Hip fractures – less common but more numerous in an ageing nation

Hip fracture rates are falling among older people for the first time but hospital admissions are rising despite the apparent success of prevention programs due to Australia’s aging population says research in the latest Medical Journal of Australia.

The study tracks a decade of hip fracture data among people aged 50 and over who were admitted to acute hospitals in NSW between July 1990 and June 2000. In the decade to June 2000, hip fracture admissions rose 41.9 per cent among men and 31.2 per cent among women. Similar increases have been observed worldwide with global numbers - estimated to be 1.3 million in 1990 - expected to rise to between 7.3 million and 21.3 million by 2050. In Australia hip fracture numbers are expected to double over 29 years and quadruple in 56 years.

Study co-author, UNSW Professor Caroline Finch, said the global increase in hip fractures is being driven by an ageing population profile in western countries together with less active lifestyles, reduced bone and muscle strength, more frequent medication use and inadequate levels of calcium and vitamin D.

“Increasing hip fracture admissions will put increasing financial pressure on NSW acute hospitals because they account for nearly one per cent of health service expenditure,” said Prof Finch, who heads the UNSW Injury Risk Management Research Centre. “We found that average length of stay for hip fracture admissions in NSW fell from 19 days to 14 days but this was accompanied by a six per cent rise in patients being transferred to institutions such as nursing homes and rehabilitation centres. In the long term, this is an unsustainable strategy because hip fracture admissions will continue to rise in line with an ageing population.”

Other key findings:

• Hip fracture rates among women are more than 2.5 times higher than in men.
• Hip fracture rates declined for in age groups except men aged 75 to 84 yrs and women 85 yrs and over.
• Increasing admissions for hip fractures were highest in people aged 85 yrs and over among men (75.8%) and women (61.3%).
• Women aged 65 to 74 years were the only age group for whom hip fracture admissions declined (-10%).

Prof Finch said the decline in NSW hip fracture rates in the decade to June 2000 might indicate the success of preventive programs such as promoting awareness of risk factors for falls, environmental changes and promoting physical activity in older people.

“The decline in hip fracture rates among women aged 50-74 and the fall in the number of admissions in women aged 65-74 might also reflect increasing use of hormone replacement therapy (HRT) known for its protective effect and its role in reducing hip fracture risk.”

Prof Finch said priority should be given to evidence based preventive measures, such as those aimed at promoting physical activity, improving medication management and minimising environmental hazards at home and in acute and residential care settings.

Prof Caroline Finch: (m) 0409 558 108 (bh) 02-9385 5361, Dan Gaffney: UNSW Faculty of Science media contact: mobile 0411 156 015