Skip to main content

Advertisement

SpringerLink
Log in

Secular trends in hip fractures in adults over 50 years old: a retrospective analysis of hospital admissions to the Brazilian Public Health System from 2004 to 2013

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration.

Purpose

Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions.

Methods

This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends.

Results

The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions.

Conclusion

Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data and materials used for the present manuscript are available to the editors.

References

  1. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381. https://doi.org/10.1007/s00198-014-2794-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 29:2520–2526. https://doi.org/10.1002/jbmr.2269

    Article  PubMed  Google Scholar 

  3. Brazilian Institute of Geography and Statistics (2010) 2010 population census. Population and households’ characteristics. Brazilian Institute of Geography and Statistics, Rio de Janeiro

  4. Pinheiro MM, Ciconelli RM, Jacques NO, Genaro PS, Martini LA, Ferraz MB (2010) The burden of osteoporosis in Brazil: regional data from fractures in adult men and women–the Brazilian osteoporosis study (BRAZOS). Rev Bras Reumatol 50:113–127. https://doi.org/10.1590/S0482-50042010000200002

    Article  PubMed  Google Scholar 

  5. Martini L, Moura E, Santos L, Malta DC, Pinheiro M (2009) Prevalência de diagnóstico auto-referido de osteoporose, Brasil, 2006. Rev Saude Publica 43:107–116. https://doi.org/10.1590/S0034-89102009000900014

    Article  PubMed  Google Scholar 

  6. Siqueira FV, Facchini LA, Hallal PC (2005) The burden of fractures in Brazil: a population-based study. Bone 37:261–266. https://doi.org/10.1016/j.bone.2005.04.002

    Article  PubMed  Google Scholar 

  7. Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Menezes PR, Pereira RM (2014) Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo ageing & health (SPAH) study. Osteoporos Int 25:2805–2815. https://doi.org/10.1007/s00198-014-2821-3

    Article  CAS  PubMed  Google Scholar 

  8. da Rocha FAC, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14:496–499. https://doi.org/10.1007/s00198-003-1394-3

    Article  Google Scholar 

  9. Silveira L, Medeiros C, Coelho M, Rosa M, Noleto S, Costa FS, Sobral B, Aguiar F, Leal C, Clemente M (2005) Incidência de fratura do quadril em área urbana do Nordeste Brasileiro. Cad Saúde Pública 21:907–912. https://doi.org/10.1590/S0102-311X2005000300025

    Article  PubMed  Google Scholar 

  10. Komatsu RS, Ramos LR, Szejnfeld VL (2004) Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging 8:362–367

    CAS  PubMed  Google Scholar 

  11. Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jónsson PV, Poór G, de Castro JAS, Xu L, Matkin CC, Nelson LM, Heyse SP (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the world health organization program for research on aging. Osteoporos Int 9:242–253. https://doi.org/10.1007/s001980050144

    Article  CAS  PubMed  Google Scholar 

  12. Silva DMW, Borba VZC, Kanis JA (2017) Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville city, Southern Brazil. Arch Osteoporos 12:111. https://doi.org/10.1007/s11657-017-0405-5

    Article  PubMed  Google Scholar 

  13. Pinheiro MM, Neto ETR, Machado FS, Omura F, Yang JHK, Szejnfeld J, Szejnfeld VL (2010) Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women. Rev Saude Publica 44:479–485. https://doi.org/10.1590/S0034-89102010000300011

    Article  PubMed  Google Scholar 

  14. Bortolon PC, Andrade CLT, Andrade CAF (2011) O perfil das internações do SUS para fratura osteoporótica de fêmur em idosos no Brasil: uma descrição do triênio 2006–2008. Cad Saúde Pública 27:733–742

    Article  PubMed  Google Scholar 

  15. Zerbini CA, Szejnfeld VL, Abergaria BH, McCloskey EV, Johansson H, Kanis JA (2015) Incidence of hip fracture in Brazil and the development of a FRAX model. Arch Osteoporos 10:224. https://doi.org/10.1007/s11657-015-0224-5

    Article  CAS  PubMed  Google Scholar 

  16. Tsukutani Y, Hagino H, Ito Y, Nagashima H (2015) Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int 26:2249–2255. https://doi.org/10.1007/s00198-015-3124-z

    Article  CAS  PubMed  Google Scholar 

  17. Liel Y, Castel H, Alkalay D (2005) Marked secular increase in the incidence rates of osteoporotic hip fractures in women and men in Southern Israel. Isr Med Assoc J 7:708–711

    PubMed  Google Scholar 

  18. Hernández JL, Olmos JM, Alonso MA, González-Fernández CR, Martínez J, Pajarón M, Llorca J, González-Macías J (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470. https://doi.org/10.1007/s00198-005-0008-7

