Increasing number and incidence of osteoporotic fractures of the proximal humerus in elderly peopleBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7064.1051 (Published 26 October 1996) Cite this as: BMJ 1996;313:1051
- Pekka Kannus, chief physiciana,
- Mika Palvanen, research fellowa,
- Seppo Niemi, research assistanta,
- Jari Parkkari, research fellowa,
- Markku Jarvinen, professorb,
- Ilkka Vuori, professora
- Accident and Trauma Research Center, UKK Institute for Health Promotion Research, PO Box 30, FIN-33501 Tampere, Finland
- Department of Surgery, Tampere University Hospital, Tampere, Finland
- Correspondence to: Dr Kannus.
- Accepted 11 June 1996
The most common forms of osteoporotic fractures occur at the distal forearm, spine, and hip. Treating less common fractures (such as those of the proximal humerus, pelvis, knee, and ankle1) is also demanding and expensive. Yet epidemiological information on these is scarce; no nationwide study of the incidence of the osteoporotic fractures of the proximal humerus has been reported.
Subjects, methods, and results
We defined an osteoporotic fracture of the proximal humerus as a fracture occurring in people aged >/=60 that resulted from minimal trauma only—that is, a fall from standing height or less. We selected all such patients admitted to Finnish hospitals in 1970–2, 1974–5, 1978–80, 1983–5, 1988–9, and 1991–3 for primary treatment of first fracture of the proximal humerus from the National Hospital Discharge Register. Previous studies have found the accuracy of the register to be 96–97%.2 3 4 The study covered the entire Finnish population. We adjusted for the subjects' age by using the mean population between 1970 and 1993 as the standard population and expressed fracture incidences as the number of cases/100 000 persons/year by sex and by age.
The total number of osteoporotic fractures of the proximal humerus increased steadily during the study period, from 212 in 1970 to 844 in 1993 (an average increase of 13% a year). The mean age of patients also increased, from 72.1 years (1970) to 76.2 years (1993). The age adjusted incidence (per 100 000 people aged >/=60) of fractures increased during 1970–93 from 50 to 106 in women and from 14 to 41 in men (fig 1).
We found a steady increase in the age specific incidences for fractures of the proximal humerus in both sexes and in all ages over the course of the study. In Finland not only is the incidence of fractures increasing but also the population at risk is increasing—a development likely to accelerate in the near future. The increasing mean age of patients is likely to mean more problems in treating these fractures, including longer times for healing and rehabilitation and more complications of fractures such as non-unions. Additionally, a higher mean age of patients is likely to increase morbidity and mortality.
Our findings resemble the secular trends of hip fractures in Finland: their incidence nearly trebled between 1970 and 1993, and the age specific incidences increased in both sexes and in all age groups.5 The reasons for the increase in osteoporotic fractures are not known. For hip fractures, the usual explanations are decreased bone mass and density (decreased bone strength) and the increased propensity of elderly people to fall (impaired balance, coordination, reaction time, and muscle strength).5 In other words, it has been suggested that elderly people may be less healthy and functionally less capable today than in the past.
If the incidence of fractures continues to increase at the same rate the annual number of first osteoporotic fractures of the proximal humerus in Finland will be about 1000 by the year 2000. However, the largest Finnish age cohorts will reach the average age for osteoporotic fractures of the proximal humerus between the years 2020 and 2030, and thus the number of these fractures is expected to increase exponentially during this period. Therefore, vigorous preventive measures, such as preventing osteoporosis and falls in elderly people, should be urgently adopted to control the increasing burden of these age related fractures.
Funding The Finnish Ministry of Health.
Conflict of interest None.