Hip fractures will nearly double worldwide by 2050

Osteoporotic hip fracture is poised to become a far more severe global public health issue as the population grows older and frailer, according to a new study led by researchers at the University of Hong Kong.

The risk is especially great among men and those over 85 years old, the study reported.

The study analysed data from 19 countries for patients 50 and older who had fractured their hips between 2005 and 2018. It found that total hip fracture counts were expected to increase over time in 18 of the 19 countries.

Hip fracture counts were projected to 2030 and 2050 using predicted population size provided by the World Bank. By 2050, the worldwide hip fracture counts will have likely doubled compared with 2018, with a larger proportional increase in men than women.

The study noted some possible reasons for the sex discrepancy. Although the incidence of hip fractures declined in most countries during the study period, the magnitude of decline was smaller for men. Men’s life expectancy, meanwhile, has been increasing, a result of better medical care, hygiene, diet, and other factors. The United Nations projects that the life expectancy of men globally will likely reach over 75 years by 2050, the age after which this study showed a high risk of hip fracture. Thus, researchers expect that the proportion of men with a high risk of hip fracture will grow.

At the same time, osteoporosis in men has been underdiagnosed and undertreated for years, said Ching-lung Cheung of the University of Hong Kong’s Department of Pharmacology and Pharmacy. ‘Our study also showed that the use of anti-osteoporosis medications following a hip fracture is lower in men than in women by 30% to 67%,’ he said. ‘Thus, more attention should be paid to preventing and treating hip fractures in men.’

A common protocol and a common data model were applied across all sites to provide comparable data. Age‐ and sex‐standardized annual incidence of hip fracture, mortality, and pharmacological treatment rates within 12 months were calculated.

Using descriptive analyses of patient-level healthcare data, the researchers found wide variability among the 19 countries studied. The overall age‐ and sex‐standardized incidence of hip fracture was estimated to be 180 per 100,000 individuals (Women 236; Men 118). But the average change in hip fracture incidence varied from -2.8% to +2.1% per year.

The most pronounced declines in fractures were seen in Denmark (‐2.8%), Singapore (‐2.8%), and Hong Kong (‐2.4%). The biggest increases were in the Netherlands (+2.1%), and South Korea (+1.2%).

The reasons for the observed variability among countries would require further in-depth research, said co-author Chor‐Wing Sing, a research assistant professor. ‘One potential reason that some countries have seen relatively large declines in hip fractures is better osteoporosis management and post-fracture care,’ she said. ‘Better fall-prevention programs and clearer guidelines for clinical care have likely made a difference.’

The new study’s key message, the authors said, is that the decline in hip fractures in many countries in recent years is not enough to offset the effect of the growing aging population. The burden of hip fracture is going to grow. But post-fracture treatment remains inadequate in many countries.

Photo by Cristina Gottardi