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William D. Leslie, MD, MSc; Siobhan O’Donnell, MSc; Sonia Jean, MSc; Claudia Lagacé, MSc; Peter Walsh, MSc; Christina Bancej, PhD; Suzanne Morin, MD, MSc; David A. Hanley, MD; Alexandra Papaioannou, MD, MSc; for the Osteoporosis Surveillance Expert Working Group

JAMA. 2009;302(8):883-889.

Context  Hip fractures are a public health concern because they are associated with significant morbidity, excess mortality, and the majority of the costs directly attributable to osteoporosis.

Objective  To examine trends in hip fracture rates in Canada.

Design, Setting, and Patients  Ecologic trend study using nationwide hospitalization data for 1985 to 2005 from a database at the Canadian Institute for Health Information. Data for all patients with a hospitalization for which the primary reason was a hip fracture (570 872 hospitalizations) were analyzed.

Main Outcome Measures  Age-specific and age-standardized hip fracture rates.

Results  There was a decrease in age-specific hip fracture rates (all P for trend <.001). Over the 21-year period of the study, age-adjusted hip fracture rates decreased by 31.8% in females (from 118.6 to 80.9 fractures per 100 000 person-years) and by 25.0% in males (from 68.2 to 51.1 fractures per 100 000 person-years). Joinpoint regression analysis identified a change in the linear slope around 1996. For the overall population, the average age-adjusted annual percentage decrease in hip fracture rates was 1.2% (95% confidence interval, 1.0%-1.3%) per year from 1985 to 1996 and 2.4% (95% confidence interval, 2.1%-2.6%) per year from 1996 to 2005 (P < .001 for difference in slopes). Similar changes were seen in both females and males with greater slope reductions after 1996 (P < .001 for difference in slopes for each sex).

Conclusions  Age-standardized rates of hip fracture have steadily declined in Canada since 1985 and more rapidly during the later study period. The factors primarily responsible for the earlier reduction in hip fractures are unknown.

Author Affiliations: Department of Medicine, University of Manitoba, Winnipeg, Canada (Dr Leslie); Public Health Agency of Canada, Ottawa, Ontario, Canada (Mss O’Donnell and Lagacé, Mr Walsh, and Dr Bancej); Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada (Ms Jean); McGill University, Montreal, Quebec, Canada (Dr Morin); University of Calgary, Calgary, Alberta, Canada (Dr Hanley); and McMaster University, Hamilton, Ontario, Canada (Dr Papaioannou).

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