Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area

Camilla Bergh, David Wennergren, Michael Möller, Helena Brisby, Camilla Bergh, David Wennergren, Michael Möller, Helena Brisby

Abstract

Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults' ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Age- and gender-specific incidence with…
Fig 1. Age- and gender-specific incidence with 95% confidence interval of all fractures registered in the SFR over 4 years, 2015‒2018.
Black line represents the total population; red line represents females and blue line represents males.
Fig 2. Fractures in group A.
Fig 2. Fractures in group A.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 3. Fractures in group B.
Fig 3. Fractures in group B.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 4. Fractures in group C.
Fig 4. Fractures in group C.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 5. Fractures in group D.
Fig 5. Fractures in group D.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 6. Fractures in group E.
Fig 6. Fractures in group E.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 7. Fractures in group F.
Fig 7. Fractures in group F.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.
Fig 8. Fractures in group G.
Fig 8. Fractures in group G.
Age- and gender-specific incidence with 95% confidence interval. Black line represents the total population; red line represents females and blue line represents males.

References

    1. Kamin ST, Beyer A, Lang FR. Outdoor motivation moderates the effects of accessibility on mobility in old age. Zeitschrift fur Gerontologie und Geriatrie. 2016;49(5):372–8. 10.1007/s00391-015-0946-4
    1. Portegijs E, Keskinen KE, Tsai LT, Rantanen T, Rantakokko M. Physical Limitations, Walkability, Perceived Environmental Facilitators and Physical Activity of Older Adults in Finland. International journal of environmental research and public health. 2017;14(3). 10.3390/ijerph14030333
    1. Alsnih RH D. The mobility and accessibility expectations of seniors in an aging population. Transportation Research Part A: Policy and Practice. 2003;37(10):903–16.
    1. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organization technical report series. 1994;843:1–129.
    1. Beerekamp MSH, de Muinck Keizer RJO, Schep NWL, Ubbink DT, Panneman MJM, Goslings JC. Epidemiology of extremity fractures in the Netherlands. Injury. 2017;48(7):1355–62. 10.1016/j.injury.2017.04.047
    1. Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ 3rd. Trends in fracture incidence: a population-based study over 20 years. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research. 2014;29(3):581–9. 10.1002/jbmr.2072
    1. Abtahi S, Driessen JHM, Vestergaard P, van den Bergh J, Boonen A, de Vries F, et al. Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2019;30(11):2217–23.
    1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of osteoporosis. 2013;8:136 10.1007/s11657-013-0136-1
    1. Abrahamsen B, Vestergaard P. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2010;21(3):373–80. 10.1007/s00198-009-0957-3
    1. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Nationwide decline in incidence of hip fracture. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research. 2006;21(12):1836–8. 10.1359/jbmr.060815
    1. Court-Brown CM, Clement ND, Duckworth AD, Biant LC, McQueen MM. The changing epidemiology of fall-related fractures in adults. Injury. 2017;48(4):819–24. 10.1016/j.injury.2017.02.021
    1. Scott D, Seibel MJ, Cumming R, Naganathan V, Blyth F, Le Couteur DG, et al. Associations of Body Composition Trajectories with Bone Mineral Density, Muscle Function, Falls and Fractures in Older Men: The Concord Health and Ageing in Men Project. The journals of gerontology Series A, Biological sciences and medical sciences. 2019.
    1. Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, et al. Obesity is not protective against fracture in postmenopausal women: GLOW. The American journal of medicine. 2011;124(11):1043–50. 10.1016/j.amjmed.2011.06.013
    1. Bolton JM, Morin SN, Majumdar SR, Sareen J, Lix LM, Johansson H, et al. Association of Mental Disorders and Related Medication Use With Risk for Major Osteoporotic Fractures. JAMA psychiatry. 2017;74(6):641–8. 10.1001/jamapsychiatry.2017.0449
    1. Court-Brown CM, Aitken SA, Ralston SH, McQueen MM. The relationship of fall-related fractures to social deprivation. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2011;22(4):1211–8. 10.1007/s00198-010-1315-1
    1. Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Archives of osteoporosis. 2013;8:137 10.1007/s11657-013-0137-0
