Hip Fractures on the Rise in the Extreme Elderly

Kate Johnson

June 13, 2012

June 13, 2012 (Berlin, Germany) — Despite declining rates of osteoporotic hip fractures, the total number of these fractures is on the rise in the extreme elderly and is predicted to climb steeply, according to research presented here at European League Against Rheumatism Congress 2012.

The extreme elderly, defined as people 80 years and older, is the fastest growing segment of the population in the world, reported Amrita Sehgal, an undergraduate student at the University of California, Los Angeles, and lead investigator of the study.

Although public health efforts successfully reduced the prevalence of osteoporotic hip fractures in the extreme elderly from 1993 to 2008, the increase in hip fracture hospitalizations in this age group in the same period is cause for concern, she said.

The projected exponential growth in the extreme elderly population "threatens a potential epidemic status for osteoporotic hip fractures. This calls for more aggressive measures toward recognition, prevention, and therapy of osteoporosis" in this age group, Sehgal reported.

The study examined 588.2 million all-cause hospitalizations from 1993 to 2008 in the National Inpatient Sample, the largest inpatient care database in the United States. It identified 4.3 million osteoporotic hip fracture hospitalizations in 565.4 million person-years of observation in people 65 years and older; 2.9 million (67.3%) of these occurred in the extreme elderly.

For people 65 to 79 years of age, the prevalence of hospitalizations for osteoporotic hip fracture decreased during the study period — from 386 to 294 per 100,000 (P < .001), she reported. For people 80 years and older, the prevalence decreased from 2236 to 1600 per 100,000 (P < .001).

However, although hip fracture hospitalizations decreased in the younger group (from 96,928 to 80,987), they increased in the older group (from 172,209 to 180,428).

It is expected that the number of extreme elderly people in the world will increase 5-fold from 2000 to 2050 (from 69.2 million to 379.0 million), and that there will be a 10-fold increase in developing countries, she said.

"We recommend increased awareness and treatment in this age group. There should be increased safety measures to prevent falls, particularly in nursing homes and care facilities, where preventive care might not be strictly enforced."

Less Use of Osteoporosis Medication Accentuates Concerns

These findings are of particular concern given the decreasing use of osteoporosis medications, said Kenneth Saag, MD, who moderated the session. He is director of the Center for Education and Research on Therapeutics of Musculoskeletal Disorders, director of the Center for Outcomes, Effectiveness Research and Education, and Jane Knight Lowe Professor of Medicine in the division of clinical immunology and rheumatology at the University of Alabama, Birmingham.

"There are fairly consistent data that there is a drop in the use of any osteoporotic therapies in the United States and other parts of the world," he said in an interview with Medscape Medical News.

"There's a growing public angst about the safety, particularly of the bisphosphonate medicines. While the safety concerns may relate mostly to the long-term use of these drugs, the concern has been translated into less initial use of the drugs," said Dr. Saag.

The "decreasing use of these drugs...could reverse this positive trend in the overall prevalence of fractures," he said. "The population is getting older and the extreme elderly are going to be disproportionately affected by osteoporosis. Internationally, we need to be attentive to this. Ultimately, the solution is to understand how to better use these drugs and how to target them, and to have new therapeutic agents available that allow us to choose drugs in an evidence-based way for particular patients."

Ms. Sehgal has disclosed no relevant financial relationships. Dr. Saag reports receiving research support from Amgen, Merck, and Novartis; and being a consultant for Amgen, Eli Lilly, and Merck.

European League Against Rheumatism (EULAR) Congress 2012: Abstract OP0043. Presented June 7, 2012.