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Feng JN, Zhang CG, Li BH, Zhan SY, Wang SF, Song CL. Global burden of hip fracture: The Global Burden of Disease Study. Osteoporos Int 2024; 35:41-52. [PMID: 37704919 DOI: 10.1007/s00198-023-06907-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
This study is the first to measure global burden of hip fracture in patients aged 55 years and older across 204 countries and territories from 1990 to 2019. Our study further proved that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention. PURPOSE Hip fracture is a tremendous universal public health challenge, but no updated comprehensive and comparable assessment of hip fracture incidence and burden exists for most of the world in older adults. METHODS Using data from the Global Burden of Diseases (GBD) 2019, we estimated the number and rates of the incidence, prevalence, and years lived with disability (YLD) of hip fracture across 204 countries and territories in patients aged 55 years and older from 1990 to 2019. RESULTS In 2019, the incidence, prevalence, and YLDs rates of hip fracture in patients aged 55 years and older were 681.35 (95% UI 508.36-892.27) per 100000 population, 1191.39 (95% UI 1083.80-1301.52) per 100000 population, and 130.78 (95% UI 92.26-175.30) per 100000 population. During the three decades, the incidence among people aged below 60 years showed a downward trend, whereas it showed a rapid upward trend among older adults. All the numbers and rates of hip fractures among females were higher than those among males and increased with age, with the highest number and rate in the highest age group. Notably, the male to female ratio of the incidence for people aged over 55 years increased from 0.577 in 1990 to 0.612 in 2019. Falls were the leading cause among both sexes and in all age groups. CONCLUSIONS The incidence and the number of hip fractures among patients aged 55 years and older increased over the past three decades, indicating that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention.
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Affiliation(s)
- Jing-Nan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Cheng-Gui Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Bao-Hua Li
- Institute of Medical Innovation, Peking University Third Hospital, Beijing, China
| | - Si-Yan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Sheng-Feng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| | - Chun-Li Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
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Wallace IJ, Toya C, Peña Muñoz MA, Meyer JV, Busby T, Reynolds AZ, Martinez J, Thompson TT, Miller-Moore M, Harris AR, Rios R, Martinez A, Jashashvili T, Ruff CB. Effects of the energy balance transition on bone mass and strength. Sci Rep 2023; 13:15204. [PMID: 37709850 PMCID: PMC10502131 DOI: 10.1038/s41598-023-42467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023] Open
Abstract
Chronic positive energy balance has surged among societies worldwide due to increasing dietary energy intake and decreasing physical activity, a phenomenon called the energy balance transition. Here, we investigate the effects of this transition on bone mass and strength. We focus on the Indigenous peoples of New Mexico in the United States, a rare case of a group for which data can be compared between individuals living before and after the start of the transition. We show that since the transition began, bone strength in the leg has markedly decreased, even though bone mass has apparently increased. Decreased bone strength, coupled with a high prevalence of obesity, has resulted in many people today having weaker bones that must sustain excessively heavy loads, potentially heightening their risk of a bone fracture. These findings may provide insight into more widespread upward trends in bone fragility and fracture risk among societies undergoing the energy balance transition.
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Affiliation(s)
- Ian J Wallace
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA.
| | | | | | - Jana Valesca Meyer
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Taylor Busby
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Adam Z Reynolds
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jordan Martinez
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | | | - Marcus Miller-Moore
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Alexandra R Harris
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Roberto Rios
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Alexis Martinez
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Tea Jashashvili
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Christopher B Ruff
- Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Rey-Rodriguez MM, Vazquez-Gamez MA, Giner M, Garrachón-Vallo F, Fernández-López L, Colmenero MA, Montoya-García MJ. Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain. BMJ Open 2020; 10:e037101. [PMID: 32973058 PMCID: PMC7517558 DOI: 10.1136/bmjopen-2020-037101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville). SETTING AND PARTICIPANTS This was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event. OUTCOME MEASURES We evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors. RESULTS The overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m2, renal failure and low plasma proteins. CONCLUSIONS Our results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.
