Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996-2007.
Increasing numbers of atypical hip fractures have been reported among patients with bisphosphonate use. However, the nature and extent of the problem are unknown despite recent investigations. To analyze national trends in hip fractures and medication use in the elderly US population, we respectively used the Nationwide Inpatient Sample (NIS) and the Medical Expenditure Panel Survey (MEPS) from 1996 to 2007. In NIS, subtrochanteric fragility fractures were compared with typical hip fractures in femoral neck and intertrochanteric regions. Between 1996 and 2007, age-adjusted rates for typical hip fractures decreased by 31.6% among women (from 1020.5 to 697.4 per 100,000 population) and 20.5% among men (from 424.9 to 337.6 per 100,000 population). In contrast, overall trends in age-adjusted rates for subtrochanteric fragility fractures remained unchanged among men (p = .34) but increased 20.4% among women from 28.4 (95% confidence interval [CI] 27.7-29.1) in 1999 to 34.2 (95% CI 33.4-34.9) per 100,000 population in 2007. The annual percentage increase was 2.1% (95% CI 1.3-2.8, p < .001) based on joinpoint regression analysis. In MEPS, bisphosphonate use increased predominantly in women (from 3.5% in 1996 to 16.6% in 2007) compared with men (2.3% in 2007). In the context of declining typical hip fractures among the US elderly, we observed small but significant increases in the incidence of subtrochanteric fragility fractures from 1999 among postmenopausal women. Using age-adjusted rates, we estimated that for every 100 or so reduction in typical femoral neck or intertrochanteric fractures, there was an increase of one subtrochanteric fragility fracture.
Wang
Zhong
Z
Intramural Research Program, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
Bhattacharyya
Timothy
T
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology
D004164:Diphosphonates
Geriatrics. 2006 Jan;61(1):31-3
16405362
Osteoporos Int. 2010 Jun;21(6):1021-9
19722103
Stat Med. 2000 Feb 15;19(3):335-51
10649300
J Clin Endocrinol Metab. 2008 Aug;93(8):2948-52
18522980
Clin Infect Dis. 2010 Mar 15;50(6):805-13
20166818
JAMA. 2000 Jun 28;283(24):3205-10
10866867
Osteoporos Int. 2007 May;18(5):585-91
17146592
Osteoporos Int. 2009 Aug;20(8):1353-62
19066707
J Bone Joint Surg Am. 2009 Nov;91(11):2556-61
19884427
N Engl J Med. 2010 May 13;362(19):1825-7
20335574
Med Care. 1998 Jan;36(1):8-27
9431328
Clin Orthop Relat Res. 2009 Jul;467(7):1921-6
19198962
Clin Endocrinol (Oxf). 2010 Feb;72(2):161-8
19302584
Arch Intern Med. 2004 Jul 26;164(14):1525-30
15277283
N Engl J Med. 2008 Mar 20;358(12):1304-6
18354114
J Bone Joint Surg Br. 2007 Mar;89(3):349-53
17356148
J Clin Endocrinol Metab. 2005 Mar;90(3):1294-301
15598694
JAMA. 2000 Jun 28;283(24):3211-6
10866868
J Bone Miner Res. 2009 Jun;24(6):1095-102
19113931
J Bone Miner Metab. 2007;25(5):333-6
17704999
J Am Geriatr Soc. 2002 Oct;50(10):1644-50
12366617
N Engl J Med. 2006 Nov 9;355(19):2048-50
17093260
JAMA. 2009 Aug 26;302(8):883-9
19706862
JAMA. 2009 Oct 14;302(14):1573-9
19826027
Osteoporos Int. 2010 Mar;21(3):399-408
19484169
JAMA. 2006 Dec 27;296(24):2947-53
17190895
J Orthop Trauma. 2008 May-Jun;22(5):346-50
18448990
Injury. 2008 Feb;39(2):224-31
18222447
Natl Vital Stat Rep. 1998 Oct 7;47(3):1-16, 20
9796247
Hong Kong Med J. 2007 Dec;13(6):485-9
18057440
JAMA. 2004 Sep 15;292(11):1326-32
15367554
N Engl J Med. 2010 May 13;362(19):1761-71
20335571
Clin Orthop Relat Res. 1995 Feb;(311):129-35
7634567
J Bone Miner Res. 2000 Jun;15(6):993-1000
10841167