Epidemiological (secular) trends of pelvic and acetabular fractures (2006-2022) in South Korea using a nationwide cohort data over ages 50: is it osteoporosis related?

Unlabelled: Osteoporotic pelvic and acetabular fractures (PAFs) rose significantly from 2006 to 2022, especially among those aged 80-89. Despite increased cases, one-year mortality rates declined from 7.29 to 4.59%. Findings highlight the need for early osteoporosis detection and targeted interventions to address aging demographics and evolving fracture trends.

Purposes: Osteoporotic fractures present a growing health challenge, especially in the context aging population. The purpose of our epidemiologic study was to determine the current trend in the number and incidence of pelvic and acetabular fractures (PAFs) providing an in-depth analysis of prevalence, demographic patterns, and related mortality.

Methods: This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database. Men and women who had pelvic and acetabular fractures, aged ≥ 50 years, between January 1 2006, and December 31 2022, were included. After proper identification using International Classification of Diseases, 10th revision (ICD-10) codes, we calculated absolute number and age-gender specific incidence rates for PAFs and one-year mortality rate following index fracture by sex and age groups.

Results: The total number of PAFs increased considerably during the study period, from 11,607 in 2006 to 35,691 in 2022, 207.5% per 16 years, an average increase of 12.9% a year. When analyzed by age groups, the total number of PAFs increased in all age groups, but showed the highest increase in 80-89. While the crude incidence of PAFs showed a consistency in 50-59, 60-69, and 70-79, a steady increase was noted in 80-89. The annual total mortality rates of PAFs within 1 year showed a decreasing trend from 7.29% in 2006 to 4.59% in 2022. When analyzed by age groups, the highest mortality rates were observed in the 80-89 age group, followed by 70-79, 60-69, and 50-59, with a consistent trend in the latter two age groups but a decreasing trend in the 80-89 age group.

Conclusion: The secular trend of PAFs reflects features typical of osteoporotic fractures, characterized by age- and gender-dependent pattern, while mortality rates are declining. With the increasing aggressive surgical interventions for PAFs, it is essential to detect osteoporosis early and implement targeted interventions for treatment and prevention in elderly patients.