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 Hip fracture rates declined each year from 2002 to 2012, the
researchers found. But starting in 2013, hip fracture rates leveled
off and were higher than expected.
These injuries can cause serious disability, loss of independence
and death.
The researchers were especially alarmed at fracture rates in women
ages 65 to 69, which had risen by 2.5 percent, and in women ages 70
to 74, which had risen by 3.8 percent, from 2014 through 2015.
Overall, the authors reported in Osteoporosis International, “the
plateau in age-adjusted hip fracture incidence rate resulted in more
than 11,000 additional estimated hip fractures over the time periods
2013, 2014, and 2015.”
The cost associated with those extra fractures was nearly $460
million, assuming a cost $40,000 per hip fracture, the research team
calculated.
“I find the trend very disturbing. When we first analyzed the data
we were uncertain whether it was real or not,” Dr. E. Michael
Lewiecki, one of the study authors, told Reuters Health by phone.
“Most hip fracture patients, who almost always have osteoporosis and
are at very high risk of having more fractures, are currently not
being evaluated and treated to reduce fracture risk,” said Lewiecki,
director of the New Mexico Clinical Research & Osteoporosis Center
in Albuquerque, New Mexico.
Osteoporosis, a disease that weakens bones, causes more than 8.9
million fractures annually, according to the International
Osteoporosis Foundation (IOF).
For the new study, researchers analyzed Medicare claims data from
2002 to 2015, from more than 2 million women age 65 or older.
Dr. Joan McGowan, director of the division of Musculoskeletal
Diseases at the U.S. National Institute of Arthritis and
Musculoskeletal and Skin Diseases in Bethesda, Maryland, told
Reuters Health by phone that she hopes the new study “gets the kind
of attention that it needs and deserves. Having fractures is not a
normal part of aging.”
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The U.S. Preventive Services Task Force (USPSTF) recommends that
women age 65 or older get screened for osteoporosis with a type of
X-ray called a DXA scan to measure bone loss. Postmenopausal women
under age 65, with risk factors for osteoporosis, should also be
screened. Risk factors include a family history of osteoporosis,
diseases such as rheumatoid arthritis, the use of certain
medications, and smoking and drinking alcohol.
The study wasn’t designed to identify why hip fracture rates are
leveling off instead of continuing to decline. Lewiecki and his
colleagues can only speculate on the reasons.
One possible explanation, they say, is that use of DXA testing has
steadily declined. Because DXA is used to diagnose osteoporosis
before the first fracture occurs and to monitor the skeletal effects
of treatment, a decline in its use could be related to a rise in hip
fracture rates, they suggest.
Another factor causing hip fracture rates to rise, they say, could
be a decrease in osteoporosis treatment – partly because fewer women
are being screened and diagnosed, and partly because patients may
fear the rare but severe side effects that have been linked with
osteoporosis drugs called bisphosphonates.
McGowan said that for patients at risk of fractures, the benefits of
medication far outweigh the risks. Worries about side effects “are
overblown,” she said. “They’re quite rare.”
“We had success in reducing hip fractures in the past. There’s loads
of opportunities to change the curve,” said McGowan.
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