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Open Access 11-10-2023 | Distal Radius Fracture | Original Article

Epidemiology of distal radius fractures in Germany - incidence rates and trends based on inpatient and outpatient data

Authors: Kevin Reiland, Burkhard Haastert, Werner Arend, Birgit Klüppelholz, Joachim Windolf, Andrea Icks, Simon Thelen, Silke Andrich

Published in: Osteoporosis International | Issue 2/2024

Abstract

Summary

We examined incidence rates (IR) for all distal radius fracture (DRF) events based on inpatient and outpatient data from a large statutory health insurance in Germany. Of all DRF, 56% were treated as inpatients, and thus, 44% treated as outpatients. IR were higher in women than in men.

Purpose

Although a distal radius fracture (DRF) is one of the most common fractures in the elderly population, epidemiological data are limited. Many studies examine only hospitalized patients, do not analyze time trends, or include only small populations. In this retrospective population-based observational study, routine data on inpatient and outpatient care of persons aged ≥ 60 years insured by a large statutory health insurance in Germany were analyzed from 2014 to 2018.

Methods

DRF were identified by ICD-10 codes. All DRF events of an individual were considered with a corresponding individual washout period. Incidence rates (IR) and time trends were estimated assuming a Poisson distribution per 100,000 person-years, with 95% confidence intervals [95% CI] and age-sex standardization to the German population in 2018. Associations of calendar year, age, sex, and comorbidity with IR were examined using Poisson regression estimating incidence rate ratios (IRR) with CI.

Results

The study population consists of 974,332 insured individuals, with 16,557 experiencing one or more DRF events during the observation period. A total of 17,705 DRF events occurred, of which 9961 (56.3%) were hospitalized. Standardized IR were 439 [424–453] (inpatient: 240 [230–251], outpatient: 199 [189–209]) in 2014 and 438 [423–452] (inpatient: 238 [227–249], outpatient: 200 [190–210]) in 2018. Female sex, older age, and comorbidity were associated with higher IR and adjusted Poisson regression showed no significant time trend (IRR overall 0.994 [0.983–1.006]).

Conclusion

A relevant proportion of DRF were treated in outpatient settings, so both inpatient and outpatient data are necessary for a valid estimate.

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Court-Brown CM, Clement ND, Duckworth AD et al (2014) The spectrum of fractures in the elderly. Bone Joint J 96-B:366–372. https://doi.org/10.1302/0301-620X.96B3.33316CrossRefPubMed

Koski A-M, Patala A, Patala E et al (2014) Incidence of osteoporotic fractures in elderly women and men in Finland during 2005-2006: a population-based study. Scand J Surg 103:215–221. https://doi.org/10.1177/1457496914525554CrossRefPubMed

Amin S, Achenbach SJ, Atkinson EJ et al (2014) Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 29:581–589. https://doi.org/10.1002/jbmr.2072CrossRefPubMed

Court-Brown CM, Clement ND, Duckworth AD et al (2017) The changing epidemiology of fall-related fractures in adults. Injury 48:819–824. https://doi.org/10.1016/j.injury.2017.02.021CrossRefPubMed

Statistisches Bundesamt (2019) Bevölkerung im Wandel: Annahmen und Ergebnisse der 14. koordinierten Bevölkerungsvorausberechnung, Wiesbaden

Putter CE de, Selles RW, Polinder S et al. (2013) Epidemiology and health-care utilisation of wrist fractures in older adults in The Netherlands, 1997-2009. Injury 44:421–426. https://doi.org/10.1016/j.injury.2012.10.025

Dimai HP, Svedbom A, Fahrleitner-Pammer A et al (2014) Epidemiology of distal forearm fractures in Austria between 1989 and 2010. Osteoporos Int 25:2297–2306. https://doi.org/10.1007/s00198-014-2766-6CrossRefPubMed

Vergara I, Vrotsou K, Orive M et al (2016) Wrist fractures and their impact in daily living functionality on elderly people: a prospective cohort study. BMC Geriatr 16:11. https://doi.org/10.1186/s12877-015-0176-zCrossRefPubMedPubMedCentral

Chen C-W, Huang T-L, Su L-T et al (2013) Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg 74:317–321. https://doi.org/10.1097/ta.0b013e31824bb325CrossRefPubMed

10.

Tsai C-H, Muo C-H, Fong Y-C et al (2011) A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int 22:2809–2815. https://doi.org/10.1007/s00198-010-1489-6CrossRefPubMed

11.

Kwon G-D, Jang S, Lee A et al (2016) Incidence and mortality after distal radius fractures in adults aged 50 years and older in Korea. J Korean Med Sci 31:630–634. https://doi.org/10.3346/jkms.2016.31.4.630CrossRefPubMedPubMedCentral

12.

Hemmann P, Ziegler P, Konrads C et al (2020) Trends in fracture development of the upper extremity in Germany-a population-based description of the past 15 years. J Orthop Surg Res 15:65. https://doi.org/10.1186/s13018-020-1580-4CrossRefPubMedPubMedCentral

13.

Rupp M, Walter N, Pfeifer C et al (2021) The incidence of fractures among the adult population of Germany – and analysis from 2009 through 2019. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.m2021.0238

14.

Bässgen K, Westphal T, Haar P et al (2013) Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200,413 inhabitants. J Public Health (Oxf) 35:255–261. https://doi.org/10.1093/pubmed/fds076CrossRefPubMed

15.

Tsukutani Y, Hagino H, Ito Y et al (2015) Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int 26:2249–2255. https://doi.org/10.1007/s00198-015-3124-zCrossRefPubMed

16.

Polinder S, Iordens GIT, Panneman MJM et al (2013) Trends in incidence and costs of injuries to the shoulder, arm and wrist in The Netherlands between 1986 and 2008. BMC Public Health 13:531. https://doi.org/10.1186/1471-2458-13-531CrossRefPubMedPubMedCentral

17.

