Abstract
Summary
China is a middle-risk country for hip fracture at present, which differs from previous data that it was low-risk. By 2050, the total number of hip fractures in people older than 65 years is predicted to be 1.3 million.
Introduction
To assess hip fracture incidence in China and examine the heterogeneity of hip fracture in seven geographical regions of China.
Methods
There were 238,230 hip fracture patients aged 65 years or older from 2013 to 2016 from a large national in-patients database (HQMS) involving 30.6 million hospitalizations. Taking into account the total national hospitalization rate per calendar year, we estimated the incidence of hip fracture per 100,000 residents older than 65 years in China overall and in seven geographical Chinese regions.
Results
The proportion of men and women older than 65 years with hip fractures was 1.00:1.95. Between 2013 and 2016, the number of hip fractures per 100,000 people age 65+ was 278. China has vast territories; the number of hip fractures per 100,000 people over 65 years old was 202 in Northeast China and 374 in Northwest China. Northwest has higher altitude, lower population density, is less developed with lower urbanization than Northeast China which is low altitude, and highly urbanized.
Conclusions
China should no longer be regarded as a low-risk country for hip fracture. By 2050, the total number of hip fractures in people older than 65 years in China is predicted to be 1.3 million. Higher altitude areas had higher hip fracture rates than lower altitude, higher urbanized areas.
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References
Ström O, Borgström F, Kanis JA, Compston J, Cooper C, Mccloskey EV et al (2011) Osteoporosis: burden, health care provision and opportunities in the eu. Arch Osteoporos 6(1-2):59–155
Cauley JA, Chalhoub D, Kassem AM, Fuleihan EH (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10(6):338–351
Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, Jaisamrarn U, Ng H, Takeuchi Y, Wu CH, **a W, Yu J, Fujiwara S (2018) An updated hip fracture projection in Asia: the Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4(1):16–21
Kanis JA, Odén A, Mccloskey EV et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256
Kannus P, Niemi S, Parkkari J, Sievanen H (2018) Continuously declining incidence of hip fracture in Finland: analysis of nationwide database in 1970–2016. Arch Gerontol Geriatr 77:64–67
Briot K, Maravic M, Roux C (2015) Changes in number and incidence of hip fractures over 12 years in France. Bone 81:131–137
Mazzucchelli Esteban R, Perez-Fernandez E, Crespí-Villarías N, García- Vadillo A, Rodriguez-Caravaca G, Gil de Miguel A et al (2017) Trends in osteoporotic hip fracture epidemiology over a 17-year period in a Spanish population: alcorco n 1999-2015. Arch Osteoporos 12:84
Michael Lewiecki E, Wright NC, Curtis JR, Siris E, Gagel RF, Saag KG, Singer AJ, Steven PM, Adler RA (2018) Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int 29:717–722
Miyasaka D, Endo N, Endo E, Sakuma M, Yamamoto N, Tanabe N, Imai N, Suda K (2016) Incidence of hip fracture in Niigata, Japan in 2004 and 2010 and the long-term trends from 1985 to 2010. J Bone Miner Metab 34:92–98
**a WB, He SL, Xu L, Liu AM, Jiang Y, Li M, Wang O, **ng XP, Sun Y, Cummings SR (2012) Rapidly increasing rates of hip fracture in Bei**g, China. J Bone Miner Res 27(1):125–129
Tian FM, Zhang L, Zhao HY, Liang CY, Zhang N, Song HP (2014) An increase in the incidence of hip fractures in Tangshan, China. Osteoporos Int 25:1321–1325
Zhang C, Feng J, Wang S, Gao P, Xu L, Zhu J, Jia J, Liu L, Liu G, Wang J, Zhan S, Song C (2020) Incidence of and trends in hip fracture among adults in urban china: a nationwide retrospective cohort study. PLoS Med 17:e1003180
Huang Y-M, Xu D, Long J, Shi Y, Zhang L, Wang H, Levin A, Zhao M-H (2019) Spectrum of chronic kidney disease in China: A national study based on hospitalized patients from 2010 to 2015. Nephrology (Carlton) 24(7):725–736
World Population Prospects: The 2017 Revision, coming form United Nations Population Division. http://data.un.org
Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997on wi. Osteoporos Int 21(3):373–380
Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgström F (2011) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 22(2):685–692
Ettinger B, Black DM, Dawson-Hughes B, Pressman AR, Melton LJ III (2010) Updated fracture incidence rates for the US version of FRAX? Osteoporos Int 21(1):25–33
