were calculated for age- and sex-specific groups.

Results

A total of 357,073 patients were included. The overall incidence rate increased by 22% over the 20-year study period from 16.4 to 27.1/100,000 person-years (py). The age-specific incidence rate in elderly > 65 years decreased by 16% (from 649.1 to 547.6/100,000 py). The incidence rate in men aged > 90 has surpassed the incidence rate in women. HLOS decreased in all age groups, hip fracture subtypes, and sexes from a mean of 18.5 to 7.2 days. The mean health care costs, over the 2015–2019 period, were lower for men (€17,723) than for women (€23,351) and increased with age to €26,639 in women aged > 80. Annual cumulative costs reached €425M, of which 73% was spent on women.

Conclusion

The total incidence of hip fractures in The Netherlands has increased by 22%. Although incidence in the elderly population is decreasing and HLOS is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00198-023-06774-y.

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Most cited references 35

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Hip fractures in the elderly: a world-wide projection.

C. Cooper, G. Campion, L J Melton (1992)

Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.

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The friction cost method for measuring indirect costs of disease.

Marc Koopmanschap, Frans Rutten, B.Martin van Ineveld … (1995)

A new approach for estimating the indirect costs of disease, which explicitly considers economic circumstances that limit production losses due to disease, is presented (the friction cost method). For the Netherlands the short-term friction costs in 1990 amount to 1.5-2.5% of net national income (NNI), depending on the extent to which short-term absence from work induces production loss and costs. The medium-term macro-economic consequences of absence from work and disability reduce NNI by an additional 0.8%. These estimates are considerably lower than estimates based on the traditional human capital approach, but they better reflect the economic impact of illness.

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A systematic review of hip fracture incidence and probability of fracture worldwide

J Kanis, Thomas A. Odén, E. McCloskey … (2012)

Summary The country-specific risk of hip fracture and the 10-year probability of a major osteoporotic fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Introduction The present study aimed to update the available information base available on the heterogeneity in the risk of hip fracture on a worldwide basis. An additional aim was to document variations in major fracture probability as determined from the available FRAX models. Methods Studies on hip fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. Results Following quality evaluation, age-standardised rates of hip fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine fracture probability. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Conclusions Worldwide, there are marked variations in hip fracture rates and in the 10-year probability of major osteoporotic fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of fractures.

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Author and article information

Contributors

E.M.M. Van Lieshout: e.vanlieshout@erasmusmc.nl

Journal

Journal ID (nlm-ta): Osteoporos Int

Journal ID (iso-abbrev): Osteoporos Int

Title: Osteoporosis International

Publisher: Springer London (London )

ISSN (Print): 0937-941X

ISSN (Electronic): 1433-2965

Publication date (Electronic): 29 April 2023

Publication date PMC-release: 29 April 2023

Publication date (Print): 2023

Volume: 34

Issue: 8

Pages: 1389-1399

Affiliations

[1 ]GRID grid.5645.2, ISNI 000000040459992X, Trauma Research Unit Department of Surgery, , Erasmus MC, University Medical Center Rotterdam, ; P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

[2 ]GRID grid.491163.8, ISNI 0000 0004 0448 3601, Consumer Safety Institute, ; Amsterdam, The Netherlands

[3 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Public Health, Erasmus MC, , University Medical Center Rotterdam, ; Rotterdam, The Netherlands

Article

Publisher ID: 6774

DOI: 10.1007/s00198-023-06774-y

PMC ID: 10382328

PubMed ID: 37119329

SO-VID: c5fc52f0-d673-4ff7-b284-4c22cf4f1db1

License:

Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 17 March 2023

Date accepted : 21 April 2023

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: proximal femoral fracture,epidemiology,incidence rate,hospital length of stay,health care costs,years lived with disability

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ScienceOpen disciplines: Orthopedics

Keywords: proximal femoral fracture, epidemiology, incidence rate, hospital length of stay, health care costs, years lived with disability

Trends in incidence, health care consumption, and costs for proximal femoral fractures in the Netherlands between 2000 and 2019: a nationwide study

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Abstract

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Conclusion

Supplementary Information

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Orthopedics

Most cited references 35

Hip fractures in the elderly: a world-wide projection.

The friction cost method for measuring indirect costs of disease.

A systematic review of hip fracture incidence and probability of fracture worldwide

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Contributors

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