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Changing rates in fracture trends are temporally associated with declining testing and treatment

reality or ecologic fallacy?

Wright, Nicole C.a; Blackston, J. Walkera; Saag, Kenneth G.a,b

Current Opinion in Rheumatology: May 2019 - Volume 31 - Issue 3 - p 316–320
doi: 10.1097/BOR.0000000000000596

Purpose of review The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a ‘crisis in the osteoporosis.’ We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data.

Recent findings Declines in hip fracture rates have been shown in studies from around the world. However, recently, using national Medicare data, Michael Lewiecki and colleagues show a plateau in the decline of hip fracture incidence in the United States from 2012 to 2015. Population-based data is integral for evaluating temporal trends; however, researchers must consider the biases associated with them including: age effects, period effects, and cohort effects. Rosengren and colleagues conducted the most comprehensive evaluation of age, period, and birth cohort effects in their study of hip fracture trends from 1987 to 2010 in Denmark and Sweden, in which they identified changes in hip fracture rates based on age, period, and cohort effects.

Summary Recent findings show clear temporal trends in changing fracture rates. Studies, which evaluated these biases largely attribute increased hip fracture rates to various age, period, and cohort effects, highlighting the importance of appropriate screening and treatment.

aDepartment of Epidemiology

bDivision of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

Correspondence to Nicole C. Wright, PhD, MPH, 1665 University Blvd., RPHB 230N, Birmingham, AL 35294, USA. Tel: +1 205 975 7686; e-mail:

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