Substantial changes in fracture rates in German hospitals in 2018 compared with 2002: an epidemiological study.

INTRODUCTION: The aim of this study was to present recent epidemiological data on extremity and axial skeletal fractures in German hospitals and to compare them with older data to detect time trends. MATERIALS AND METHODS: Inpatient data from the German National Hospital Discharge Registry were used. The absolute number and age-standardized incidence of fractures in 2002 and 2018 were analysed by fracture location according to the International Classification of Disease. Data were analysed according to age group. Male: female ratios (MFRs) and incidence rate ratios (IRRs) were calculated to compare the 2018 and 2002 data. RESULTS: The absolute number of fractures of the nine analysed locations was 15.2% higher in 2018 than in 2002. By fracture location, the changes were as follows (absolute change + IRR): "neck" (S12): + 172%, IRR = 2.6; "rib(s), sternum, thoracic spine" (S22): + 57%, IRR = 1.3; "lumbar spine and pelvis" (S32): + 66%, IRR = 1.3; "shoulder and upper arm" (S42): + 36%, IRR = 1.2; "forearm" (S52): + 13%, IRR = 1.0; "wrist and hand level" (S62): - 32%, IRR = 0.7; "femur" (S72): + 24%, IRR = 0.9; "lower leg, including ankle" (S82): - 24%, IRR = 0.7; "foot, except ankle" (S92): - 4%, IRR = 0.9. The overall MFR changed from 0.7 in 2002 to 0.6 in 2018. The age group of 45-54 years represented a turning point, males were more often affected than females in the younger age groups, and the opposite trend was observed in the older age groups. CONCLUSIONS: The increase in the absolute fracture rates was due to increased rates of femur, shoulder, upper arm, forearm, and axial skeletal fractures, with elderly women being the main contributors. Femur fractures were found to be the most common fractures treated in German hospitals.

Changing epidemiology of lower extremity fractures in adults over a 15-year period - a National Hospital Discharge Registry study.

BACKGROUND: Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in 2002 compared to 2017 and to evaluate those changes. METHODS: Inpatient data from the German National Hospital Discharge Registry (ICD10) for 2002 and 2017 were evaluated. Changes in total counts and incidence rates were analysed for fractures in the following locations: femoral neck, pertrochanteric, subtrochanteric, distal femur, femoral shaft, proximal and distal tibia, tibial shaft, medial and lateral malleolus, and other parts of the lower leg (including bi- and trimalleolar fractures), calcaneus, talus, other tarsal bones, metatarsal bones, greater toe, lesser toe, other fractures of foot or unspecific fractures of foot and toe. Patients were classed into age groups by sex: 15-24, 25-34,35-44, 45-54, 55-64, 65-74, 75-84, 85-90 and >  90 years. RESULTS: The total count for lower extremity fractures in men and women increased slightly by 4.5% from 305,764 in 2002 to 319,422 in 2017. Hip and femur fractures increased by 23.5% from 150,565 in 2002 to 185,979 in 2017. The number of these fractures among men increased by 46% and among women by 15.3%. The total count of lower leg fractures decreased by 15.4% from 131,162 in 2002 to 110,924 in 2017. Especially, younger age groups showed a decline for all tibial segments and ankle fractures. For both sexes, the number of lower leg fractures in those 75 years or older increased in all lower leg fracture locations. Most femur and lower leg fractures occurred in women. The incidence of fractures rose sharply from 2002 to 2017, especially for older cohorts. CONCLUSION: The total numbers of lower extremity fractures increased slightly in 2017 compared to 2002 - especially hip and femur fractures among men. The incidence of almost all lower extremity fracture types among older people increased during this time. Women were particularly affected. Therefore, focused prevention programmes should be considered including an extended fracture spectrum in the elderly.