What is the burden of fractures for a nation? An analysis of statutory health insurance cases in Germany.

Introduction: Fractures represent a major clinical and socioeconomic burden; however, existing epidemiological data in Germany are largely based on inpatient cohorts and may underestimate the true incidence by omitting conservatively managed cases. This study aimed to quantify the national burden of fractures using nationwide outpatient statutory health insurance data. Methods: A retrospective analysis of nationwide outpatient billing data from the Central Institute for Statutory Health Insurance Physicians (ZI) was conducted, covering approximately 90% of the German population. All ICD-10 fracture diagnoses recorded between 2015 and 2022 were included. To avoid double-counting, repeated documentation of identical diagnoses within four consecutive quarters was excluded. Incidence rates were calculated per 100 000 inhabitants using population data from the Federal Statistical Office. Fractures were analysed by anatomical site, age and sex using descriptive epidemiological methods. Results: A total of 18 171 815 fractures were identified between 2015 and 2022. In 2022, 2 400 606 fractures were recorded, corresponding to an incidence of 2845.71 per 100 000 inhabitants. Overall fracture incidence increased by 7.5% during the study period, with a temporary decline in 2020 followed by a rebound in subsequent years. The most frequent fracture sites were the distal radius, toes, fingers, ribs and lumbar spine. The largest relative increases were observed for distal femur (+38.7%), pelvic ring (+37.1%) and cervical spine fractures (+36.9%). Fracture incidence was higher in females than in males and increased markedly with age, particularly in individuals aged ≥65 years. Conclusions: This nationwide analysis demonstrates a growing fracture burden in Germany, particularly among older adults. Outpatient data provide a comprehensive perspective on fracture epidemiology beyond surgically treated cases. These findings highlight the need for improved strategies in fracture prevention and outpatient care, and underline the importance of integrating inpatient and outpatient data for future health policy planning.