Variation in UK fracture incidence by age, sex, geography, ethnicity,

socioeconomic status and time: Results from the UK CPRD

Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,

Cyrus Cooper*, Nicholas C Harvey**CC and NCH are joint senior author

Presenter Disclosure Information:This speaker has no conflicts of interest

Background

• Economic and personal costs of osteoporotic fracture substantial– 37bn Euros, 1.18m QALYs lost annually1

• Large variability in fracture incidence worldwide – differences according to geography, ethnicity, socioeconomics2

• Last study in UK published 20013 – current study 1988-20124

1. Hernlund et al, Arch Osteoporos, 8 (2013) 136.2. Kanis et al, Osteoporos Int. 23 (2012) 2239-2256.

3. Van Staa et al, Bone 29 (2001) 517-522.4. Curtis EM et al., Bone 87 (2016) 19-26

Aim

• To describe the incidence of fracture in the UK by age, sex, fracture site, geographic location, socioeconomic status, ethnicity and calendar time

• UK Clinical Practice Research Datalink - anonymised electronic patient records collected by General Practitioners

• Approximately 6.9% of the UK population, with representative demographics

• Data stored as READ codes referenced to ICD-9, validated fracture outcomes4; standardised ethnicity5

• All individuals aged >18 yrs with a fracture recorded on GP records between 1988-2012 included in analysis

• Incidence calculated (per 10,000 py) by age, sex, fracture site, ethnicity, socioeconomic status, geographic location, calendar period

https://www.cprd.com/home/4. Van Staa, Pharmacoepidemiol Drug Saf. 9 (2000) 359-3665. Mathur et al, J Public Health (Oxf). 36 (2014) 684-692

Methods

Age- and sex-specific fracture incidence rate at any site among UK adults, 1988-2012

25 30 35 40 45 50 55 60 65 70 75 80 85 90 90+0

50

100

150

200

250

300

350

400

450

male

female

Age category

Incid

ence

/10,

000

pers

on y

ears

Men Women

Age group No. of cases Rate per 10,000 py No. of cases Rate per 10,000 py18-49 years 121219 94.8 78265 54.350+ years 75331 71.8 185267 155.4

Curtis EM et al., Bone 87 (2016) 19-26

Total follow-up time:Men = 23,285,904 pyWomen = 26,342,685 py

Regional variation in fragility fracture incidence in men and women aged 50+ years within the UK

Relative rates of fracture are displayed in comparison to London

Differences keeping with patterns of socioeconomic status, rural population, possibly ethnicity differences, falls, vitamin D deficiency

Fragility fracture: spine, hip, wrist, rib, pelvis, and humerus

Curtis EM et al., Bone 87 (2016) 19-26

Socioeconomic status and fracture incidence in UK men and women aged 50+ years

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1 2 3 4 5

Rela

tive

rate

of f

ract

ure

Index of Multiple Deprivation Category

Fragility

Men

Women

IMD 5 = most deprivedCurtis EM et al., Bone 87 (2016) 19-26

RR fracture hip fracture males category 5= 1.3

Possible causes: smoking, alcohol, diet, prevalence of obesity, influence of manual work may account for sex differences

Incidence of fragility and femur/hip by ethnicity in UK men and women aged 50+ years

Men aged 50+ yrs Women aged 50+ yrsFracture

type EthnicityNumber of

casesRate per

10,000 pyNumber of

casesRate per

10,000 py

Fragility Black 88 15.75 149 22.26 Mixed 22 17.37 77 50.12 South Asian 289 26.85 491 44.46 Other/ unknown 20883 36.19 59824 97.23 White 25285 41.74 71081 104.03

Hip/femur Black 26 4.57 44 6.45 Mixed 4 3.07 14 8.77 South Asian 68 6.15 115 10.03 Other/ unknown 6767 11.13 22390 33.52 White 7901 12.27 24520 32.61

Curtis EM et al., Bone 87 (2016) 19-26

Incidence of fragility fractures in UK men and women, 1990-2012

+

+

+

+

-

+

--

+

Conclusions

• Up to date age- and sex-specific fractures rates for the UK presented

• Marked variation in rates by geographic location, socioeconomic status and ethnicity

• Reasons for differences likely multiple (e.g. diet, lifestyle, adiposity, BMD, bone geometry)

• In contrast to the plateau/decrease in hip fracture rates previously shown we observed an increasing rate in hip fractures in men, and vertebral fractures in both men and women

• Potential implications for healthcare planning in UK and elsewhere

Acknowledgements

Supervisors:

Professor Nicholas Harvey

Professor Cyrus CooperCo-authors:

Dr R van der Velde

Dr R Moon

Dr J van den Bergh

Dr C Wyers

Dr P Geusens

Dr F de Vries

Prof T van Staa

Variation in UK fracture incidence by age, sex, geography, ethnicity,

socioeconomic status and time: Results from the UK CPRD

Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,

Cyrus Cooper*, Nicholas C Harvey**CC and NCH are joint senior author

Presenter Disclosure Information:This speaker has no conflicts of interest