Secular Trends of Hip Fractures in Lebanon: A 2011–2020 MoPH Registry-Based Analysis

Abstract

Hip fractures are among the most serious consequences of osteoporosis in older adults, leading to hospitalization, functional decline, mortality, and substantial healthcare burden. Lebanon is one of the few countries in the Middle East and North Africa region with registry-based hip fracture data, but updated estimates are needed to refine national incidence rates, assess recent secular trends, and inform fracture risk prediction tools and health policy. This thesis aimed to examine secular trends in hip fracture incidence among Lebanese adults aged 50 years and older between 2011 and 2020 using data from the Lebanese Ministry of Public Health hip fracture registry, while applying refined methods to improve case ascertainment and reduce duplicate counting. We conducted a retrospective population-based analysis of national administrative data from the Ministry of Public Health hip fracture registry. Eligible cases included Lebanese adults aged ≥50 years admitted with hip fracture between 2011 and 2020. We identified hip fracture cases using ICD-10 codes and refined the process through matching relevant Current Procedural Terminology codes. A unifying patient identifier was used to distinguish incident hip fracture events from duplicate admissions and repeat fractures. We estimated crude, age-specific, sex-specific, and age-standardized incidence rates per 100,000 population. Age-standardized rates were estimated using the United Nations 2015 world population. We assessed temporal trends using period comparisons, annual percent change (APC), and joinpoint regression. We also compared our findings to regional estimates. We also investigated the effects of age, sex and time period on the incidence rates using multivariable regression analysis. Sensitivity analysis was conducted using different case ascertainment approaches for comparison. A total of 8,613 hip fracture events were identified among 8,195 Lebanese individuals aged ≥50 years during 2011–2020. 418 refracture events occurred, with 4.8% of patients sustaining at least one subsequent fracture; 54.5% of recurrent fractures occurred within the first year after the index fracture. Hip fracture incidence increased markedly with age and remained consistently higher in women than in men throughout the study period. Crude rates ranged between 191-274 per 100,000 in women and 94-146 per 100,000 in men with both rates increasing markedly in the period between 2017-2020. In women, annual age-standardized rates generally exceeded 200 per 100,000 and increased in the later years, reaching approximately 255 per 100,000 in 2020. In men, rates were lower and ranged from approximately 65 to 92 per 100,000, with an increase observed toward the end of the study period. APC analysis showed a significant upward shift in rates in women in the period between 2017-2020. Joinpoint regression suggested a non-significant decline between 2011 and 2018, followed by a significant increase between 2018 and 2020. In multivariable models, age, sex, and period were significant predictors of incidence, while temporal changes were generally similar in men and women. Compared with regional estimates, Lebanon’s age-standardized rates fell within the range reported in selected Middle Eastern countries, with women consistently showing higher rates than men. Hip fracture incidence in Lebanon among adults aged ≥50 years remains strongly age-dependent and consistently higher in women than in men. After a period of relative stability or modest decline, incidence increased in the later years of the study, particularly after 2018. The identification of early recurrent fractures highlights an important window for secondary prevention. These findings provide updated national estimates that may support recalibration of fracture risk prediction tools, inform cost-effectiveness analyses, and guide policies aimed at improving osteoporosis care, fracture prevention, and post-fracture management in Lebanon and the region.