Extreme elderly account for two-thirds of osteoporotic hip fractures

By Ingrid Grasmo

Study findings presented at the Annual Congress of the European League Against Rheumatism, held in Berlin, Germany, show that nearly two-thirds of American osteoporotic hip fractures occur among individuals aged 80 years or older.

The extreme elderly are the fastest growing segment of the population in the world, estimated to increase by more than three-fold from 2000 to 2050. However, little epidemiologic data exist on osteoporotic hip fractures in this population to date.

"We know that hip fracture in the extreme elderly is a serious problem due to the associated consequences of hospitalization, disability, and mortality," said lead study author Amrita Sehgal (University of California, Berkeley, USA) in an associated press release.

She added: "This data is cause for concern as the impact highlighted will only increase along with this population segment."

Using data from the US Nationwide Inpatient Sample (NIS), the researchers examined 4.3 million hospitalizations during 1993‑2008 with diagnoses of osteoporotic hip fractures in elderly (65‑79 years) and extreme elderly patients (≥80 years). Patients were excluded if there was major trauma, open fractures, or femoral tumors.

Of the observed fractures, 67.3% occurred among patients aged 80 years and older, with osteoporotic hip fracture hospitalizations increasing significantly from 172,209 in 1993 to 180,428 in 2008. This occurred despite hip fracture prevalence rates decreasing significantly from 2236 to 1600 per 1000 person-years over the same time frame.

Sehgal noted that the rise in the absolute number of hip fracture hospitalizations coincided with the dramatic increase in the extreme elderly population, from 7.7 million in 1993 to over 11.2 million in 2008, corresponding to a 46% elevation.

While the extreme elderly population accounted for 41.3% of the elderly population in 2008, they accounted for over 69% of all osteoporotic hip fracture hospitalizations, up from 64% in 1993.

Conversely, hip fracture hospitalizations in the elderly decreased from 96,928 (386 per 1000 person‑years) in 1993 to 80,987 (294 per 1000 person‑years) in 2008, even as the number of individuals in this patient group increased from 25.1 to 27.1 million.

"The question now is how we manage the extreme elderly more effectively to limit the impact that osteoporotic fractures have going forward," said Sehgal, adding that the findings "call for more aggressive measures towards recognition, prevention, and therapy of osteoporosis during the medical care of extreme elderly."

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