Lesnyak O, Ismailov S, Shakirova M, Alikhanova N, Kanis JA (2020) Epidemiology of hip fracture and the development of a FRAX model for uzbekistan. Arch Osteoporos 15(1):119
Diaz-Ledezma C, Bengoa F, Dabed D, Rojas N, López A (2020) Hip fractures in the elderly Chilean population: a projection for 2030. Arch Osteoporos 15(1):116
Tamaki J, Fujimori K, Ikehara S et al (2019) Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012–2015. Osteoporos Int 30(5):975–983
Yong EL, Ganesan G, Kramer MS, Logan S, Lau TC, Cauley JA, Tan KB (2019) Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium. Osteoporos Int 30(4):879–886
Tsang SWY, Kung AWC, Kanis JA, Johansson H, Oden A (2009) Ten-year fracture probability in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores. Osteoporos Int 20(11):1939–1945
Tian F, Sun X, Liu J, Liu ZK, Liang CY, Zhang L (2017) Unparallel gender-specific changes in the incidence of hip fractures in Tangshan, China. Arch Osteoporos 12(1):18
Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ (2015) Projection of osteoporosis-related fractures and costs in China 2010-2050. Osteoporos Int 26(7):1929–1937
Wang SY, Li YH, Chi GB, **ao SY, Ozanne-Smith J, Stevenson M, Phillips MR (2008) Injury-related fatalities in China: an under-recognised public-health problem. Lancet 372(9651):1765–1773
Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, Wan X, Yu S, Jiang Y, Naghavi M, Vos T, Wang H, Lopez AD, Murray CJL (2013) Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381(9882):1987–2015
World Population Prospects 2019. https://population.un.org/wpp/Download/Probabilistic/Population/
Kanis JA, Johnell O, Oden A, Jonsson B, de Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 27(5):585–590
Kanis JA, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19(4):399–428
Piscitelli P, Feola M, Rao C, Celi M, Gasbarra E, Neglia C, Quarta G, Liuni FM, Parri S, Iolascon G, Brandi ML, Distante A, Tarantino U (2014) Ten years of hip fractures in Italy: for the first time a decreasing trend in elderly women. World J Orthop 5(3):386–391
Drevet S, Bioteau C, Maziu C et al (2014) Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res 100(6):669–674
Guo Z, Wills P, Viitanen M, Fastbom J, Winblad B (1998) Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study. Am J Epidemiol 148(9):887–892
Zhong BS, Qi GM, Chang YM, Zhu HM, Zhao YL, Hu ZM, Xue QY, Du J, Cheng XG (2009) IOF (China Health Promotion Foundation (CHPF); Osteoporosis Committee of China Ger- ontological Society; China Osteoporosis Foundation (COF)). https://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Asia/Asian_regional_audit_China.pdf
Editorial board of Chinese white paper on osteoporosis prevention and treatment of China Health Promotion Foundation (2009) White paper on osteoporosis in China. Chin J Health Manage 3(3):148–154
Zhang Y, Tang W, Zhang X, Zhang Y, Zhang L (2015) National health insurance development in China from 2004 to 2011: coverage versus benefits. PLoS ONE 10(5): e0124995.
National Working Committee on Children and Women State Council, People’s Republic of China. (2018). Children in China: an Atlas of social indicators 2018. https://www.unicef.cn/en/figure-325-health-insurance-coverage-1998-2003-2008-and-2013
Ueng SW, Lee SS, Lin SS, Wang CR, Liu SJ, Yang HF, Tai CL, Shih CH (1998) Bone healing of tibial lengthening is enhanced by hyperbaric oxygen therapy: a study of bone mineral density and torsional strength on rabbits. J Trauma 44(4):676–681
Stephen M, Warren MD, Douglas S et al (2001) Hypoxia regulates osteoblast gene expression. J Surg Res 99(1):147–155
Uttinga J, Robinsb SP, Brandao-Burcha A et al (2006) Hypoxia inhibits the growth, diferentiation and bone-forming capacity of rat osteoblasts. Exp Cell Res 312(10):1693–1702
Muzylal M, Price JS, Horton MA (2006) Hypoxia induces giant osteoclast formation and extensive bone resorption in the cat. Caleif Tissue Int 79:301–309
Basu M, Malhotra AS, Pal K, Chatterjee T, Ghosh D, Haldar K, Verma SK, Kumar S, Sharma YK, Sawhney RC (2013) Determination of bone mass using multisite quantitative ultrasound and biochemical markers of bone turnover during residency at extreme altitude: a longitudinal study. High Alt Med Biol 14(2):150–154
Bozzini C, Champin GM, Alippi RM, Bozzini CE (2013) Static biomechanics in bone from growing rats exposed chronically to simulated high altitudes. High Alt Med Biol 14(4):367–374
Bozzini C, Picasso EO, Champin GM, Alippi RM, Bozzini CE (2016) Structural and material mechanical quality of femoral shafts in rats exposed to simulated High Altitude from Infancy to Adulthood. High Alt Med Biol 17(1):50–53
Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 3:1–17
Finsen V, Benum P (1987) Changing incidence of hip fractures in rural and urban areas of central norway. Clin Orthop Relat Res 218:104–110
Chen W, Hzh L, Liu S, Liu B et al (2017) National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health 5(8):e807–e817
Zhu Y, **ng X, Liu S, Chen W, Zhang Y (2020) Epidemiology of low-energy wrist, hip, and spine fractures in Chinese populations 50 years or older: a national population-based survey. Medicine 99(5):e18531
Ren Y, Hu J, Lu B, Zhou W, Tan B (2019) Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population. Bone 122:143–149
Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y et al (2018) Chronic obstructive pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med 6(6):421–430
Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos 8(1-2):136
Ong T, Sahota O, Marshall L, Moran CG (2013) Re: trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001-09. Age Ageing 42(6):816–816
Prada D, Zhong J, Colicino E, Zanobetti A, Schwartz J, Dagincourt N, Fang SC, Kloog I, Zmuda JM, Holick M, Herrera LA, Hou L, Dominici F, Bartali B, Baccarelli AA (2017) Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies. Lancet Planet Health 1:e337–e347
Zhang Z, Zhu D, Cui B, Ding R, Shi X, He P (2020) Association between particulate matter air pollution and lung cancer. Thorax 75:85–87
Lin H, Qian ZM, Guo Y, Zheng Y, Ai S, Hang J, Wang X, Zhang L, Liu T, Guan W, Li X, **ao J, Zeng W, **an H, Howard SW, Ma W, Wu F (2018) The attributable risk of chronic obstructive pulmonary disease due to ambient ne particulate pollution among older adults. Environ Int 113:143–148
Liang F, Yang X, Liu F, Li J, **ao Q, Chen J, Liu X, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Wu X, Li Y, Hu D, Huang J, Liu Y, Lu X, Gu D (2019) Long- term exposure to ambient ne particulate matter and incidence of diabetes in China: a cohort study. Environ Int 126:568–575
Griths CJ, Mudway IS (2018) Air pollution and cognition. BMJ 363:k4904
United States Environmental Protection Agency, (2009). Final report: integrated science assessment for particulate matter. http://cfpub.epa.gov/ncea/risk/recordisplay.cfm?deid=216546
Alver K, Meyer HE, Falch JA, Sogaard AJ (2010) Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study. Osteoporos Int 21:1751–1760
Qiao D, Pan J, Chen G, **ang H, Tu R, Zhang X, Dong X, Wang Y, Luo Z, Tian H, Mao Z, Huo W, Zhang G, Li S, Guo Y, Wang C (2020) Long-term exposure to air pollution might increase prevalence of osteoporosis in Chinese rural population. Environ Res 183:109264
Deiuliis JA, Kampfrath T, Zhong J et al (2012) Pulmonary T cell activation in response to chronic particulate air pollution. Am J Phys Lung Cell Mol Phys 302:399–409
Grassi F, Tell G, Robbie-Ryan M, Gao Y, Terauchi M, Yang X, Romanello M, Jones DP, Weitzmann MN, Pacici R (2007) Oxidative stress causes bone loss in estrogen-de cient mice through enhanced bone marrow dendritic cell activation. Proc Natl Acad Sci U S A 104:15087–15092
Moller P, Loft S (2010) Oxidative damage to DNA and lipids as biomarkers of exposure to air pollution. Environ Health Perspect 118:1126–1136
Ming-Hui Y, **n-Bao WU, **ao-Feng G et al (2017) Management of geriatric hip fractures:implementation of geriatric orthopedic co-management and comparison with practice in the UK. Chin J Bone Joint 6(3):169–173
Chen M, Zhang Y, Du Y et al (2019) Epidemiological and clinical study of hip fracture in hospitalized elderly patients in Shanghai, China. Arch Osteoporos 14(1):37
Acknowledgments
The authors thank the Bureau of Medical Administration and Medical Service Supervision, National Health and Family Planning Commission of the People’s Republic of China for the support of this study.
Funding
This study was funded by Bei**g Municipal Administration of Hospital Clinical Medicine Development of Special Funding Support, Code: ZYLX201506; Bei**g Municipal Administration of Hospitals Incubating Program, Code: PX 2019015; Bei**g HealthCare Project, Code: Bei**g 19-17.
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Gong, X.F., Li, X.P., Zhang, L.X. et al. Current status and distribution of hip fractures among older adults in China. Osteoporos Int 32, 1785–1793 (2021). https://doi.org/10.1007/s00198-021-05849-y
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DOI: https://doi.org/10.1007/s00198-021-05849-y