Secular trends in fracture incidence in the united kingdom between 1990-2012 in subjects 50 years or older

Objectives: There is increasing evidence of secular changes in age and sex adjusted fracture incidence globally. Since altered fracture rates have major implications for healthcare provision and planning, we investigated secular trends in age and sex adjusted fracture incidence amongst the UK population aged 50 years or above from 1990 till 2012. Materials and methods: We undertook a retrospective observational study using the Clinical Practice Research Data link (CPRD), representative for the UK population. Site specific fracture incidence was calculated by calendar year for men and women separately, with fracture type categorized according to ICD-9 classification. Linear regression analyses were used to calculate mean annualized change in absolute fracture incidence and to test for trend by calendar year. For presentational purposes, mean rates in the first 5 years (1990-1994) and last 5 years (2008-2012) were calculated. Results: Overall fracture incidence was unchanged in both women (168.2 to 170.0 per 10,000 py) and men (74.8 to 78.9 per 10,000 py) from 1990 to 2012. The incidence of hip fracture remained stable in women (1990-1994: 33.8 per 10,000 person years (py) vs. 2008-2012: 33.5 per 10,000 py; p trend annualized change in incidence= 0.80), but increased in men (from 10.8 to 13.4 per 10,000 py; p = 0.002). Incidence of clinical vertebral fractures increased in women (8.9 to 11.8 per 10,000 py; p =0.005) but remained stable in men (4.6 to 5.9 per 10,000 py; p = 0.72). Similarly incidence of radius/ ulna fractures did not change in men (9.6 per 10,000 py; p =0.25), and decreased in women (50.4 to 41.2 per 10,000 py; p= 0.001). Secular trends amongst fractures of the carpus, scapula, humerus, foot, pelvis, skull, clavicle, ankle, patella and ribs varied according to fracture site and sex. Conclusion: Although, overall sex-specific fracture incidence in the UK population aged 50 years or over appears to have remained stable over the last two decades, there have been noticeable changes in incidences of individual fracture types. Given that the impact of a fracture on morbidity, mortality and health economy varies according to fracture site, these data clearly inform the provision of healthcare services in the UK.