Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality

Chor Wing Sing, Tzu Chieh Lin, Sharon Bartholomew, J. Simon Bell, Corina Bennett, Kebede Beyene, Pauline Bosco-Levy, Brian D. Bradbury, Amy Hai Yan Chan, Manju Chandran, Cyrus Cooper, Maria de Ridder, Caroline Y. Doyon, Cécile Droz-Perroteau, Ganga Ganesan, Sirpa Hartikainen, Jenni Ilomaki, Han Eol Jeong, Douglas P. Kiel, Kiyoshi KubotaEdward Chia Cheng Lai, Jeff L. Lange, E. Michael Lewiecki, Julian Lin, Jiannong Liu, Joe Maskell, Mirhelen Mendes de Abreu, James O'Kelly, Nobuhiro Ooba, Alma B. Pedersen, Albert Prats-Uribe, Daniel Prieto-Alhambra, Simon Xiwen Qin, Ju Young Shin, Henrik T. Sørensen, Kelvin Bryan Tan, Tracy Thomas, Anna Maija Tolppanen, Katia M.C. Verhamme, Grace Hsin Min Wang, Sawaeng Watcharathanakij, Stephen J. Wood, Ching Lung Cheung, Ian C.K. Wong

Research output: Contribution to journalArticleResearchpeer-review

52 Citations (Scopus)


In this international study, we examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age- and sex-standardized incidence rates of hip fractures, post-hip fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all-cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databases. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (95% confidence interval [CI] 94.8–95.4) in Brazil to 315.9 (95% CI 314.0–317.7) in Denmark per 100,000 population. Incidence rates decreased over the study period in most countries; however, the estimated total annual number of hip fractures nearly doubled from 2018 to 2050. Within 1 year following a hip fracture, post-hip fracture treatment ranged from 11.5% (95% CI 11.1% to 11.9%) in Germany to 50.3% (95% CI 50.0% to 50.7%) in the United Kingdom, and all-cause mortality rates ranged from 14.4% (95% CI 14.0% to 14.8%) in Singapore to 28.3% (95% CI 28.0% to 28.6%) in the United Kingdom. Males had lower use of anti-osteoporosis medication than females, higher rates of all-cause mortality, and a larger increase in the projected number of hip fractures by 2050. Substantial variations exist in the global epidemiology of hip fractures and postfracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the aging population.

Original languageEnglish
Pages (from-to)1064-1075
Number of pages12
JournalJournal of Bone and Mineral Research
Issue number8
Publication statusPublished - Aug 2023



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