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August 2009
A new study published in the Journal of the American Medical Association
(JAMA) on August 26, 2009, “Trends in Hip Fracture Rates in Canada,” has shown that overall, standardized
(i.e. age-adjusted) rates of hip fractures have steadily declined in Canada since 1985.
However, even though age-standardized hip fracture rates are on the
decline, these fractures and their devastating consequences are still a growing problem in Canada because of
the larger number of elderly. This continues to demand sustained, coordinated efforts directed towards
fracture and falls prevention. The study’s authors write: “because the prevalence of osteoporosis increases
with age, the global burden of osteoporosis is projected to rise markedly over the next few decades as the
number of elderly individuals increases. The incidence of hip fractures is an index of osteoporosis burden
and the potential impact of preventive efforts in the population.”
William D. Leslie, M.D., M.Sc., of the University of Manitoba, and Chair
of Osteoporosis Canada’s Scientific Advisory Council, along with his colleagues, analyzed nationwide
hospitalization data from the Canadian Institute for Health Information from1985 to 2005. Over these 21
years, age-adjusted rates of hip fracture declined 31.8 percent in females and 25 percent in males. “For the
overall population, the average age-adjusted annual percentage decrease in hip fracture rates was 1.2 percent
per year from 1985 to 1996 and 2.4 percent per year from 1996 to 2005,” the authors write.
“Similar trends have been reported in other countries, including the
United States,” the authors write. The study speculates on factors contributing to the decline in fracture
rates, such as increased access to bone mineral density testing and treatment over the later years in the
study, but it notes that the explanation for the earlier reduction in hip fractures is not known. The decline
began before bone density testing or pharmacological treatments for osteoporosis were widely available, and
there is little evidence to suggest that improvements in physical activity, calcium and vitamin D intake or
prevention of falls are responsible. “Overweight and obesity are epidemic in modern societies and may
contribute to reduced fracture rates,” they write.
Although the percentage rates decreased, the absolute number of hip
fracture increased over the study period - a phenomenon attributable to the changing age structure of the
population, the authors note.
“Hip fractures continue to exert major effects on the population,
particularly the elderly, and on the health care system, related to the morbidity, costs and mortality from
these fractures,” the authors conclude. “Therefore, the decreasing incidence rates are not grounds for
complacency toward osteoporosis prevention and treatment.”
For more information, see the full research article: JAMA
2009;302[8]:883-889.
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