title: Osteoporotic hip fractures: bisphosphonates sales and observed turning point in trend. A population-based retrospective study.
abstract: The aim is to examine the temporal trends of hip fracture incidence in Portugal by sex and age groups, and explore the relation with anti-osteoporotic medication. From the National Hospital Discharge Database, we selected from 1st January 2000 to 31st December 2008, 77,083 hospital admissions (77.4% women) caused by osteoporotic hip fractures (low energy, patients over 49years-age), with diagnosis codes 820.x of ICD 9-CM. The 2001 Portuguese population was used as standard to calculate direct age-standardized incidence rates (ASIR) (100,000 inhabitants). Generalized additive and linear models were used to evaluate and quantify temporal trends of age specific rates (AR), by sex. We identified 2003 as a turning point in the trend of ASIR of hip fractures in women. After 2003, the ASIR in women decreased on average by 10.3 cases/100,000 inhabitants, 95% CI (-15.7 to -4.8), per 100,000 anti-osteoporotic medication packages sold. For women aged 65-69 and 75-79 we identified the same turning point. However, for women aged over 80, the year 2004 marked a change in the trend, from an increase to a decrease. Among the population aged 70-74 a linear decrease of incidence rate (95% CI) was observed in both sexes, higher for women: -28.0% (-36.2 to -19.5) change vs -18.8%, (-32.6 to -2.3). The abrupt turning point in the trend of ASIR of hip fractures in women is compatible with an intervention, such as a medication. The trends were different according to gender and age group, but compatible with the pattern of bisphosphonates sales.
authors.affiliation: Rua do Campo Alegre, 823, 4150-180 Porto, INEB, Instituto de Engenharia Biomédica, Portugal. smfalves@gmail.com
authors.forename: Sandra Maria
authors.initials: SM
authors.lastname: Alves
authors.forename: Theodoros
authors.initials: T
authors.lastname: Economou
authors.forename: Carla
authors.initials: C
authors.lastname: Oliveira
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Ribeiro
authors.forename: Nuno
authors.initials: N
authors.lastname: Neves
authors.forename: Enrique
authors.initials: E
authors.lastname: Goméz-Barrena
authors.forename: Maria Fátima
authors.initials: MF
authors.lastname: Pina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates