What is the impact of an Ageing population on future increases in hip fracture burden?

Worldwide, the number of hip fractures is projected to nearly double by 2050 compared to 2018, primarily driven by the demographic shift towards an ageing population. This significant demographic change directly impacts future increases in hip fracture burden, placing substantial pressure on healthcare systems and increasing economic costs globally.

Quick Summary

Growing numbers of older adults, particularly those over 85, are expected to significantly increase the overall volume and healthcare costs of hip fractures, despite potentially decreasing age-specific incidence rates in some areas. This poses a major public health challenge, emphasizing the need for proactive prevention strategies, particularly targeting risk factors like falls and osteoporosis.

Key Points

• Projected Increase: Worldwide, the number of hip fractures is projected to nearly double by 2050, primarily due to the growth of the elderly population.

• Age and Risk: The risk of hip fracture is highest in the oldest age groups, which are also the fastest-growing demographic, meaning the overall burden will increase even if age-specific rates decline.

• Underlying Causes: Osteoporosis and falls are the primary mechanisms leading to hip fractures in older adults, compounded by frailty, comorbidities, and medication side effects.

• Sex Differences: While historical incidence was much higher in women, the gap is narrowing. Men are projected to see a larger percentage increase in fractures by 2050 and have higher post-fracture mortality rates.

• Economic Strain: Hip fractures pose a significant economic burden due to high costs for surgery, hospitalization, and long-term care. Projections indicate a substantial increase in healthcare expenditure to manage this burden.

• Preventative Measures: Strategies to mitigate the impact include population screening for osteoporosis, implementing fall prevention programs, encouraging healthy diets rich in calcium and vitamin D, and ensuring timely treatment.

• Societal Impact: The rising fracture burden leads to increased morbidity, mortality, loss of independence, and greater need for long-term care facilities.

The Demographic Engine: How Population Aging Fuels the Increase

The primary factor driving the projected rise in hip fracture burden is the increasing global population of older adults, especially those over 80 and 85, who face the highest risk. Even with potential declines in age-specific incidence rates in some regions, the sheer number of older individuals will lead to a significant increase in total fractures. Projections suggest the total number of cases could nearly double by 2050. The oldest age groups are particularly vulnerable due to higher rates of comorbidities, frailty, and cognitive issues that increase fall risk and lead to poorer outcomes. For instance, men aged 85 and older in Finland saw a 13-fold increase in hip fractures between 1972 and 2018.

The Role of Osteoporosis and Falls

Osteoporosis, which weakens bones, and falls are the main causes of hip fractures in older adults. An older person with osteoporosis is much more likely to fracture a hip from a fall from a standing height.

Common factors contributing to hip fracture include:

• Osteoporosis: Weakens bones, making them fragile.
• Frailty: Reduces muscle strength and balance, increasing fall risk.
• Medications: Some drugs can cause dizziness or bone weakening.
• Sensory and Neurological Issues: Poor vision or conditions like Parkinson's increase fall risk.
• Sarcopenia: Loss of muscle mass and strength contributes to falls.

Comparison of Hip Fracture Trends by Sex

Hip fracture rates have historically been higher in women, but recent trends show this gap narrowing.

Feature	Females	Males
Historical Incidence	Higher rates.	Lower rates.
Current Trend	Decreasing age-specific rates in many Western countries.	Rising age-specific rates, potentially outpacing the decline in women.
Projections	Contribute significantly to overall burden due to larger elderly population.	Projected to see a larger percentage increase in total hip fractures by 2050.
Risk Factors	Often linked to post-menopausal bone loss.	Associated with more comorbidities and higher mortality after fracture.
Healthcare Experience	More often screened and treated for osteoporosis.	Osteoporosis is often underdiagnosed and undertreated, even after a fracture.
Mortality	Face significant risks.	Often face a higher mortality rate in the year following a hip fracture than women.

Significant Economic and Social Implications

The rising number of hip fractures will severely impact healthcare systems and public spending. Hip fractures are expensive, requiring extensive resources for emergency care, surgery, hospitalization, and rehabilitation. The economic burden includes increased healthcare costs, greater demand for skilled services, and pressure on hospital infrastructure. There are also significant social implications, including higher mortality and morbidity, loss of independence, and a greater need for long-term care facilities.

Conclusion

The impact of an ageing population on future hip fracture burden is substantial. While age-specific rates may decline in some areas, the growing number of older adults, particularly the very old, will lead to a significant increase in total hip fractures globally. This demographic trend, combined with factors like osteoporosis and falls, will place immense strain on healthcare systems and economies. Addressing this requires comprehensive strategies focusing on prevention, such as osteoporosis screening and fall prevention programs, alongside improvements in acute fracture care to manage the rising burden.

Frequently Asked Questions

Why is the number of hip fractures increasing globally if incidence rates are stable or falling in some regions?

The overall number of hip fractures is increasing because the global population is aging, and the total number of older adults is growing substantially. While age- and sex-standardized incidence rates have decreased in some areas due to improved healthcare, this is not enough to offset the demographic shift towards a larger elderly population, especially the oldest-old, who are at the highest risk.

How does an ageing population affect healthcare systems dealing with hip fractures?

An ageing population increases the burden on healthcare systems through higher costs for emergency care, surgery, hospitalization, and rehabilitation. It also creates a greater demand for skilled medical professionals and requires more acute and long-term care beds, impacting overall healthcare capacity.

What is the role of osteoporosis in the increased hip fracture burden?

Osteoporosis is a primary factor in the increased hip fracture burden. As bones weaken with age, individuals with osteoporosis become highly susceptible to fractures, even from a simple fall from a standing height. Combined with a larger elderly population, this leads to a higher volume of fractures.

Are there differences in how men and women are affected by hip fracture trends?

Yes, there are significant differences. Historically, women have had higher hip fracture rates, but age-specific rates for men are projected to increase faster than those for women in many areas. Men with hip fractures tend to have more comorbidities and experience higher mortality rates than women, yet are often underdiagnosed and undertreated for osteoporosis.

What are the key risk factors for hip fractures in an ageing population?

Besides age, key risk factors include osteoporosis, falls, muscle weakness (sarcopenia), impaired vision and balance, and certain medications that can affect bone density or cause dizziness. Lifestyle factors like low calcium/vitamin D intake, lack of exercise, and excessive alcohol use also contribute to the risk.

What can be done to mitigate the future increase in hip fracture burden?

Mitigation strategies include implementing robust fall prevention programs, promoting regular weight-bearing exercise to improve muscle strength and balance, and prioritizing osteoporosis screening and treatment. Public health interventions targeting diet and home safety modifications are also crucial.

Does a hip fracture affect quality of life and independence in older adults?

Yes, a hip fracture can drastically impact an older adult's quality of life and independence. Many do not regain their pre-fracture mobility or functional ability. It is associated with increased dependency, higher rates of long-term care facility residence, and significantly increased morbidity and mortality.