Fracture Incidence in 1233 Elderly Women and Risk Factors for Hip Fracture. A 20-year Population Based Follow-Up Study in Primary Care in Sweden.

Hans Thulesius, Moses Sjölander, Lisa Alvunger, Anna Segernäs Kvitting, Pär Wanby, Ferdinando Petrazzuoli, Robert Eggertsen, Anna Lindgren, Daniel Albertsson

Keywords: hip fracture, women, follow-up study, population based cohort, primary care

Background:

Fragility fractures are a significant problem worldwide, affecting patients, healthcare systems and society as a whole. In Sweden, 70,000 fragility fractures occur annually, with 16,000 of them being hip fractures.

Research questions:

To describe the incidence of fragility fractures in a population based cohort of elderly women over a 20-year period following the initiation of a fracture prevention intervention study in primary care in Sweden. Additionally, to compare the incidence of fragility fractures with baseline risk factors for such fractures.

Method:

A retrospective follow-up design, including 1,233 elderly women aged 70 or older who answered a baseline questionnaire in 2001. We collected data from radiology reports on type of fracture, side of the body affected, and date of fracture between 2001 and 2021.

Results:

We found that 884 fragility fractures occurred in 536 women (43.5%) between 2001 and 2021. Of these, 268 were hip fractures, the most common type of fracture. The highest incidence of fragility fractures and hip fractures was found among women aged 90-94, with 39.5 hip fractures per 1000 person-years. In multivariate Cox regression analysis, women with a baseline height greater than 167 cm (HR = 1.6; 95% CI, 1.1-2.2) or weight less than 60 kg (HR = 1.5; 95% CI, 1.1-2.0) had an increased risk of hip fracture.
Repeated fragility fractures occurred in 14.1% of women in the intervention group and 18.6% of women in the control group (p = 0.047).

Conclusions:

This population based study highlights the burden of fragility fractures in Sweden, with hip fractures being the most common type.
Women who at baseline were tall or low weight had an increased risk of hip fractures regardless of age.
Fewer repeated fragility fractures occurred in the intervention group than in the control group.

Points for discussion:

How much are GPs in EGPRN member countries involved in the care of women with fragility fractures?

Is prescribing osteoporosis treatment the only way GPs can help to prevent fragility fractures?

Can prescribing activities that both can strengthen muscles and improve the psychosocial network of elderly be a task for primary care?