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Extremity fracture hospitalizations and related deaths have declined overall in older adults, especially among women. But the number of hospitalizations for certain fracture types appears to be increasing in this age group, pointing to the need for more post-acute rehabilitation options in the future.

That’s according to a study examining fracture hospitalizations in older adults from 2003 to 2017, the first U.S. study to do so, investigators say. The researchers attribute the overall decline to fewer low-energy femur fractures, predominantly falls from standing height (which they said account for 65% of all fracture hospitalizations).

In women aged 75 years and older, declines also may be due to the use of preventive osteoporosis drugs (bisphosphonates), which is more common in women than men, and a shift toward treating some fractures in outpatient settings.

The declines are encouraging, but other fracture hospitalization trends increased during the same time period, reported first author Lisa Reider Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore. Incidences of high-energy fractures — caused by events such as car accidents or falls from high heights — have risen in men, for example. And hospitalizations for multiple fractures also have trended upward, a shift that again was more pronounced among men than women. 

One possible explanation for the increase in high-energy injury hospitalizations in men may be the improved health of some older adults, which enables them to continue engaging in physically demanding, higher-risk activities, the researchers said. 

And in addition to these increases, there also was an overall uptick in the incidence of extremity fracture hospitalizations of the tibia/fibula, foot, shoulder/upper arm, and wrist. What’s more, approximately 80% of fracture hospitalizations are due to lower extremity fractures, “which are particularly disabling due to weight bearing restrictions and need for assistive devices,” the researchers noted. 

“The increasing incidence of fracture hospitalization from high-energy injuries among men suggests that older adults with complex injuries will be seen with more prevalence in the future,” Reider and colleagues predicted.

Those trends, coupled with the decline in fracture-related deaths, may predict a growing need for fracture-related rehabilitation and recovery care, Reider and colleagues concluded.

Among other study results:

  • Incidence of fracture hospitalization was consistently highest for those aged 85 and older — both men and women. 
  • Incidence of hospitalization for high-energy injuries increased 20% among men aged 65 to 74 years and 10% in men aged 75 to 84 years, but not in women.
  • Among women, incidence of hospitalization for low-energy injuries declined 10% in women aged 85 years and older but was more stable in the 65-to-74 age range.

Full findings were published in the Journal of the American Geriatrics Society.