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Published in: Osteoporosis International 7/2011

01-07-2011 | Original Article

Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis

Authors: W. D. Leslie, M. Sadatsafavi, L. M. Lix, M. Azimaee, S. Morin, C. J. Metge, P. Caetano

Published in: Osteoporosis International | Issue 7/2011

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Abstract

Summary

We examined trends in fracture rates over 20 years in the Province of Manitoba, Canada. Hip fractures, major low-trauma fractures, and high-trauma fractures declined significantly from 1986 to 2006.

Introduction

Secular decreases in hip fracture rates have been reported in some countries. Whether this phenomenon applies to other fracture sites is not well described.

Methods

We used 20 years of data from the Population Health Research Data Repository for the Province of Manitoba, Canada. Age-adjusted fracture rates were calculated for men and women age 50 years and older 1986–2006 according to fracture site and mechanism (presence/absence of external injury codes). Generalized linear models with generalized estimating equations were used to derive adjusted annual rates and test for linear change in men and women.

Results

Major low-trauma fractures (hip, forearm, spine, and humerus) showed a significant annual linear decline in women (−1.2% [95% CI, −0.7% to −1.8%]) and in men (−0.4% [95% CI, −0.7% to −0.2%]). Hip fracture showed a significant annual decline for both sexes, while forearm and humerus fractures showed a significant decline only in women. The only fracture category that did not show a significant annual decline in either sex was the spine. The observed annual reduction in high-trauma fractures was even larger and did not show a sex difference (−1.8% [95% CI, −2.8% to −0.7%]).

