The number of hip fractures in Canadian seniors is expected to rise exponentially over the next 40 years, according to a study in the Nov. 15 issue of the Canadian Medical Association Journal.
"This study is a wake-up call," says lead investigator Emmanuel Papadimitropoulos, a graduate student in the department of nutritional sciences at the University of Toronto. "It highlights the serious implications for Canadians if the rate of hip fractures is not reduced by some form of intervention."
The study estimates the number of hip fractures in the elderly will increase four-fold in the next 45 years, a trend attributed to the increasing number of people over the age of 65. "About 12 per cent of the Canadian population are currently 65 years or older," explains Papadimitropoulos. "By 2041 the figure will rise to 25 per cent."
Using hospital discharge data for the fiscal year 1993-94 from the Canadian Institute for Health Information for provinces which reported all hip fractures (Ontario, British Columbia and Alberta), the researchers projected the national rate for hip fractures in Canadians over the age of 65. The rate and number of hip fractures in 2041 was then estimated using Statistics Canada population projections.
The data reveals that in the fiscal year 1993/94 an estimated 23,375 hip fractures occurred in Canada (17,823 in women and 5,552 in men). Estimating that patients with hip fractures require an average acute care stay of 21 days, the total number of hospital days in the fiscal year 1993/94 used to treat hip fractures was 465,000 days. The investigators project that by the year 2041 there will be 88,124 hip fractures, requiring an estimated 1.8 million acute care hospital days.
The analysis also determines an average of seven per cent of people die during their acute hospitalization for hip fractures, a rate that increases exponentially with increasing age and is twice as great for men as for women. "The implications are costly, both in terms of quality of life and health care resources. Without intervention to prevent this trend, hip fractures will be driving how we spend our health care resources," says Papadimitropoulos, who also works in the health economics department of Eli Lilly Canada Inc.
Fractures of the hip, wrist and back are often attributed to osteoporosis, a disease characterized by low bone mass and deterioration of bone tissue. The Osteoporosis Society of Canada estimates that 1.4 million Canadians currently suffer from the disease, the largest portion of these people being postmenopausal women. "By preventing osteoporosis through measures such as exercise, diet and hormone replacement therapy we can reduce the number of hip fractures, explains investigator Carol Greenwood, an associate professor in the department of nutritional sciences and research scientist at Baycrest Centre for Geriatric Care.
"This analysis presents an opportunity to start planning how we will care for the growing number of people with hip fractures," explains Peter Coyte, a professor of health economics in the department of health administration and adjunct senior scientist at the Institute for Clinical Evaluative Sciences, who was also involved in conducting the research. "We need to look at many factors, such as the availability of orthopedic surgeons, rehabilitation care, home care and support for family care givers." Coyte points out more research needs to be done to see if community-based care could be a better cost-effective way of dealing with the projected trend.
The study's investigators also include Robert Josse, a U of T professor of medicine, chair of the scientific advisory board of the Osteoporosis Society of Canada and chief of endocrinology and metabolism at St. Michael's Hospital. "This research places osteoporosis and its consequences in the forefront with other conditions that will effect the elderly and especially women, " explains Josse. "Strategies for prevention and effective treatment are urgently needed."
The research was supported in part by Ortho-McNeil Inc. Greenwood is supported by the Natural Sciences and Engineering Research Council of Canada and Coyte is supported by grants from the Ontario Ministry of Health to the Institute for Clinical Evaluative Sciences, the Arthritis Community Research and Evaluation Unit and the Hospital Management Research Unit.
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Journal
Canadian Medical Association Journal