Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
Osteoporos Int. 2011 Jan;22(1):105-11. doi: 10.1007/s00198-010-1205-6. Epub 2010 Mar 23.
Hip fractures are substantial problem worldwide. The increase in rate with age does not continue into very old age. Rates decline in successive birth cohorts. If the increasing trend in period effect continues, there will be a substantial increase in hip fracture incidence.
The purpose of this study is to (1) determine incidence rates for fracture neck of femur (FNF) for the period 1974-2007, (2) estimate age, cohort, and period effects, and (3) predict the burden of FNF in 2025.
Age adjusted incidence rates were estimated using New Zealand hospital discharge data for 1974-2007. Age-period-cohort modeling was used to estimate individual effects of these factors after adjusting for the other two factors. Future fracture burden was estimated under two scenarios.
Age-adjusted rates for women increased from 1974 to 1987 whereas rates for men have increased from 1974 until 2007. Risk increased from 70 years of age but dropped among the very elderly. Period effects showed a steady increase in risk throughout 1974-2007. In contrast, the risk was lower in later cohorts. If there is no change in the period effect from 2007 we estimate a reduction in the burden of illness from FNF, especially for women. However if the period effect continues to increase, there will be substantial increases in FNF incidence, especially for men.
The effect of population aging on FNF incidence is predictable because projections are based on an existing population. The increasing health and improvement in measures of physical status of older people through the last century, explain the decline in FNF incidence in later cohorts. The steady increase in period effect may be due to increased survival of the very frail. This burden of illness resulting from FNFs must be addressed by population based, research proven approaches to fall and fracture prevention.
（1）确定 1974 年至 2007 年股骨颈骨折（FNF）的发病率；（2）评估年龄、队列和时期效应；（3）预测 2025 年 FNF 的发病负担。
使用新西兰住院数据对 1974 年至 2007 年的 FNF 发病率进行年龄校正。采用年龄-时期-队列模型，在调整其他两个因素后，估计这些因素的个体效应。在两种情况下对未来骨折负担进行了估计。
女性年龄校正率从 1974 年至 1987 年上升，而男性年龄校正率从 1974 年上升至 2007 年。风险从 70 岁开始增加，但在非常高龄人群中下降。时期效应显示风险在整个 1974 年至 2007 年持续增加。相比之下，后期队列的风险较低。如果 2007 年后时期效应没有变化，我们估计 FNF 发病负担将减少，尤其是对女性。然而，如果时期效应继续增加，FNF 的发病率将大幅上升，尤其是对男性。
人口老龄化对 FNF 发病率的影响是可以预测的，因为预测是基于现有人口。上个世纪，人们的健康状况和身体状况的改善，解释了后期队列中 FNF 发病率的下降。时期效应的稳步增加可能是由于非常脆弱人群的生存能力提高所致。这种由 FNF 引起的疾病负担必须通过基于人群的、经过研究证实的方法来预防跌倒和骨折。
