Elsevier

Injury

Volume 37, Issue 8, August 2006, Pages 691-697
Injury

Review
Epidemiology of adult fractures: A review

https://doi.org/10.1016/j.injury.2006.04.130Get rights and content

Summary

The epidemiology of adult fractures is changing quickly. An analysis of 5953 fractures reviewed in a single orthopaedic trauma unit in 2000 showed that there are eight different fracture distribution curves into which all fractures can be placed. Only two fracture curves involve predominantly young patients; the other six show an increased incidence of fractures in older patients. It is popularly assumed that osteoporotic fractures are mainly seen in the thoracolumbar spine, proximal femur, proximal humerus and distal radius, but analysis of the data indicates that 14 different fractures should now be considered to be potentially osteoporotic. About 30% of fractures in men, 66% of fractures in women and 70% of inpatient fractures are potentially osteoporotic.

Introduction

In recent years fractures, particularly those occurring in osteoporotic bone, have become a major health issue. They are relatively common and treatment has become increasingly expensive and complicated. Despite this, there is little known about their epidemiology. Buhr and Cooke1 published their classic paper on fracture epidemiology in 1959, and a number of studies have been undertaken since then,4, 5, 6, 11, 12, 14 but the results are somewhat contradictory. We believe that the changing epidemiology of fractures has not generally been fully appreciated. The studies that have been undertaken suggest a world incidence of 9.0–22.8/1000/year.4, 11 We believe it likely that there are variations in fracture incidence in different parts of the world, but studies within England and Wales have also shown wide variations, the reasons for which are not fully understood. Some studies have used data from Accident and Emergency Departments, and possibly this resulted in over-estimations, as inexperienced doctors frequently over-diagnose certain fractures. Other studies have used data from orthopaedic fracture clinics, but not all fractures are referred to these clinics, resulting in under-estimations. Another problem is in that in many large cities orthopaedic trauma is managed in a number of hospitals, and the analysis of data from a single hospital may give skewed results.

In an attempt to correctly define the epidemiology of fractures in the local population, a retrospective study of all individuals presenting to the Orthopaedic Trauma Unit of the Royal Infirmary of Edinburgh in the year 2000 was undertaken.3

Section snippets

Method

The Royal Infirmary of Edinburgh is the only orthopaedic trauma unit treating adults in Midlothian and East Lothian. All orthopaedic trauma patients in the area attend the hospital, and all outpatient fractures are reviewed at outpatient clinics. Children under the age of 12 years attend the local paediatric hospital and were excluded from analysis. The overall population served by the Royal Infirmary of Edinburgh in 2000 was 534,715. All inpatients and outpatients were included, and all

Results

Analysis of the fractures that presented in the year 2000 showed that there were 5953 inpatient and outpatient fractures. The average age of the patients was 49.1 years, with a gender ratio of 50:50. The incidence of fractures in men was 11.67/1000/year and in women was 10.65/1000/year. The overall age and gender incidence curves are shown in Fig. 1. This demonstrates a relatively uniform incidence in women up to the menopause and a rapid increase thereafter. In men the pattern is different;

Conclusions

Our results show that the epidemiology of fractures is changing quickly. Improved social conditions and medical treatment have led to an increasingly aged population with an increasing number of fractures in both men and women. It seems likely that this trend will continue, that there will be further changes in fracture epidemiology and that some of the other fractures listed in Table 3 will soon have to be regarded as osteoporotic. We believe that this particularly applies to humeral

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