Secular trends of hip fractures in Lebanon 2006-2017: Implications for clinical practice and public health policy in the Middle East region

Abstract

Country-specific hip fracture incidence rates (IRs) and longevity allow FRAX to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are non-existent. Using the Ministry of Public Health hip fracture registry, we calculated age and sex-specific hip fracture IRs in Lebanon, from 2006-2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006-2008). The registry recorded 6,985 hip fractures, 74% at the femoral neck, 23% inter-trochanteric, and 3% sub-trochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years vs. 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range 1.5-2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006-2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator.