Forecasting the burden of hip fracture in Norway towards 2050 by educational level: The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).

Aims: Hip fracture burden is expected to increase due to the ageing population. Given that hip fracture incidence differs by educational attainment, and that a shift in the older population's educational level will manifest itself in coming decades, we investigated future hip fracture trends in Norway and their variation by attained educational level.

Methods: Estimated annual hip fracture numbers in the population aged 50+ years in 2020-2050 were based on information from the Norwegian Epidemiologic Osteoporosis Studies hip fracture database and official population projections from Statistics Norway. Projected educational attainment was obtained from the Wittgenstein Centre for Demography and Global Human Capital. We explored two scenarios: first, assuming that the observed 2019 rates remain constant until 2050, and second, assuming a continuing rate of decline corresponding to that observed during 1999-2019.

Results: The projections showed that the annual number of hip fractures will increase by 91% in women and 131% in men given constant sex- and age-specific rates, and by 27% in women and 66% in men given declining rates. The majority of hip fractures are expected in the group with secondary education, however, the numbers will increase steeply in people with tertiary education due to the temporal shift in educational attainment.

Conclusions: The annual number of hip fractures may double by 2050, placing high demands on the healthcare services. The majority of hip fractures are projected to occur in people with secondary and tertiary education. It is vital to intensify preventive efforts, not least in the high-risk populations.