    Article  PubMed  Google Scholar 

  19. Trajanoska K, Schoufour JD, de Jonge EAL et al (2018) Fracture incidence and secular trends between 1989 and 2013 in a population based cohort: the Rotterdam study. Bone 114:116–124. https://doi.org/10.1016/j.bone.2018.06.004

    Article  PubMed  Google Scholar 

  20. van der Velde RY, Wyers CE, Curtis EM, Geusens P, van den Bergh JPW, de Vries F, Cooper C, van Staa TP, Harvey NC (2016) Secular trends in fracture incidence in the UK between 1990 and 2012. Osteoporos Int 27:3197–3206. https://doi.org/10.1007/s00198-016-3650-3

    Article  PubMed  PubMed Central  Google Scholar 

  21. Saad RK, Harb H, Bou-Orm IR, Ammar W, Fuleihan GEL (2020) Secular trends of hip fractures in lebanon, 2006 to 2017: implications for clinical practice and public health policy in the middle east region. J Bone Miner Res 35:71–80. https://doi.org/10.1002/jbmr.3870

    Article  PubMed  Google Scholar 

  22. Hiligsmann M, Bruyère O, Roberfroid D, Dubois C, Parmentier Y, Carton J, Detilleux J, Gillet P, Reginster JY (2012) Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007). Arthritis Care Res (Hob) 64:744–750. https://doi.org/10.1002/acr.21607

    Article  Google Scholar 

  23. Adams AL, Shi J, Takayanagi M, Dell RM, Funahashi TT, Jacobsen SJ (2013) Ten-year hip fracture incidence rate trends in a large California population, 1997–2006. Osteoporos Int 24:373–376. https://doi.org/10.1007/s00198-012-1938-5

    Article  CAS  PubMed  Google Scholar 

  24. Pueyo-Sánchez MJ, Larrosa M, Suris X, Casado E, Auleda J, Fusté J, Ortún V (2017) Secular trend in the incidence of hip fracture in Catalonia, Spain, 2003–2014. Age Ageing 46:324–328. https://doi.org/10.1093/ageing/afw196

    Article  PubMed  Google Scholar 

  25. Garofoli R, Maravic M, Ostertag A, Cohen-Solal M (2019) Secular trends of hip fractures in France: impact of changing characteristics of the background population. Osteoporos Int 30:355–362. https://doi.org/10.1007/s00198-018-4666-7

    Article  CAS  PubMed  Google Scholar 

  26. Siggeirsdottir K, Aspelund T, Jonsson BY, Mogensen B, Gudmundsson EF, Gudnason V, Sigurdsson G (2014) Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989–2008. Osteoporos Int 25:211–219. https://doi.org/10.1007/s00198-013-2422-6

    Article  CAS  PubMed  Google Scholar 

  27. Rosengren BE, Ahlborg HG, Mellström D, Nilsson J, Björk J, Karlsson MK (2012) Secular trends in Swedish hip fractures 1987–2002: birth cohort and period effects. Epidemiology 23:623–630. https://doi.org/10.1097/EDE.0b013e318256982a

    Article  PubMed  Google Scholar 

  28. Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgström F (2011) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 22:685–692. https://doi.org/10.1007/s00198-010-1271-9

    Article  CAS  PubMed  Google Scholar 

  29. Abtahi S, Driessen JHM, Vestergaard P, van den Bergh J, Boonen A, de Vries F, Burden AM (2018) Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010. Arch Osteoporos 30:2217–2223. https://doi.org/10.1007/s11657-018-0503-z

    Article  Google Scholar 

  30. Kannus P, Niemi S, Parkkari J, Sievänen H (2018) Continuously declining incidence of hip fracture in Finland: analysis of Nationwide database in 1970–2016. Arch Gerontol Geriatr 77:64–67. https://doi.org/10.1016/j.archger.2018.04.008

    Article  PubMed  Google Scholar 

  31. Leslie WD, Sadatsafavi M, Lix LM, Azimaee M, Morin S, Metge CJ, Caetano P (2011) Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22:2137–2143. https://doi.org/10.1007/s00198-010-1470-4

    Article  CAS  PubMed  Google Scholar 

  32. Chen FP, Shyu YC, Fu TS, Sun CC, Chao AS, Tsai TL, Huang TS (2017) Secular trends in incidence and recurrence rates of hip fracture: a nationwide population-based study. Osteoporos Int 28:811–818. https://doi.org/10.1007/s00198-016-3820-3

