Epidemiological trends and treatment patterns of hip fractures in Japan: A 26-year nationwide survey (1998-2023).
BACKGROUND Japan is one of the most rapidly aging countries in the world, making long-term monitoring of hip fracture trends crucial for health policy. This study aimed to analyze changes in the epidemiology and treatment patterns of hip fractures using nationwide survey data from 1998 to 2023. METHODS Annual surveys were conducted from 1998 to 2023, targeting Japanese Orthopaedic Association-certified training facilities and clinics with inpatient facilities affiliated with the Japanese Clinical Orthopaedic Association. We registered femoral neck and trochanteric fractures in patients aged ≥35 years and collected data on age, sex, fracture type, injury circumstances, treatment methods, hospital stay duration, and age-adjusted incidence rates. RESULTS The total number of cases increased 3.5-fold, from 35,333 in 1998 to 122,940 in 2023. The mean age rose from 78.7 to 83.3 years, with cases aged ≥90 years showing a 37-fold increase. Age-adjusted incidence rates in women peaked around 2015, declined by 2020, and recently plateaued. In men, marked increases were observed from 2005 to 2015, particularly in those aged ≥80 years, with high levels continuing through 2020-2023, showing age-class-specific stability or slight variations. The femoral neck/trochanteric fracture ratio reversed from 0.78 to 1.10, and femoral neck fractures became predominant after 2020. The operative treatment rate was 94.7% in 2023, with a mean preoperative waiting time of 4.0 days. Indoor injury rates increased from 63.6% to 77.2%, whereas hospital stays decreased by 36.1% from 54.8 to 35.0 days. CONCLUSIONS This 26-year continuous survey revealed a marked increase in hip fractures, particularly in the super-elderly population. While healthcare efficiency has improved, further enhancements are necessary to address anticipated future increases. Hip fracture incidence appears to plateau in women while remaining relatively high in men, indicating the need to strengthen primary and secondary prevention strategies for male osteoporosis.