Updated incidence and costs of hip fractures in elderly Italian population



We aimed at updating our previous researches about the burden of hip fractures in elderly Italian population.


We analyzed national hospitalizations records from 2000 to 2014 to compute age- and sex-specific standardized rates.


1,335,375 hospitalizations were recorded in people ≥ 65 (1,031,816 women: 77.27% and 303,559 men: 22.73%) over 15 years, passing from 73,493 in year 2000 to 94,525 in 2014, with an overall increase of 28.62% over the 15-year period (females: + 25.1%; males: + 41.2%). About 84.9% of total hip fractures were suffered by patients aged ≥ 75 years old. Direct hospitalization costs and rehabilitation costs increased from 343 to 457 million Euros and from 392 to 504 million Euros from year 2000 to 2014, respectively. Overall costs of hip fractures raised from 735 to 961 million Euros (+ 30.74% from 2000 to 2014).


The number of hip fractures and related hospitalizations costs in Italian elderly population is still increasing due to the absolute number of fractures occurring in people ≥ 65 years old and particularly over 75 years old.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Kanis JA, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428. https://doi.org/10.1007/s00198-008-0560-z

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Piscitelli P, Iolascon G, Gimigliano F et al (2007) Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey. Osteoporos Int 18:211–219. https://doi.org/10.1007/s00198-006-0224-9

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Bouee S, Lafuma A, Fagnani F et al (2006) Estimation of direct unit costs associated with non-vertebral osteoporotic fractures in five European countries. Rheumatol Int 26:1063–1072. https://doi.org/10.1007/s00296-006-0180-x

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S

    CAS  Article  Google Scholar 

  5. 5.

    Piscitelli P, Brandi ML, Tarantino U et al (2010) Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003–2005. Reumatismo 62:113–118

    CAS  PubMed  Google Scholar 

  6. 6.

    Piscitelli P, Chitano G, Johannson H et al (2013) Updated fracture incidence rates for the Italian version of FRAX(R). Osteoporos Int 24:859–866. https://doi.org/10.1007/s00198-012-2021-y

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Piscitelli P, Gimigliano F, Gatto S et al (2010) Hip fractures in Italy: 2000–2005 extension study. Osteoporos Int 21:1323–1330. https://doi.org/10.1007/s00198-009-1084-x

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kanis JA, Oden A, McCloskey EV et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256. https://doi.org/10.1007/s00198-012-1964-3

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Cooper C, Cole ZA, Holroyd CR et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288. https://doi.org/10.1007/s00198-011-1601-6

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Piscitelli P, Feola M, Rao C et al (2014) Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women. World J Orthop 5:386–391. https://doi.org/10.5312/wjo.v5.i3.386

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Piscitelli P, Camboa P, Forcina B et al (2006) Incidence and costs of hip fractures vs acute myocardial infarction among population of Local Health Authorities Lecce/1 and Lecce/2: a two years survey. Ital J Public Health 3:75–77

    Google Scholar 

  12. 12.

    Tediosi F, Bartolacci S, Roti L et al (2003) La valutazione economica dei percorsi assistenziali dei soggetti con Ictus e Frattura del femore in Toscana: risultati di uno studio pilota. Mecosan 48:21–32

    Google Scholar 

  13. 13.

    Tediosi F, Bartolacci S, Roti L et al (2004) L’assistenza ospedaliera e riabilitativa per le fratture osteoporotiche in Toscana. Politiche sanitarie 5:61–69

    Google Scholar 

  14. 14.

    Visentin P, Ciravegna R, Fabris F (1997) Estimating the cost per avoided hip fracture by osteoporosis treatment in Italy. Maturitas 26:185–192

    CAS  Article  Google Scholar 

  15. 15.

    Tarantino U, Piscitelli P, Feola M et al (2018) Decreasing trend of hip fractures incidence in Italy between 2007 and 2014: epidemiological changes due to population aging. Arch Osteoporos 13:23. https://doi.org/10.1007/s11657-018-0423-y

    Article  PubMed  Google Scholar 

  16. 16.

    Compston J (2004) Action plan for the prevention of osteoporotic fractures in the European community. Springer, Berlin

    Book  Google Scholar 

  17. 17.

    Piscitelli P, Brandi M, Cawston H et al (2014) Epidemiological burden of postmenopausal osteoporosis in Italy from 2010 to 2020: estimations from a disease model. Calcif Tissue Int 95:419–427. https://doi.org/10.1007/s00223-014-9910-3

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Autier P, Haentjens P, Bentin J et al (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 11:373–380

    CAS  Article  Google Scholar 

  19. 19.

    Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8:611–617. https://doi.org/10.1007/s001980050107

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Hernandez JL, Olmos JM, Alonso MA et al (2006) Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int 17:464–470. https://doi.org/10.1007/s00198-005-0008-7

    Article  PubMed  Google Scholar 

  21. 21.

    Johnell O, Gullberg B, Allander E et al (1992) The apparent incidence of hip fracture in Europe: a study of national register sources. Osteoporos Int 2:298–302

    CAS  Article  Google Scholar 

  22. 22.

    Mann E, Icks A, Haastert B et al (2008) Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatr 8:35. https://doi.org/10.1186/1471-2318-8-35

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Ray NF, Chan JK, Thamer M et al (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35. https://doi.org/10.1359/jbmr.1997.12.1.24

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Vestergaard P, Rejnmark L, Mosekilde L (2008) Strongly increasing incidence of hip fractures in Denmark from 1977 to 1999]. Ugeskr Laeger 170:621–623

    PubMed  Google Scholar 

Download references


The authors are grateful to the Department of Studies and Documentation of the Italian Ministry of Health (Direzione Generale del Sistema Informativo-Coordinamento e Sviluppo NSIS) for having provided the data from the National Hospitalizations Database (SDO). The authors are also grateful to the Laboratory of Health Economics of Foggia University, to the ISBEM Research Centre and to the Division of Orthopaedics and Traumatology, Tor Vergata Foundation University Hospital, University of Rome Tor Vergata (Rome, Italy) for the medical writing and editorial work.

Author information




UT, PP, MF, CN, ER, AA, CR, have conceived the study and participated in its designed coordination and helped to draft the manuscript. UT, PP, MF, CN, AM, ER, AA, CR, MR, AD, SE all participated to draft the manuscript and performed all the analyses and statistics of the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Prisco Piscitelli.

Ethics declarations

Conflict of interest

UT and GI has received research grant and funding for consulting/speaking by Merck, Sanofi-Aventis, Novartis, Stroder-Servier, Ely Lilly, Roche, Glaxo; Nicomed; PP, CN, MF, ER, AA, MA, MR, CR, AM, AD, SE: no disclosures.

Statement of human and animal rights

No animal or human rights were addressed for the purpose of this study.

Informed consent

No informed consent was needed, as this is a mere observational and statistical research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Piscitelli, P., Neglia, C., Feola, M. et al. Updated incidence and costs of hip fractures in elderly Italian population. Aging Clin Exp Res 32, 2587–2593 (2020). https://doi.org/10.1007/s40520-020-01497-0

Download citation


  • Hip fractures
  • Osteoporosis
  • Hospitalizations
  • Incidence
  • Costs