    1. Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, et al. Epidemiology of hip fractures in Oslo, Norway. Bone. 2001;29(5):413–8. 10.1016/s8756-3282(01)00603-2
    1. Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons. 2014;53(5):606–8.
    1. Driessen JH, Hansen L, Eriksen SA, van Onzenoort HA, Henry RM, van den Bergh J, et al. The epidemiology of fractures in Denmark in 2011. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(6):2017–25. 10.1007/s00198-016-3488-8
    1. Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Moller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC musculoskeletal disorders. 2016;17:159 10.1186/s12891-016-1009-8
    1. Wennergren D, Bergdahl C, Ekelund J, Juto H, Sundfeldt M, Moller M. Epidemiology and incidence of tibia fractures in the Swedish Fracture Register. Injury. 2018;49(11):2068–74. 10.1016/j.injury.2018.09.008
    1. Kihlstrom C, Moller M, Lonn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC musculoskeletal disorders. 2017;18(1):82 10.1186/s12891-017-1444-1
    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–7. 10.1016/j.injury.2006.04.130
    1. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2005;16 Suppl 2:S3–7. 10.1007/s00198-004-1702-6
    1. Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. 2017;104:29–38. 10.1016/j.bone.2017.01.024
    1. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2000;11(8):669–74. 10.1007/s001980070064
    1. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2001;12(5):417–27. 10.1007/s001980170112
    1. Wennergren D, Ekholm C, Sandelin A, Moller M. The Swedish fracture register: 103,000 fractures registered. BMC musculoskeletal disorders. 2015;16:338 10.1186/s12891-015-0795-8
    1. Svenska frakturregistret registercentrum. Täckningsgradsanaalys 2017 [cited 2019 June 7]. Available from .
    1. Müller ME N S., Koch P. and Schatzker J. The comprehensive classification of fractures of long bones/AO classification of fractures.1990.
    1. Wennergren D, Moller M. Implementation of the Swedish Fracture Register. Der Unfallchirurg. 2018;121(12):949–55. 10.1007/s00113-018-0538-z
    1. Wennergren D, Stjernstrom S, Moller M, Sundfeldt M, Ekholm C. Validity of humerus fracture classification in the Swedish fracture register. BMC musculoskeletal disorders. 2017;18(1):251 10.1186/s12891-017-1612-3
    1. Wennergren D, Ekholm C, Sundfeldt M, Karlsson J, Bhandari M, Moller M. High reliability in classification of tibia fractures in the Swedish Fracture Register. Injury. 2016;47(2):478–82. 10.1016/j.injury.2015.11.002
    1. Juto H, Moller M, Wennergren D, Edin K, Apelqvist I, Morberg P. Substantial accuracy of fracture classification in the Swedish Fracture Register: Evaluation of AO/OTA-classification in 152 ankle fractures. Injury. 2016;47(11):2579–83. 10.1016/j.injury.2016.05.028
    1. Knutsson SB, Wennergren D, Bojan A, Ekelund J, Moller M. Femoral fracture classification in the Swedish Fracture Register—a validity study. BMC musculoskeletal disorders. 2019;20(1):197 10.1186/s12891-019-2579-z
    1. Morgonskold D, Warkander V, Savvides P, Wihlborg A, Bouzereau M, Moller H, et al. Inter- and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register. World journal of orthopedics. 2019;10(1):14–22. 10.5312/wjo.v10.i1.14
    1. Court-Brown CM, Biant L, Bugler KE, McQueen MM. Changing epidemiology of adult fractures in Scotland. Scottish medical journal. 2014;59(1):30–4. 10.1177/0036933013518148
    1. van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29(6):517–22. 10.1016/s8756-3282(01)00614-7
    1. Dimai HP, Svedbom A, Fahrleitner-Pammer A, Resch H, Muschitz C, Thaler H, et al. Epidemiology of distal forearm fractures in Austria between 1989 and 2010. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25(9):2297–306. 10.1007/s00198-014-2766-6
    1. Court-Brown CM, Duckworth AD, Clement ND, McQueen MM. Fractures in older adults. A view of the future? Injury. 2018;49(12):2161–6. 10.1016/j.injury.2018.11.009
    1. Cummings SR, Eastell R. Stop (mis)classifying fractures as high- or low-trauma or as fragility fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2020;31(6):1023–4. 10.1007/s00198-020-05325-z
    1. Axelsson KF, Johansson H, Lundh D, Moller M, Lorentzon M. Association Between Recurrent Fracture Risk and Implementation of Fracture Liaison Services in Four Swedish Hospitals: A Cohort Study. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research. 2020;35(7):1216–23. 10.1002/jbmr.3990

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren