Osteoporotic hip fractures: Bisphosphonates sales and observed turning point in trend. A population-based retrospective study

• Published in: Bone (New York, N.Y.) N.Y.), 2013-04, Vol.53 (2), p.430-436
• Main Authors: Alves, Sandra Maria, Economou, Theodoros, Oliveira, Carla, Ribeiro, Ana Isabel, Neves, Nuno, Goméz-Barrena, Enrique, Pina, Maria Fátima
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-osteoporotic medication; Biological and medical sciences; Bisphosphonates; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Female; Fundamental and applied biological sciences. Psychology; Hip fractures; Hip Fractures - epidemiology; Hip Fractures - prevention & control; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Orthopedics; Osteoporosis; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Population studies; Retrospective Studies; Traumas. Diseases due to physical agents; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2012.12.014

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 49 years-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.