PARIS, France—New research conducted by a 17-year-old high school student suggests that the US is having a significant impact on the osteoporosis epidemic. The study, presented at the annual European League Against Rheumatism (EULAR) meeting in Paris, France1, shows that nontraumatic hip fracture hospitalizations declined from 1988 to 2005 despite the aging of the population during these years.

"This decrease is likely due to a combination of improved awareness, screening, early diagnosis and treatment."—Amrita Sehgal
"This decrease is likely due to a combination of improved awareness, screening, early diagnosis and treatment," said lead researcher Amrita Sehgal, a 17-year-old student at Menlo-Atherton High School in Woodside, California. "Hopefully we will be able to build upon such advances to further decrease this rate, improve patient prognosis, and reduce the impact of osteoporosis overall."

High school student takes on osteoporosis

Sehgal and colleagues analyzed data from the Nationwide Inpatient Sample (NIS). They analyzed all inpatient hospitalizations data from 1988 to 2005 for primary or secondary diagnosis of nontraumatic hip fractures and compared them with total all-cause US hospitalizations using data from the US Census Bureau.

The number of people aged ≥50 increased by 14.7% from 1988 to 2005 (25.6% to 29.4%, respectively). As a result, many epidemiologists predicted a boom in rates of osteoporosis and related fractures, but according to the new findings, they were wrong.

Decline in nontraumatic hip fractures seen from 1988-2005

Overall during this period, there were 647.7 million all-cause hospitalizations in 4.85 billion person-years of observation (133.4 per 1000 person-years); there were 4,467,281 hospitalizations for hip fractures (92 per 100,000 person-years; 0.69% of all-cause hospitalizations). Moreover, all-cause US hospitalizations increased from 35.2 million in 1988 to 39.2 million in 2005—an increase of 11.4% over 18 years, however, hip fracture hospitalizations decreased from 302,740 (0.86% of all-cause hospitalizations) to 181,567 (0.46 % of all-cause hospitalizations).

The prevalence rate per 100,000 US population decreased by almost 50% from 123.3 to 61.4 (P <.0001). The significant declines in the prevalence started after 1992. In 1988, hip fractures accounted for 4,297,908 inpatient days; by 2005, the numbers had dropped by almost 73% to 1,212,516 days (P <.0001). In addition, fatality rates improved from 4.5% to 3.4% (P <.05). However, the total costs of care for such hospitalizations (in 2005 US dollars, assuming 3% inflation rate) increased from $4.04 billion to $5.9 billion (P <.05).

Decline in Nontraumatic Hip Fracture Hospitalizations in the US From 1988-2005
Year Number Prevalence per 100,000
1988 302740 123.30
1990 308552 123.14
1992 316547 123.50
1993 278171 107.43
1994 263887 100.94
1995 254828 96.56
1996 254750 95.63
1997 240942 89.59
1998 235541 86.79
1999 225818 82.47
2000 211373 74.90
2001 206856 72.55
2002 193015 67.02
2003 190436 65.48
2004 182292 62.08
2005 181567 61.36

Adapted from EULAR 2008.1

Reference

1. Sehgal A, Vadhavkar S, Mithal A, et al. A victory on the war on osteoporosis? Declining prevalence of hospitalizations for non-traumatic hip fractures in the US. Presented at: EULAR 2008; June 11-14, 2008; Paris, France. Abstract OP-0034.