Jerrhag D, Englund M, Karlsson MK et al (2017) Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord 18:240. https://doi.org/10.1186/s12891-017-1596-zCrossRefPubMedPubMedCentral

18.

Maravic M, Taupin P, Landais P et al (2010) Hospitalized wrist fractures in France: incidence and burden trend changes. Orthop Traumatol Surg Res 96:662–666. https://doi.org/10.1016/j.otsr.2010.04.012CrossRefPubMed

19.

Stirling ERB, Johnson NA, Dias JJ (2018) Epidemiology of distal radius fractures in a geographically defined adult population. J Hand Surg Eur 43:974–982. https://doi.org/10.1177/1753193418786378CrossRef

20.

Leslie WD, Sadatsafavi M, Lix LM et al (2011) Secular decreases in fracture rates 1986-2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22:2137–2143. https://doi.org/10.1007/s00198-010-1470-4CrossRefPubMed

21.

Lippuner K, Popp AW, Schwab P et al (2011) Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis. Osteoporos Int 22:2487–2497. https://doi.org/10.1007/s00198-010-1487-8CrossRefPubMed

22.

Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83CrossRefPubMed

23.

Sundararajan V, Henderson T, Perry C et al (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57:1288–1294. https://doi.org/10.1016/j.jclinepi.2004.03.012CrossRefPubMed

24.

Le CT (2003) Introductory biostatistics. Wiley, New York, ChichesterCrossRef

25.

Hansen L, Judge A, Javaid MK et al (2018) Social inequality and fractures-secular trends in the Danish population: a case-control study. Osteoporos Int 29:2243–2250. https://doi.org/10.1007/s00198-018-4603-9CrossRefPubMedPubMedCentral

26.

Bynum JPW, Bell J-E, Cantu RV et al (2016) Second fractures among older adults in the year following hip, shoulder, or wrist fracture. Osteoporos Int 27:2207–2215. https://doi.org/10.1007/s00198-016-3542-6CrossRefPubMedPubMedCentral

27.

Pijpers E, Ferreira I, de Jongh RT et al (2012) Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Age Ageing 41:358–365. https://doi.org/10.1093/ageing/afr145CrossRefPubMed

28.

Dukas LC, Schacht E, Mazor Z et al (2005) A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65 ml/min. Osteoporos Int 16:332–338. https://doi.org/10.1007/s00198-004-1690-6CrossRefPubMed

29.

Øyen J, Gjesdal CG, Brudvik C et al (2010) Low-energy distal radius fractures in middle-aged and elderly men and women--the burden of osteoporosis and fracture risk: a study of 1794 consecutive patients. Osteoporos Int 21:1257–1267. https://doi.org/10.1007/s00198-009-1068-xCrossRefPubMed

30.

Schubert I, Ihle P, Köster I (2010) Interne Validierung von Diagnosen in GKV-Routinedaten: Konzeption mit Beispielen und Falldefinition (Internal confirmation of diagnoses in routine statutory health insurance data: concept with examples and case definitions). Gesundheitswesen 72:316–322. https://doi.org/10.1055/s-0030-1249688CrossRefPubMed

31.

Pfau N (2016) Diagnosen aus dem ambulant-ärztlichen Versorgungsbereich als Bestandteil der Gesundheitsberichterstattung des Bundes. WISTA - Wirtschaft und Statistik, pp 97–106. https://www.destatis.de/DE/Methoden/WISTA-Wirtschaft-und-Statistik/2016/06/diagnosenversorgungsbereich-gbe-062016.pdf?__blob=publicationFile. Accessed 18 Sep 2023

32.

Hoffmann F, Icks A (2012) Unterschiede in der Versichertenstruktur von Krankenkassen und deren Auswirkungen für die Versorgungsforschung: Ergebnisse des Bertelsmann-Gesundheitsmonitors (Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor). Gesundheitswesen 74:291–297. https://doi.org/10.1055/s-0031-1275711CrossRefPubMed

33.

Blümel M, Spranger A, Achstetter K et al (2020) Germany: health system review. Health Syst Transit 22:1–272PubMed

34.

Icks A, Haastert B, Glaeske G et al (2012) Correction factor for the analysis of the hip fracture incidence--differences between age, sex, region, and calendar year. Wien Klin Wochenschr 124:391–394. https://doi.org/10.1007/s00508-012-0188-zCrossRefPubMed

35.

Hoffmann W, Latza U, Baumeister SE et al (2019) Guidelines and recommendations for ensuring Good Epidemiological Practice (GEP): a guideline developed by the German Society for Epidemiology. Eur J Epidemiol 34:301–317. https://doi.org/10.1007/s10654-019-00500-xCrossRefPubMedPubMedCentral

36.

Swart E, Gothe H, Geyer S et al (2015) Gute Praxis Sekundärdatenanalyse (GPS): Leitlinien und Empfehlungen (Good Practice of Secondary Data Analysis (GPS): guidelines and recommendations). Gesundheitswesen 77:120–126. https://doi.org/10.1055/s-0034-1396815CrossRefPubMed

Title: Epidemiology of distal radius fractures in Germany - incidence rates and trends based on inpatient and outpatient data
Authors: Kevin Reiland
Burkhard Haastert
Werner Arend
Birgit Klüppelholz
Joachim Windolf
Andrea Icks
Simon Thelen
Silke Andrich
Publication date: 11-10-2023
Publisher: Springer London
Keyword: Distal Radius Fracture
Published in: Osteoporosis International / Issue 2/2024
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-023-06904-6

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Epidemiology of distal radius fractures in Germany - incidence rates and trends based on inpatient and outpatient data

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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