title: The impact of preventive measures on the burden of femoral fractures - a modelling approach to estimating the impact of fall prevention exercises and oral bisphosphonate treatment for the years 2014 and 2025.
abstract: BACKGROUND
  Due to the demographic transition with a growing number of old and oldest-old persons the absolute number of fragility fractures is expected to increase in industrialized countries unless effective preventive efforts are intensified. The main causes leading to fractures are osteoporosis and falls. The aim of this study is to develop population based models of the potential impact of fall-prevention exercise and oral bisphosphonates over the coming decade.
  
  
  METHODS
  The German federal state of Bavaria served as the model population. Model interventions were limited to community-dwelling persons aged 65 years and older. Models are based on fall-prevention exercise being offered to all persons aged 70 to 89 years and oral bisphosphonate treatment offered to all persons with osteoporosis as defined by a T-score of ≤ - 2.5. Treatment effect sizes are estimated from meta-analyses. Reduction in all femoral fractures in the population of community-dwelling persons aged 65 years and older is the outcome of interest. A spreadsheet-based modelling approach was used for prediction.
  
  
  RESULTS
  In 2014, reduction of femoral fractures by 10 % required 21 % of all community-dwelling persons aged 70-89 to participate in fall-prevention exercise, or 37 % of those with osteoporosis to receive oral bisphosphonates. Without intervention, demographic changes will result in a 24 % increase in femoral fractures by 2025. To lower the increase of fractures between 2014 and 2025 to 10 %, fall-prevention-exercise participation rate needs to be 25 % and bisphosphonate treatment rates 41 %, whereas to hold the 2025 rates flat at 2014 rates require 43 % fall-prevention-exercises participation, and is not achievable using oral bisphosphonates.
  
  
  CONCLUSIONS
  Unrealistic high treatment and participation rates of the two analysed measures are needed to achieve substantial effects on the expected burden of femoral fractures at present and in the future.
authors.affiliation: Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany. petra.benzinger@rbk.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Benzinger
authors.affiliation: Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.affiliation: School of Nursing, Midwifery & Social Work and Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Todd
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Bleibler
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Helmholzstrasse 22, 89081, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany.|Institute of Epidemiology and Medical Biometry, Ulm University, Helmholzstrasse 22, 89081, Ulm, Germany.
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000284:Administration, Oral; D000368:Aged; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D015444:Exercise / Q000523:psychology*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D005858:Germany; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D011157:Population Dynamics
chemical_list: D004164:Diphosphonates
keywords: Epidemiology; Falls; Femoral fractures; Osteoporosis; Prevention