    Article  CAS  PubMed  Google Scholar 

  33. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256. https://doi.org/10.1007/s00198-012-1964-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Decentralized hospital information system of Brazilian unified health system – SIH/DATASUS. http://sihd.datasus.gov.br/principal/index.php. Accessed 10 June 2020

  35. International statistical classification of disease and health-related problems. http:// http://www2.datasus.gov.br/DATASUS/index.php?area=060203. Acesses 10 June 2020

  36. Neter J, Kutner MH, Nachtsheim CJ, Wasserman W (1996) Applied linear statistical models. Richard D Irwing, Illinois, IL

  37. Silva ARB, Martinez LC, Pinheiro MM, Szejnfeld VL (2020) Low-trauma ankle fractures in Brazil: secular trends in patients over 50 years old from 2004 to 2013. Arch Osteoporos 15:105. https://doi.org/10.1007/s11657-020-00777-6

    Article  CAS  PubMed  Google Scholar 

  38. Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, Grauer A, Arellano J, Lemay J, Harmon AL, Broder MS, Singer AJ (2019) Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus 3:e10192. https://doi.org/10.1002/jbm4.10192

    Article  PubMed  PubMed Central  Google Scholar 

  39. Arantes HP, Kulak CA, Fernandes CE, Zerbini C, Bandeira F, Barbosa IC, Brenol JC, Russo LA, Borba VC, Chiang AY, Bilezikian JP, Lazaretti-Castro M (2013) Correlation between 25-hydroxyvitamin D levels and latitude in Brazilian postmenopausal women: from the arzoxifene generations trial. Osteoporos Int 24:2707–2712. https://doi.org/10.1007/s00198-013-2366-x

    Article  CAS  PubMed  Google Scholar 

  40. Looker AC, SarafraziIsfahani N, Fan B, Shepherd JA (2017) FRAX-based estimates of 10-year probability of hip and major osteoporotic fracture among adults aged 40 and over: United States, 2013 and 2014. Natl Health Stat Report 103:1–16

    Google Scholar 

  41. Orces CH (2009) Epidemiology of hip fractures in Ecuador. Rev Panam Salud Publica 25:438–442. https://doi.org/10.1590/s1020-49892009000500009

    Article  PubMed  Google Scholar 

  42. Clark P, Lavielle P, Franco-Marina F, Ramírez E, Salmerón J, Kanis JA, Cummings SR (2005) Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study. Osteoporos Int 16:2025–2030. https://doi.org/10.1007/s00198-005-1991-4

    Article  PubMed  Google Scholar 

  43. Morosano M, Masoni A, Sánchez A (2005) Incidence of hip fractures in the city of Rosario, Argentina. Osteoporos Int 16:1339–1344. https://doi.org/10.1007/s00198-005-1839-y

    Article  PubMed  Google Scholar 

  44. Abrahamsen B, Laursen HVB, Skjødt MK, Jensen MH, Vestergaard P (2020) Age at hip fracture and life expectancy in Denmark - secular trends over two decades. Bone 130:115083. https://doi.org/10.1016/j.bone.2019.115083

    Article  PubMed  Google Scholar 

Download references

Funding

This study received financial support from Remaining Funds from the Brazilian Society of Rheumatology.

Author information

Authors and Affiliations

  1. Rheumatology Division, Federal University of Sao Paulo/Paulista School of Medicine (Unifesp/EPM), São Paulo, Brazil

    Alex Rocha Bernardes da Silva, Laura Christina Martinez, Marcelo de Medeiros Pinheiro & Vera Lúcia Szejnfeld

Authors
  1. Alex Rocha Bernardes da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Christina Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcelo de Medeiros Pinheiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vera Lúcia Szejnfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed uniformly to the study design and statistical analysis. Alex Rocha Bernardes da Silva and Vera Lúcia Szejnfeld wrote the manuscript.

Corresponding author

Correspondence to Alex Rocha Bernardes da Silva.

Ethics declarations

Ethics approval

The research was approved by the ethics committee of the Federal University of São Paulo and was registered on the Brazil Platform.

Consent to participate

This manuscript is an analysis of a Brazilian Government’s database. It was not necessary to obtain freely given informed consent from the participants.

Consent for publication

This manuscript is an analysis of a Brazilian Government’s database. It was not necessary to obtain consent from individuals to publish their data.

Conflicts of interest

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 510 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

da Silva, A.R.B., Martinez, L.C., de Medeiros Pinheiro, M. et al. Secular trends in hip fractures in adults over 50 years old: a retrospective analysis of hospital admissions to the Brazilian Public Health System from 2004 to 2013. Arch Osteoporos 17, 50 (2022). https://doi.org/10.1007/s11657-022-01092-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-022-01092-y

Keywords

Search

Navigation