Conclusion

We observed a decrease in both low-trauma and high-trauma fracture rates over the study period. This decline was apparent in years prior to widespread osteoporosis testing or availability of modern pharmacotherapy.
Literature
1.
go back to reference Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194(2 Suppl):S3–S11PubMedCrossRef Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194(2 Suppl):S3–S11PubMedCrossRef
2.
go back to reference Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733PubMedCrossRef Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733PubMedCrossRef
3.
go back to reference Berger C, Goltzman D, Langsetmo L, Joseph L, Kreiger N, Tenenhouse A et al (2010) Peak bone mass from longitudinal data: implications for the prevalence, pathophysiology, and diagnosis of osteoporosis. J Bone Miner Res 25:1948–1957PubMedCrossRef Berger C, Goltzman D, Langsetmo L, Joseph L, Kreiger N, Tenenhouse A et al (2010) Peak bone mass from longitudinal data: implications for the prevalence, pathophysiology, and diagnosis of osteoporosis. J Bone Miner Res 25:1948–1957PubMedCrossRef
4.
go back to reference Gehlbach SH, Avrunin JS, Puleo E (2007) Trends in hospital care for hip fractures. Osteoporos Int 18(5):585–591PubMedCrossRef Gehlbach SH, Avrunin JS, Puleo E (2007) Trends in hospital care for hip fractures. Osteoporos Int 18(5):585–591PubMedCrossRef
5.
go back to reference Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19(8):1139–1145PubMedCrossRef Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19(8):1139–1145PubMedCrossRef
6.
go back to reference Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21(12):1836–1838PubMedCrossRef Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21(12):1836–1838PubMedCrossRef
7.
go back to reference Melton LJ, Atkinson EJ, Madhok R (1996) Downturn in hip fracture incidence. Public Health Rep 11(2):146–150 Melton LJ, Atkinson EJ, Madhok R (1996) Downturn in hip fracture incidence. Public Health Rep 11(2):146–150
8.
go back to reference Melton LJ, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM et al (2008) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20(5):687–694PubMedCrossRef Melton LJ, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM et al (2008) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20(5):687–694PubMedCrossRef
9.
go back to reference Leslie WD, O'Donnell S, Jean S, Lagacé C, Walsh P, Bancej C et al (2009) Trends in hip fracture rates in Canada. JAMA 302(8):883–889PubMedCrossRef Leslie WD, O'Donnell S, Jean S, Lagacé C, Walsh P, Bancej C et al (2009) Trends in hip fracture rates in Canada. JAMA 302(8):883–889PubMedCrossRef
10.
go back to reference Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM et al (2001) Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? QJM 94(11):575–597PubMedCrossRef Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM et al (2001) Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? QJM 94(11):575–597PubMedCrossRef
11.
go back to reference Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882PubMedCrossRef Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882PubMedCrossRef
12.
go back to reference Pike C, Birnbaum HG, Schiller M, Sharma H, Burge R, Edgell ET (2010) Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US. Pharmacoeconomics 28(5):395–409PubMedCrossRef Pike C, Birnbaum HG, Schiller M, Sharma H, Burge R, Edgell ET (2010) Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US. Pharmacoeconomics 28(5):395–409PubMedCrossRef
13.
go back to reference Shi N, Foley K, Lenhart G, Badamgarav E (2009) Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone 45(6):1084–1090PubMedCrossRef Shi N, Foley K, Lenhart G, Badamgarav E (2009) Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone 45(6):1084–1090PubMedCrossRef
14.
go back to reference Obrant KJ, Bengnér U, Johnell O, Nilsson BE, Sernbo I (1989) Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif Tissue Int 44(3):157–167PubMedCrossRef Obrant KJ, Bengnér U, Johnell O, Nilsson BE, Sernbo I (1989) Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif Tissue Int 44(3):157–167PubMedCrossRef
15.
go back to reference Cooper C, Atkinson EJ, Kotowicz M, O'Fallon WM, Melton LJ (1992) Secular trends in the incidence of postmenopausal vertebral fractures. Calcif Tissue Int 51(2):100–104PubMedCrossRef Cooper C, Atkinson EJ, Kotowicz M, O'Fallon WM, Melton LJ (1992) Secular trends in the incidence of postmenopausal vertebral fractures. Calcif Tissue Int 51(2):100–104PubMedCrossRef
16.
go back to reference Melton LJ, Amadio PC, Crowson CS, O'Fallon WM (1998) Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 8(4):341–348PubMedCrossRef Melton LJ, Amadio PC, Crowson CS, O'Fallon WM (1998) Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 8(4):341–348PubMedCrossRef
17.
go back to reference Oskam J, Kingma J, Klasen HJ (1998) Fracture of the distal forearm: epidemiological developments in the period 1971–1995. Injury 29(5):353–355PubMedCrossRef Oskam J, Kingma J, Klasen HJ (1998) Fracture of the distal forearm: epidemiological developments in the period 1971–1995. Injury 29(5):353–355PubMedCrossRef
18.
go back to reference Jónsson B, Bengnér U, Redlund-Johnell I, Johnell O (1999) Forearm fractures in Malmö, Sweden. Changes in the incidence occurring during the 1950s, 1980s and 1990s. Acta Orthop Scand 70(2):129–132PubMedCrossRef Jónsson B, Bengnér U, Redlund-Johnell I, Johnell O (1999) Forearm fractures in Malmö, Sweden. Changes in the incidence occurring during the 1950s, 1980s and 1990s. Acta Orthop Scand 70(2):129–132PubMedCrossRef
