Rosengren B E, Björk J, Cooper C, Abrahamsen B
Clinical and Molecular Research Unit, Departments of Orthopedics and Clinical Sciences, Skåne University Hospital Malmö, Lund University, 205 02, Malmö, Sweden.
Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark.
Osteoporos Int. 2017 Jan;28(1):139-149. doi: 10.1007/s00198-016-3768-3. Epub 2016 Sep 19.
This study used nationwide hip fracture data from Denmark and Sweden during 1987-2010 to examine effects of (birth) cohort and period. We found that time trends, cohort, and period effects were different in the two countries. Results also indicated that hip fracture rates may increase in the not so far future.
The reasons for the downturn in hip fracture rates remain largely unclear but circumstances earlier in life seem important.
We ascertained hip fractures in the populations ≥50 years in Denmark and Sweden in national discharge registers. Country- and sex-specific age-period-cohort (APC) effects during 1987-2010 were evaluated by log-likelihood estimates in Poisson regression models presented as incidence rate ratios (IRR).
There were 399,596 hip fractures in SE and 248,773 in DK. Age-standardized hip fracture rate was stable in SE men but decreased in SE women and in DK. Combined period + cohort effects were generally stronger in SE than DK and in women than men. IRR per period ranged from 1.05 to 1.30 in SE and 0.95 to 1.21 in DK. IRR per birth cohort ranged from 1.07 to 3.13 in SE and 0.77 to 1.67 in DK. Relative period effects decreased with successive period in SE and described a convex curve in DK. Relative cohort effects increased with successive birth cohort in both countries but with lower risks for DK women and men and SE women born around the 1930s (age 75-86 years today and responsible for most hip fractures) partly explaining the recent downturn. Men and women born thereafter however seem to have a higher hip fracture risk, and we expect a reversal of the present decline in rates, with increasing hip fracture rates in both Denmark and Sweden during the upcoming decade.
Time trends, cohort, and period effects were different in SE and DK. This may reflect differences in general health as evident in known differences in life expectancy, healthcare organization, and prevention such as use of anti-osteoporosis drugs. Analyses indicate that hip fracture rates may increase in the not so far future.
本研究使用了丹麦和瑞典1987 - 2010年期间全国范围的髋部骨折数据，以研究（出生）队列和时期的影响。我们发现两国的时间趋势、队列和时期效应有所不同。结果还表明，在不久的将来髋部骨折率可能会上升。
髋部骨折率下降的原因在很大程度上仍不明确，但生命早期的情况似乎很重要。
我们在丹麦和瑞典的国家出院登记册中确定了年龄≥50岁人群中的髋部骨折情况。通过泊松回归模型中的对数似然估计来评估1987 - 2010年期间特定国家和性别的年龄 - 时期 - 队列（APC）效应，以发病率比（IRR）表示。
瑞典有399,596例髋部骨折，丹麦有248,773例。瑞典男性的年龄标准化髋部骨折率稳定，但瑞典女性和丹麦的该率有所下降。时期 + 队列的综合效应在瑞典通常比丹麦更强，在女性中比男性更强。瑞典每个时期的IRR范围为1.05至1.30，丹麦为0.95至1.21。瑞典每个出生队列的IRR范围为1.07至3.13，丹麦为0.77至1.67。瑞典的相对时期效应随着连续时期而下降，并在丹麦呈现出凸曲线。在两国，相对队列效应都随着连续出生队列而增加，但丹麦的女性和男性以及瑞典20世纪30年代左右出生的女性（如今年龄在75 - 86岁，占大多数髋部骨折病例）的风险较低，这部分解释了近期的下降趋势。然而，此后出生的男性和女性似乎有更高的髋部骨折风险，并且我们预计目前的下降趋势将会逆转，在未来十年丹麦和瑞典的髋部骨折率都将上升。
瑞典和丹麦的时间趋势、队列和时期效应有所不同。这可能反映了总体健康状况的差异，如预期寿命、医疗保健组织以及预防措施（如使用抗骨质疏松药物）方面已知的差异。分析表明，在不久的将来髋部骨折率可能会上升。
