# Epidemiology of hip fractures in Costa Rica and development of country- specific thresholds to estimate fracture risk

## TL;DR

This paper studies hip fracture rates in Costa Rica and creates a country-specific model to better assess and manage fracture risk.

## Contribution

The paper introduces a Costa Rica-specific FRAX® model calibrated with national data to estimate fracture risk.

## Key findings

- Hip fracture incidence in Costa Rica is higher in women and increases with age.
- Costa Rica has higher fracture rates than neighboring Latin American countries.
- Hip fractures are projected to rise from 3,176 in 2020 to 9,946 by 2050.

## Abstract

A country-specific FRAX® model for Costa Rica was developed using national hip fracture data from 2015–2019. Hip fracture incidence increased with age, was consistently higher in women, and exceeded rates reported in neighboring Latin American countries. Costa Rica also demonstrated higher 10-year major osteoporotic fracture probabilities at older ages compared with regional FRAX® models. An estimated 3,176 hip fractures occurred in 2020, with projections indicating an increase to 9,946 cases by 2050. These findings underscore the growing burden of hip fractures in Costa Rica and the need for targeted prevention strategies.

To describe the epidemiology of hip fractures in Costa Rica and to develop a country-specific FRAX® model calibrated with national fracture and mortality data.

All hip fractures (ICD-10 S72.0, S72.1, S72.2) recorded in the Caja Costarricense de Seguro Social registry from 2015–2019 were included. Age- and sex-specific incidence rates were combined with United Nations mortality data to construct a Costa Rica–specific FRAX® model. Ten-year fracture probabilities were estimated and compared with those from other Latin American countries with calibrated FRAX® models. National projections for hip fracture burden in 2020 and 2050 were derived using United Nations population forecasts. Age-specific FRAX® assessment and intervention thresholds were developed following established international methodology.

Hip fracture incidence increased with age and was consistently higher in women than in men. Compared with other Latin American countries, Costa Rica demonstrated higher age-specific hip fracture rates and higher 10-year major osteoporotic fracture probabilities at older ages. An estimated 3,176 hip fractures occurred in adults aged ≥ 50 years in 2020, with a projected increase to 9,946 by 2050. Age-specific FRAX® threshold curves showed widening separation with advancing age, reflecting increasing fracture probability in older age groups.

Costa Rica exhibits a comparatively high burden of hip fractures and fracture risk, which is expected to rise substantially with population aging. The newly developed Costa Rica–specific FRAX® model provides an essential tool for improving fracture risk assessment and guiding evidence-based osteoporosis management in clinical practice.