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Osteoporotic fracture trends in a population of US managed care enrollees from 2007 to 2017

Lewiecki EM1, Chastek B2, Sundquist K2, Williams SA3, Weiss RJ4, Wang Y4, Fitzpatrick LA4, Curtis JR5.

Osteoporos Int. 2020 Feb 15. doi: 10.1007/s00198-020-05334-y. [Epub ahead of print]

Abstract
This study expands on previous findings that hip fracture rates may no longer be declining. We found that age- and sex-adjusted fracture rates in the US plateaued or increased through mid-2017 in a population of commercially insured and Medicare Advantage health plan enrollees, in contrast to a decline from 2007 to 2013.

INTRODUCTION:
The purpose of this study was to evaluate fracture trends in US commercial and Medicare Advantage health plan members aged ≥ 50 years between 2007 and 2017.

METHODS:
Retrospective analysis of the Optum Research Database from January 1, 2007, to May 31, 2017.

RESULTS:
Of 1,841,263 patients identified with an index fracture, 930,690 were case-qualifying and included in this analysis. The overall age- and sex-adjusted fracture rate decreased from 14.67/1000 person-years (py) in 2007 to 11.79/1000 py in 2013, followed by a plateau for the next 3 years and then an increase to 12.50/1000 py in mid-2017. In females aged ≥ 65 years, fracture rates declined from 27.49/1000 py in 2007 to 22.08/1000 py in 2013, then increased to 24.92/1000 py in mid-2017. Likewise, fracture rates in males aged ≥ 65 years declined from 2007 (12.00/1000 py) to 2013 (10.72/1000 py), then increased to 12.04/1000 py in mid-2017. The age- and sex-adjusted fracture rates for most fracture sites declined from 2007 to 2013 by 3.7% per year (P = 0.310).

CONCLUSIONS:
Following a consistent decline in fracture rate from 2007 to 2013, trends from 2014 to 2017 indicate fracture rates are no longer declining and, for some fracture types, rates are rising.