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Affiliation(s)
| | - M A Vazquez-Gamez
- Medicine Department, Universidad de Sevilla Facultad de Medicina, Sevilla, Spain
| | - Mercè Giner
- Citología e Histología Normal y Patológica, Universidad de Sevilla Facultad de Medicina, Sevilla, Spain
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Aamodt G, Renolen R, Omsland TK, Meyer HE, Rabanal KS, Søgaard AJ. Ethnic differences in risk of hip fracture in Norway: a NOREPOS study. Osteoporos Int 2020; 31:1587-1592. [PMID: 32266435 PMCID: PMC7360634 DOI: 10.1007/s00198-020-05390-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/11/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED Hip fracture is a major public health problem, and the incidence rates vary considerably between countries. Ethnic differences in bone mineral density have been identified as a factor to explain some of the geographical differences in rates of hip fracture. In this Norwegian register-based study, we found that all immigrant groups experienced lower risk of hip fracture than individuals born in Norway. INTRODUCTION Norway is among the countries with the highest incidence rates. The aim of this study was to investigate differences in risk of hip fracture between ethnic groups living in Norway. METHODS We linked individuals in the Norwegian Population and Housing Census conducted in 2001 and a database consisting of all hip fractures in Norway in the period 2001-2013. Residents (n = 1,392,949) between 50 and 89 years and born in nine different geographical regions of the world were examined, and we computed age-standardized incidence rates for the different geographic regions-denoted ethnic groups in the paper. Gender-stratified Cox regression analysis, adjusted for age, was used to model risk of hip fracture as a function of region of birth. RESULTS Age-standardized incidence rates of hip fracture varied considerably between regions of birth living in Norway, in both genders. All immigrant groups had lower risk of hip fracture compared to the Norwegian-born population. Immigrants from Central and Southeast Asia had the lowest risk of hip fracture when compared to individuals born in Norway (HR = 0.2, 95% CI 0.1-0.3 and HR =0.2, 95% CI 0.2-0.4 in men and women, respectively). CONCLUSION Lower risk of hip fracture was found in all immigrant groups compared to the Norwegian-born majority population.
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Affiliation(s)
- G Aamodt
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Post box 5003, NMBU, 1432, Ås, Norway.
| | - R Renolen
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Post box 5003, NMBU, 1432, Ås, Norway
| | - T K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - H E Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K S Rabanal
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - A J Søgaard
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Wallace IJ, Marsh D, Otárola-Castillo E, Billings BK, Mngomezulu V, Grine FE. Secular decline in limb bone strength among South African Africans during the 19th and 20th centuries. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 172:492-499. [PMID: 32003457 DOI: 10.1002/ajpa.24014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/19/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES South African Africans have been reported to have experienced negative or null secular trends in stature and other measures of skeletal structure across the 19th and 20th centuries, presumably due to poor living conditions during a time of intensifying racial discrimination. Here, we investigate whether any secular trend is apparent in limb bone strength during the same period. MATERIALS AND METHODS Cadaver-derived skeletons (n = 221) were analyzed from female and male South African Africans who were born between 1839 and 1970, lived in and around Johannesburg, and died between 1925 and 1991 when they were 17-90 years of age. For each skeleton, a humerus and femur were scanned using computed tomography, and mid-diaphyseal cross-sectional geometric properties were calculated and scaled according to body size. RESULTS In general linear mixed models accounting for sex, age at death, and skeletal element, year of birth was a significant (p < .05) negative predictor of size-standardized mid-diaphyseal cortical area (a proxy for resistance to axial loading) and polar moment of area (a proxy for resistance to bending and torsion), indicating a temporal trend toward diminishing limb bone strength. No significant interactions were detected between year of birth and age at death, suggesting that the decline in limb bone strength was mainly due to changes in skeletal maturation rather than severity of age-related bone loss. DISCUSSION Limb bone strength is thus potentially another feature of the skeletal biology of South African Africans that was compromised by poor living conditions during the 19th and 20th centuries.
