Using national discharge and medical claims data, we studied the epidemiology of femoral fractures from 1996 to 2006. The annual hip fracture incidence declined from 600/100,000 to 400/100,000, without decline in the more rare femur fractures. Incidence rates for subtrochanteric and femoral shaft fractures were each below 20 per 100,000.

The aim of treatment of postmenopausal osteoporosis is to reduce the frequency of vertebral and non-vertebral fractures (especially at the hip), which are responsible for morbidity associated with the disease. Results of large placebo controlled trials have shown that alendronate, raloxifene, risedronate, the 1–34 fragment of parathyroid hormone, and nasal calcitonin, greatly reduce the risk of vertebral fractures. Furthermore, a large reduction of non-vertebral fractures has been shown for alendronate, risedronate, and the 1–34 fragment of parathyroid hormone. Calcium and vitamin D supplementation is not sufficient to treat individuals with osteoporosis but is useful, especially in elderly women in care homes. Hormone replacement therapy remains a valuable option for the prevention of osteoporosis in early postmenopausal women. Choice of treatment depends on age, the presence or absence of prevalent fractures, especially at the spine, and the degree of bone mineral density measured at the spine and hip. Non-pharmacological interventions include adequate calcium intake and diet, selected exercise programmes, reduction of other risk factors for osteoporotic fractures, and reduction of the risk of falls in elderly individuals.

Purpose: Recent studies have indicated that statins may reduce the risk of colorectal cancer. In the high-risk IBD population, analysis of the effect of statins has been limited by small sample size. We examined statins and CRC risk in non-IBD and IBD populations using two large administrative claims databases. Methods: CRC cases were defined as patients ages 18 and older, with newly diagnosed CRC between 1/1/01 and 12/31/03. The CRC diagnosis was validated by examining for evidence of a colonoscopy or bowel surgery ±60 days from the diagnosis date. Extent of statin therapy was measured during a 12-month period prior to the CRC diagnosis date. For each case, 20 control patients who were continuously enrolled between 1/1/00 and 12/31/03 and who had no record of CRC or bowel surgery were randomly selected, and matched by age, gender, and calendar year on the CRC diagnosis date. We matched 20 controls to cases in order to enrich the control group with IBD patients. Odds ratios were computed using conditional logistic regression models and adjusting for age; gender; ever use of NSAIDs, glucocorticosteroids, immunomodulators, and 5-ASAs; hospitalization; physician visits; and colonoscopy 61–365 days before the CRC diagnosis date. Results: A total of 18,440 CRC cases and 368,800 matched controls were identified. Of these, 364 CRC cases and 1,172 controls were diagnosed with IBD (ulcerative colitis and/or Crohn's disease). Among non-IBD patients, ever use of statins resulted in a modest reduction of CRC (adj OR = 0.92, 95% CI = 0.89–0.96). A nonstatistically significant risk reduction among ever users of statins was observed in the IBD patient population (adj OR = 0.74, 95% CI = 0.52–1.05). Increasing the number of prescriptions for statins in the non-IBD population showed a slight directional benefit compared to non-users of statins (1–2 prescriptions, adj OR = 1.00, 95% CI = 0.93–1.08; 3–4 prescriptions, adj OR = 1.01, 95% CI = 0.98–1.04; and ≥5 prescriptions, adj OR = 0.90, 95% CI = 0.88–0.93; trend p-value = 0.02). Limited sample size precluded our ability to assess trend among IBD patients. Conclusions: This large case-control study shows a modest reduction in the risk of CRC among non-IBD patients receiving statins, but the association was not confirmed in IBD patients. It is possible that carcinogenic factors present in IBD may be greater or work by a different mechanism than the possible chemopreventive effect of statins.

Purpose: To determine whether inflammatory bowel disease (IBD) patients have an increased risk of vertebral and non-vertebral fragility fractures compared to a non-IBD population. Methods: Fracture cases were defined as patients ≥18 years of age with a newly diagnosed vertebral or non-vertebral fragility fracture between 1/1/01 and 6/30/03 (index date) in the Ingenix Lab/Rx Database™ and between 1/1/01 and 12/31/02 (index date) in the Medstat MarketScan Database®. We identified fragility fractures by only including patients with closed fractures, and excluding patients with a record of malignant neoplasm and/or trauma ‘E codes’ at any point. A vertebral fracture diagnosis was validated with a record of a radiologic examination ±15 days from the diagnosis date. For each case, 1 control patient with no record of a vertebral or non-vertebral fracture was randomly selected, and matched by age (±2 years), gender, and calendar year. IBD patients were identified by having a diagnosis of ulcerative colitis or Crohn's disease or ≥2 5-ASA prescriptions in the year prior to the index date. Odds ratios were computed using conditional logistic regression models and adjusting for age, gender, and glucocorticosteroid use in the 12 months prior to the index date. Results: After combining both databases, a total of 141,266 fragility fracture cases and 141,266 matched controls were identified. Of these, 1,126 fracture cases and 696 controls were diagnosed with IBD. Overall, IBD patients appeared to have a 62% higher risk for fracture (OR = 1.62, 95% CI = 1.47–1.78). After adjusting for age, gender, and glucocorticosteroid use, the risk remained elevated (adjusted OR = 1.46, 95% CI = 1.33–1.61). Based on crude odds ratios, ulcerative colitis patients were 55% more likely to develop a fracture compared to non-IBD patients (OR = 1.55, 95% CI = 1.33–1.79), and Crohn's disease patients were more than 70% more likely to have a fracture versus non-IBD patients (OR = 1.71, 95% CI = 1.46–2.00). Conclusions: The results of this case-control study suggest an increased risk of fragility fractures among IBD patients, even after adjusting for glucocorticosteroid use. It will be important to assess the effect of fracture-prevention treatment in an IBD population.