Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD: Find out more at: https://nos.org.uk/conference

1. Variation in UK fracture incidence by age, sex,
geography, ethnicity, socioeconomic status
and time: Results from the UK CPRD
Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P
W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,
Cyrus Cooper*,Nicholas C Harvey*
*CC and NCH are joint senior author
Presenter Disclosure Information:
This speaker has no conflicts of interest

2. Background
• Economic and personal costs of
osteoporotic fracture
substantial– 37bn Euros, 1.18m
QALYs lost annually1
• Large variability in fracture
incidence worldwide –
differences according to
geography, ethnicity,
socioeconomics2
• Last study in UK published 20013
– current study 1988-20124 1. Hernlund et al, Arch Osteoporos, 8 (2013) 136.
2. Kanis et al, Osteoporos Int. 23 (2012) 2239-2256.
3. Van Staa et al, Bone 29 (2001) 517-522.
4. Curtis EM et al., Bone 87 (2016) 19-26

3. Aim
• To describe the incidence of fracture in the
UK by age, sex, fracture site, geographic
location, socioeconomic status, ethnicity
and calendar time

4. • UK Clinical Practice Research Datalink - anonymised electronic patient
records collected by General Practitioners
• Approximately 6.9% of the UK population, with representative
demographics
• Data stored as READ codes referenced to ICD-9, validated fracture
outcomes4; standardised ethnicity5
• All individuals aged >18 yrs with a fracture recorded on GP records
between 1988-2012 included in analysis
• Incidence calculated (per 10,000 py) by age, sex, fracture site, ethnicity,
socioeconomic status, geographic location, calendar period
https://www.cprd.com/home/
4. Van Staa, Pharmacoepidemiol Drug Saf. 9 (2000) 359-366
5. Mathur et al, J Public Health (Oxf). 36 (2014) 684-692
Methods

5. Age- and sex-specific fracture incidence rate at
any site among UK adults, 1988-2012
0
50
100
150
200
250
300
350
400
450
25 30 35 40 45 50 55 60 65 70 75 80 85 90 90+
Incidence/10,000personyears
Age category
male
female
18-49 years 121219 94.8 78265 54.3
50+ years 75331 71.8 185267 155.4
Curtis EM et al., Bone 87 (2016) 19-26
Total follow-up time:
Men = 23,285,904 py
Women = 26,342,685 py

6. Regional variation in fragility fracture incidence
in men and women aged 50+ years within the UK
Relative rates of fracture are
displayed in comparison to
London
Differences keeping with
patterns of socioeconomic
status, rural population,
possibly ethnicity
differences, falls, vitamin D
deficiency
Fragility fracture: spine,
hip, wrist, rib, pelvis, and
humerus
Curtis EM et al., Bone 87 (2016) 19-26

7. Socioeconomic status and fracture incidence in
UK men and women aged 50+ years
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1 2 3 4 5
Relativerateoffracture
Index of Multiple Deprivation Category
Fragility
Men
Women
IMD 5 = most deprived
Curtis EM et al., Bone 87 (2016) 19-26
RR fracture hip fracture
males category 5= 1.3
Possible causes: smoking,
alcohol, diet, prevalence of
obesity, influence of manual
work may account for sex
differences

8. Incidence of fragility and femur/hip by ethnicity
in UK men and women aged 50+ years
Black 88 15.75 149 22.26
Mixed 22 17.37 77 50.12
South Asian 289 26.85 491 44.46
Other/ unknown 20883 36.19 59824 97.23
White 25285 41.74 71081 104.03
Black 26 4.57 44 6.45
Mixed 4 3.07 14 8.77
South Asian 68 6.15 115 10.03
Other/ unknown 6767 11.13 22390 33.52
White 7901 12.27 24520 32.61
Curtis EM et al., Bone 87 (2016) 19-26

9. Incidence of fragility fractures in UK men and
women, 1990-2012
+
+
+
+
-
+
-
-
+

10. Conclusions
• Up to date age- and sex-specific fractures rates for the UK
presented
• Marked variation in rates by geographic location,
socioeconomic status and ethnicity
• Reasons for differences likely multiple (e.g. diet, lifestyle,
adiposity, BMD, bone geometry)
• In contrast to the plateau/decrease in hip fracture rates
previously shown we observed an increasing rate in hip
fractures in men, and vertebral fractures in both men and
women
• Potential implications for healthcare planning in UK and
elsewhere

11. Acknowledgements
Supervisors:
Professor Nicholas
Harvey
Professor Cyrus
Cooper
Co-authors:
Dr R van der Velde
Dr R Moon
Dr J van den Bergh
Dr C Wyers
Dr P Geusens
Dr F de Vries
Prof T van Staa

12. Variation in UK fracture incidence by age, sex,
geography, ethnicity, socioeconomic status
and time: Results from the UK CPRD
Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P
W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,
Cyrus Cooper*,Nicholas C Harvey*
*CC and NCH are joint senior author
Presenter Disclosure Information:
This speaker has no conflicts of interest