Fractures in the elderly: epidemiology and demography

Osteoporosis and osteoporosis-related fractures are a major source of both morbidity and cost in the elderly, the fractures that are most commonly associated with osteoporosis being those of the hip, the distal forearm and the vertebrae, although it is believed that most other fractures occurring in the elderly are also related to osteoporosis. In this review, the incidence of all types of fracture is described based on the available literature, and the foreseeable trends resulting from demographic changes are discussed. Emphasis is given to the epidemiology of hip fracture since this is the most serious consequence of osteoporosis. Hip fractures occur all over the world, most currently occurring in Western countries, mainly Europe and the USA, but it is expected that there will be a large increase in the number of hip fractures in other countries because of demographic changes. The incidence of hip fractures increases exponentially with age, resulting in a 1-year incidence of 1% in women aged 80 in Western countries. Most hip fractures occur in women, but this is again partly due to demography, because of the longer life expectancy of women. Wrist fractures occur more often in women and do not show the same increase with age as hip fractures. The incidence reaches a plateau at age 60-70. Vertebral fractures show a modest increase with age and are again more common in women than men. The incidence of all other fractures increases modestly with age