Global burden of hip fractures – trends in incidence, post-fracture treatment, and mortality; a multi-country, observational study

Date of Approval: 
2020-09-25 00:00:00
Lay Summary: 
One in five people with a hip fracture die within a year, and up to 50 percent lose their functional independence (ie, need long-term assistance completing everyday tasks, such as walking or dressing). In addition, individuals who fracture a hip have a greater chance of another fracture in the future. To reduce the risk of a subsequent fracture, clinical guidelines recommend treatment with medicines. Regardless of the existing guidelines, some regions report low extents of treatment after the fracture. We aim to describe hip fractures over time among adults in multiple countries. Specifically, we will measure the frequency of the hip fracture, percentage of hip fracture patients who receive treatment to prevent fracture in the future, and the frequency of death after the fracture. The findings of the study will help us better understand possible causes, risk factors of hip fracture, and how effective are current healthcare practices. In addition, the results of this study will help developing future initiatives aiming to improve patient health.
Technical Summary: 
We aim to characterize hip fractures by year among men and women aged 50 years and above within multiple countries. The UK hip fracture patients will be characterised using CPRD linked to the HES and ONS Death Registration Data. Specific objectives: 1) to estimate the annual incidence of hip fracture; 2) to estimate the proportion of patients having use of a pharmacological treatment for fracture prevention within 12 months following their initial hip fracture by year; 3) to estimate the mortality rate within 12 months following patients’ initial hip fracture by year. It is a descriptive cohort study using retrospective electronic health records. Common protocol and an analytical common data model (ACDM) will be used to obtain aggregated data from each national or regional database. The study will consist of annual cohorts of hip fracture patients from each database. Outcomes: Patient characteristics (age, sex, history of anti-osteoporotic medication use). Annual hip fracture incidence rate (IR), calculated as the sum of all hip fracture episodes divided by the population at-risk. Osteoporosis treatment proportion for new medication users, and by the type of treatment (oral bisphosphonates, parenteral bisphosphonates, denosumab, teriparatide, and others) within 3, 6, and 12 months following the initial fracture by year. Mortality within 3, 6, and 12 months following the initial fracture by year. Frequency proportions, means and standard deviation, or medians and interquartile range will be used to describe patient characteristics. IRs will be age and sex-standardized using population published by WHO in 2001. A linear regression model will be used to test for time trends in the annual incidence proportion. The age and sex-standardized mortality ratio will be calculated using age-specific mortality in Global reported by WHO. HES data will be used to determine hospitalizations; ONS Death Registration Data will be used to obtain date of death.
Health Outcomes to be Measured: 
Hip fracture episodes; Osteoporosis treatment proportion; Mortality after fracture
Application Number: 

James O'Kelly - Chief Investigator - Amgen Ltd
James O'Kelly - Corresponding Applicant - Amgen Ltd
Joe Maskell - Collaborator - Amgen Ltd
Kevin de Silva - Collaborator - Amgen Ltd
Vaiva Gerasimaviciute - Collaborator - Amgen Ltd

HES Admitted Patient Care;ONS Death Registration Data