19.
go back to reference Melton LJ, Crowson CS, O'Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37PubMedCrossRef Melton LJ, Crowson CS, O'Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37PubMedCrossRef
20.
go back to reference Roos NP, Shapiro E (1999) Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system. Med Care 37(6 Suppl):JS10–JS14PubMedCrossRef Roos NP, Shapiro E (1999) Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system. Med Care 37(6 Suppl):JS10–JS14PubMedCrossRef
21.
go back to reference Roos LL, Roos NP, Cageorge SM, Nicol JP (1982) How good are the data? Reliability of one health care data bank. Med Care 20(3):266–276PubMedCrossRef Roos LL, Roos NP, Cageorge SM, Nicol JP (1982) How good are the data? Reliability of one health care data bank. Med Care 20(3):266–276PubMedCrossRef
22.
go back to reference Roos LL, Gupta S, Soodeen R, Jebamani L (2005) Data quality in an information-rich environment: Canada as an example. Can J Aging 24(Suppl 1):153–170PubMedCrossRef Roos LL, Gupta S, Soodeen R, Jebamani L (2005) Data quality in an information-rich environment: Canada as an example. Can J Aging 24(Suppl 1):153–170PubMedCrossRef
23.
go back to reference Roos LL, Nicol JP (1999) A research registry: uses, development, and accuracy. J Clin Epidemiol 52(1):39–47PubMedCrossRef Roos LL, Nicol JP (1999) A research registry: uses, development, and accuracy. J Clin Epidemiol 52(1):39–47PubMedCrossRef
25.
go back to reference Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7(4):390–406PubMedCrossRef Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7(4):390–406PubMedCrossRef
26.
go back to reference McCulloch C, Searle S (2001) Generalized, linear, and mixed models. Wiley, New York McCulloch C, Searle S (2001) Generalized, linear, and mixed models. Wiley, New York
27.
go back to reference Zeger S, Liang K, Albert P (1989) Models for longitudinal data: a generalized estimating equation approach. Biometrics 45(1):347CrossRef Zeger S, Liang K, Albert P (1989) Models for longitudinal data: a generalized estimating equation approach. Biometrics 45(1):347CrossRef
28.
go back to reference Fox J (1998) Applied regression analysis and generalized linear models, 3rd edn. Wiley, New York Fox J (1998) Applied regression analysis and generalized linear models, 3rd edn. Wiley, New York
29.
go back to reference Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21(3):373–380PubMedCrossRef Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21(3):373–380PubMedCrossRef
30.
go back to reference Kannus P, Palvanen M, Niemi S, Sievänen H, Parkkari J (2009) Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone 44(4):656–659PubMedCrossRef Kannus P, Palvanen M, Niemi S, Sievänen H, Parkkari J (2009) Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone 44(4):656–659PubMedCrossRef
31.
go back to reference Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358PubMedCrossRef Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358PubMedCrossRef
32.
go back to reference Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M (2008) Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970–2006 and prediction for the future. Bone 43(2):340–342PubMedCrossRef Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M (2008) Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970–2006 and prediction for the future. Bone 43(2):340–342PubMedCrossRef
33.
go back to reference Kelsey JL, Samelson EJ (2009) Variation in risk factors for fractures at different sites. Curr Osteoporos Rep 7(4):127–133PubMedCrossRef Kelsey JL, Samelson EJ (2009) Variation in risk factors for fractures at different sites. Curr Osteoporos Rep 7(4):127–133PubMedCrossRef
34.
go back to reference Stafford RS, Drieling RL, Hersh AL (2004) National trends in osteoporosis visits and osteoporosis treatment, 1988–2003. Arch Intern Med 164(14):1525–1530PubMedCrossRef Stafford RS, Drieling RL, Hersh AL (2004) National trends in osteoporosis visits and osteoporosis treatment, 1988–2003. Arch Intern Med 164(14):1525–1530PubMedCrossRef
35.
go back to reference Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20(6):898–905PubMedCrossRef Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20(6):898–905PubMedCrossRef
36.
go back to reference Zhao L, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J et al (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23(1):17–29PubMedCrossRef Zhao L, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J et al (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23(1):17–29PubMedCrossRef
37.
go back to reference Zingmond D, Melton L, Silverman S (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15(8):603–610PubMedCrossRef Zingmond D, Melton L, Silverman S (2004) Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 15(8):603–610PubMedCrossRef
38.
go back to reference Leslie WD, O'Donnell S, Lagacé C, Walsh P, Bancej C, Jean S et al (2010) Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int 21:1317–1322PubMedCrossRef Leslie WD, O'Donnell S, Lagacé C, Walsh P, Bancej C, Jean S et al (2010) Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int 21:1317–1322PubMedCrossRef
Metadata
Title
Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis
Authors
W. D. Leslie
M. Sadatsafavi
L. M. Lix
M. Azimaee
S. Morin
C. J. Metge
P. Caetano
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-010-1470-4

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