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Abstract
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I am writing to you regarding the article titled 'Trends in prevalence of fractures among adults in the United States, 1999-2020: a population-based study' by Bin Xu et al.1, published on 3rd November in the International Journal of Surgery. As a clinical orthopedist with a focus on epidemiological studies, I have read the article with great interest, particularly the methodology pertaining to the prevalence estimates of hip, wrist, and vertebral fractures among U.S. adults.
The authors presented unadjusted prevalence rates as endorsed by Lesko et al.2. Their findings indicate a significant increase in wrist and vertebral fractures over two decades, while hip fractures remained stable. Yet, the NHANES (National Health and Nutrition Examination Survey) guidelines advise weighted analyses due to its complex sampling design, which is essential for accurate U.S. population representation - something the unadjusted figures might not fully capture due to the oversampling of certain subgroups3. The complex, multistage probability sampling design necessitates the use of weighted analysis to ensure that the estimates are representative of the U.S. population. Unadjusted estimates may not accurately reflect the prevalence due to the oversampling of certain subpopulations within NHANES.
To address this, we have conducted a weighted analysis of the NHANES data from 1999 to 2020. In our weighted analysis of the same NHANES data, there is a discernible rise in overall fracture prevalence, from 8 to 14%. Notably, hip fractures increased from just over 2% to nearly 3%, and wrist fractures surged from ~7 to 11%. Spine fractures also showed a moderate increase. These results, depicted in Figure 1, offer a different perspective on the fracture trends among U.S. adults.
Further examination reveals that adults over 65 are twice as likely to suffer hip fractures as those aged 50-64. There are also marked differences across races and ethnicities, with non-Hispanic Whites exhibiting a higher prevalence of wrist and spine fractures compared to Mexican American and non-Hispanic Black populations (Table 1). These insights align with those of Bin Xu et al. and underscore the necessity for fracture prevention strategies tailored to different demographic groups, paving the way for personalized healthcare interventions. ...
Language: en |