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Hip fractures: What are the future projections?

A hip fracture is a common and serious injury that usually requires surgery. Even after surgery and rehabilitation, the injury often has a profound impact on general function level and mobility and affects quality of life in general. And according to various projections, the number of hip fractures will be increasing.

In 1992, Cooper et al. reported that the global hip fracture incidence will increase dramatically from 1.26 million fractures to 6.26 million fractures by 2050[1]. In 1997, Gullberg et al. supported the projected growth with global numbers up to 4.5 million by 2050[2].

It has been more than 20 years, since both Cooper et al. and Gullberg et al. published study results about global hip fracture projections. Does recent and current literature support the results from back then? We have collected available data and projections for different regions and countries to throw a light on this.

Asia

Assessing the number of hip fractures for Asia, Cooper et al. and Gullberg et al. projected that the total numbers by 2050 will be 3.25 million and 2.02 million respectively (45% of the total numbers of hip fractures). Thus, Asia has long been regarded as a “high risk” region with the highest increase in hip fracture number.

The projections made by Cooper and Gullberg were only based on incidence data obtained from 1 to 3 countries in Asia. Using the most updated incidence rate and projected population size, the latest estimation shows that the total number of hip fractures in 9 Asian countries or regions would reach 2.56 million by 2050. Notably, this number will be greater if the whole Asia is included in the projection. For instance, if the hip fracture incidence rate for remaining parts of Asia is assumed to be similar to that in the 9 countries, the total number of hip fracture occurrences would be estimated to about 3.66 million, which is more than that projected by Cooper and Gullberg.

China and India contribute to the highest absolute number increase in hip fracture, because these 2 countries have the highest population size. Indeed, these 2 countries constitute approximately 37% of the world population. Thus, hip fracture is expected to be a huge burden for Asia[3].

USA

Although no statistics on projections up to 2050 has been found for USA, a recent analysis of US Medicare claims data show that from 2002 to 2015 age-adjusted hip fracture rates for 2013, 2014, and 2015 were higher than projected for women aged ≥65 years. Previous studies reported a decrease in the annual incidence of hip fractures in the US beginning in 1995, coincident with the introduction of modern diagnostic tools and therapeutic agents for osteoporosis.

In recent years, however, there has been less bone density testing and fewer prescriptions for osteoporosis treatments. The large osteoporosis treatment gap raises concern of possible adverse effects on hip fracture rates.

Researchers assessed hip fracture incidence in the US to determine if the previous decline in hip fracture incidence continued. They found that hip fracture rates declined each year from 2002 to 2012 and then plateaued at levels higher than projected for years 2013, 2014, and 2015, resulting in an estimated increase of more than 11,000 hip fractures[4].

Australia and New Zealand

Data from Australia and New Zealand show that although the incidence of minimal trauma hip fracture has decreased over time, the actual number of hip fractures continues to increase due to the rising number of older adults. Current projections suggest that by 2022 there will be more than 30,000 hip fractures each year. In 2015-16, approximately 22,000 people aged 50 and over were hospitalised for a minimal trauma hip fracture[5]

UK

About 70–75,000 hip fractures (proximal femoral fractures) occur annually in the UK. Due to an ever-increasing ageing population, demographic projections indicate that the UK annual incidence will rise to 101,000 in 2020[6].

Sweden

In the year 2050, the annual number of hip fractures in Sweden will have approximately doubled compared to 2002. This is a result of changes in age-specific fracture incidence during the last decade, an increase in the population at risk, and changes in age distribution within this population—with a higher proportion of elderly men and women in 2050 than in 2002[7].

Conclusion

Although no single and updated study on global hip fracture projections has been found, it is obvious and fair to conclude that the number of hip fractures continues to increase in most countries worldwide, implicating that Cooper and Gullberg are not completely off target with their projections.

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