Academic journal article Bulletin of the World Health Organization

Secular Increase in the Incidence of Hip Fractures in Belgium between 1984 and 1996: Need for a Concerted Public Health Strategy. (Research)

Academic journal article Bulletin of the World Health Organization

Secular Increase in the Incidence of Hip Fractures in Belgium between 1984 and 1996: Need for a Concerted Public Health Strategy. (Research)

Article excerpt

Voir page 945 le resume en francais. En la pagina 945 figura un resumen en espanol.


Fractures of the proximal end of the femur (hip fractures) are considered to be the most serious consequence of osteoporosis, and the burden posed by this condition has consistently been increasing in most developed and developing countries (1-3). Prevention of osteoporosis is therefore a major public health concern. Wide variations in the incidence of hip fractures have been reported between and within countries (3-5), and have been attributed to genetic, environmental, and behavioural factors. Consequently, public health policies that are aimed at improving primary or secondary prevention procedures cannot simply be transferred from one country to another. Attempts to optimize the efficiency of these policies should be based on comprehensive epidemiological surveys carried out in the country or region where the prevention strategy is to be applied.

No recent data on the incidence of hip fractures are available for Belgium, but such data have been collected for some neighbouring countries (1, 6, 7). The only report ever published for Belgium (8) suggested that there was a dramatic increase (5.6% per year) in hip fractures between 1977 and 1982. We carried out the present survey to determine whether this trend is still continuing. We compared the incidence of hip fractures in both males and females and examined the respective roles of demographic and secular aspects and their contribution to changes in hip fracture incidence between 1984 and 1996. Finally, since there is currently no appropriate strategy for screening and preventing osteoporosis in Belgium, we projected these observed changes on population estimates for the next 50 years and calculated the future hip fracture incidence in Belgium.

Materials and methods

Using the national database of hospital bills, which fully covers the annual hospital stays in Belgium (population, ca.10 million), we determined the incidence of proximal femoral (hip) fractures for the whole country from 1984 to 1996 (Source: Institut National d'Assurance-Maladie-Invalidite, Avenue de Tervueren, Brussels, Belgium). The format of this registry excludes double-counting of one admission or of omissions since it is based on supervised reimbursement of the acute care costs of all medical and surgical procedures (8). In order to minimize any possible random errors or fluctuations linked to data acquisition, we calculated the annual incidence of hip fractures as the mean of the incidence observed over three consecutive years. The Belgian national database of hospital bills is coded according to the nature of the procedure performed. Three codes are related to surgical procedures (osteosynthesis) directly identified as linked to a fracture of the proximal femur, and two codes are related to hip arthroplasty (femoral prosthetic replacement and total hip prosthetic replacement). The same coding system for health-related procedures has been used in Belgium since 1963 and is one of the most detailed coding systems worldwide, including codes for 8300 different procedures. In order to distinguish hip arthroplasties linked to a femoral neck fracture from those related to other diagnoses (mainly osteoarthritis), we conducted a 6-month survey in nine major Belgian hospitals (representing 10% of the overail number of hospital stays) and identified the diagnosis for each of the hip surgical procedures. The nine hospitals included in this sample were selected since they were the largest hospitals in each of the major cities of the French-speakin part of Belgium. The incidence of fractures of the femoral diaphysis was used as the control.

The sex- and age-related incidences were obtained for 1993 (the selected reference-year) by accessing the database of one of the largest Belgian Social Security Agencies (Union Nationale des Mutualites Socialistes), which covers 27% of all Belgian citizens. …

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