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      Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area

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          Abstract

          Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults’ ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.

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          Epidemiology of adult fractures: A review.

          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.
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            Osteoporosis in the European Union: medical management, epidemiology and economic burden

            Summary This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). Introduction Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. Methods The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010. Results Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. Conclusions In spite of the high social and economic cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by the aging populations, the use of pharmacological interventions to prevent fractures has decreased in recent years, suggesting that a change in healthcare policy is warranted.
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              Epidemiology of osteoporotic fractures.

              Several osteoporotic fractures such as hip fractures have a very high morbidity and mortality, and there are similar new findings for vertebral fractures. There have been several definitions of an osteoporotic fracture, and recently updated definitions have specified fractures occurring at a site associated with low BMD and which increase in incidence after the age of 50 years. Other definitions are based on clinical diagnosis. Lifetime risk of any osteoporotic fracture is very high and lies within the range of 40-50% in women and 13-22% for men. Measuring the true burden of osteoporotic fractures involves multiplying the morbidity of hip fractures according to age group: for women aged 50-54 years, the disability caused by osteoporotic fractures is 6.07 times that accounted for by hip fracture alone, and for women aged 80-84 years, the incidence of hip fractures should be multiplied by 1.55; for men aged 50-54 years, the incidence of hip fractures should be multiplied by 4.48, and for those aged 80-84 years by 1.50.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 December 2020
                2020
                : 15
                : 12
                : e0244291
                Affiliations
                [1 ] Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
                [2 ] Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
                Medical College of Wisconsin, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-0116-4114
                Article
                PONE-D-20-30350
                10.1371/journal.pone.0244291
                7751975
                33347485
                3d70d8ca-6636-423f-aad4-3fc207453361
                © 2020 Bergh et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 September 2020
                : 8 December 2020
                Page count
                Figures: 8, Tables: 5, Pages: 18
                Funding
                Funded by: the Swedish Research Council
                Award Recipient :
                Funded by: Government Funding of Clinical Research within the National Health Service (ALF) from Västra Götaland
                Award ID: ALFGBG72293
                Award Recipient :
                Funded by: the Gothenburg Medical Association
                Award Recipient :
                Funded by: The Felix Neubergh Foundation
                Award Recipient :
                This research was supported by grants from the Swedish Research Council (M.M), Government Funding of Clinical Research within the National Health Service (ALF) from Västra Götaland ALFGBG722931 (H.B), the Felix Neubergh Foundation (C.B.) and the Gothenburg Medical Association (C.B.), all in Sweden.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Trauma Medicine
                Traumatic Injury
                Bone Fracture
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Femur
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Femur
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Humerus
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Humerus
                Medicine and Health Sciences
                Epidemiology
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Bone
                Diaphyses
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Bone
                Diaphyses
                Biology and Life Sciences
                Anatomy
                Biological Tissue
                Connective Tissue
                Bone
                Diaphyses
                Medicine and Health Sciences
                Anatomy
                Biological Tissue
                Connective Tissue
                Bone
                Diaphyses
                Biology and Life Sciences
                Anatomy
                Body Limbs
                Legs
                Ankles
                Medicine and Health Sciences
                Anatomy
                Body Limbs
                Legs
                Ankles
                Biology and Life Sciences
                Anatomy
                Body Limbs
                Arms
                Forearms
                Medicine and Health Sciences
                Anatomy
                Body Limbs
                Arms
                Forearms
                People and Places
                Population Groupings
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                Custom metadata
                Supporting files available upon request due to study data is governed by the data access policy at the Swedish Fracture Register, Sweden. Request can be made to Swedish Fracture Registry, coordinator; Karin Pettersson, Swedish Fracture Register, Department of Orthopedic, R-huset, 431 80 Mölndal, Sweden or to karin.mar.pettersson@ 123456vgregion.se and those who meet the criteria for access to anonymized patient level data will be granted data access.

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