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Affiliation(s)
- Ian J Wallace
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico
| | - D'Arcy Marsh
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | | | - Brendon K Billings
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick E Grine
- Department of Anthropology, Stony Brook University, Stony Brook, New York
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Abstract
PURPOSE OF REVIEW Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. RECENT FINDINGS Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.
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Affiliation(s)
- Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof.-Kuentscher-Str. 8, 82418, Murnau am Staffelsee, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Sabrina Sandriesser
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof.-Kuentscher-Str. 8, 82418, Murnau am Staffelsee, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Emily Bliven
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof.-Kuentscher-Str. 8, 82418, Murnau am Staffelsee, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Christian von Rüden
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof.-Kuentscher-Str. 8, 82418, Murnau am Staffelsee, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Department of Trauma Surgery, BG Klinikum Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Prof.-Kuentscher-Str. 8, 82418, Murnau am Staffelsee, Germany.
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
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Madimenos FC, Liebert MA, Cepon‐Robins TJ, Urlacher SS, Josh Snodgrass J, Sugiyama LS, Stieglitz J. Disparities in bone density across contemporary Amazonian forager‐horticulturalists: Cross‐population comparison of the Tsimane and Shuar. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 171:50-64. [DOI: 10.1002/ajpa.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Felicia C. Madimenos
- Department of Anthropology Queens College (CUNY) Flushing New York
- New York Consortium on Evolutionary Primatology (NYCEP) New York New York
| | - Melissa A. Liebert
- Department of Anthropology Northern Arizona University Flagstaff Arizona
| | | | | | | | - Lawrence S. Sugiyama
- Department of Anthropology University of Oregon Eugene
- Institute of Cognitive and Decision Sciences University of Oregon Eugene Oregon
| | - Jonathan Stieglitz
- Université Toulouse 1 Capitole Toulouse France
- Institute for Advanced Study in Toulouse Toulouse France
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Stieglitz J, Trumble BC, Finch CE, Li D, Budoff MJ, Kaplan H, Gurven MD. Computed tomography shows high fracture prevalence among physically active forager-horticulturalists with high fertility. eLife 2019; 8:48607. [PMID: 31418688 PMCID: PMC6726459 DOI: 10.7554/elife.48607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/14/2019] [Indexed: 12/25/2022] Open
Abstract
Modern humans have more fragile skeletons than other hominins, which may result from physical inactivity. Here, we test whether reproductive effort also compromises bone strength, by measuring using computed tomography thoracic vertebral bone mineral density (BMD) and fracture prevalence among physically active Tsimane forager-horticulturalists. Earlier onset of reproduction and shorter interbirth intervals are associated with reduced BMD for women. Tsimane BMD is lower versus Americans, but only for women, contrary to simple predictions relying on inactivity to explain skeletal fragility. Minimal BMD differences exist between Tsimane and American men, suggesting that systemic factors other than fertility (e.g. diet) do not easily explain Tsimane women's lower BMD. Tsimane fracture prevalence is also higher versus Americans. Lower BMD increases Tsimane fracture risk, but only for women, suggesting a role of weak bone in women's fracture etiology. Our results highlight the role of sex-specific mechanisms underlying skeletal fragility that operate long before menopause.
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Affiliation(s)
- Jonathan Stieglitz
- Université Toulouse 1 Capitole, Toulouse, France.,Institute for Advanced Study in Toulouse, Toulouse, France
| | - Benjamin C Trumble
- Center for Evolution and Medicine, Arizona State University, Tempe, United States.,School of Human Evolution and Social Change, Arizona State University, Tempe, United States
| | | | - Caleb E Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, United States
| | - Dong Li
- School of Medicine, Emory University, Atlanta, United States
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-University of California at Los Angeles Medical Center, Torrance, United States
| | - Hillard Kaplan
- Economic Science Institute, Chapman University, Orange, United States
| | - Michael D Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
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