Life expectancy is rising more rapidly in Africa than any other continent globally, and a new study published in the journal Osteoporosis International, has shown that this will mean a drastic increase in the number of people breaking a hip in South Africa, from current levels of approximately 11,000, to over 26,000 per year by 2050.

The research was led by the University of Bristol, and funded by The Wellcome Trust in partnership with the UK National Institute for Health Research (NIHR), with additional funding from the University of Kwazulu-Natal and the South African Medical Research Council (MRC). The investigation formed part of the Fractures-E3 research study of the Epidemiology, Economic impact and Ethnography of bone fractures in Sub-Saharan Africa.

Hip fractures are devastating injuries, which can lead to long periods in hospital, large declines in quality of life due to loss of independence, and can often cause people to die. Dr Sapna Dela, from the University of KwaZulu-Natal and co-lead author, and her team collected data on 2,767 patients admitted with a hip fracture during a 1-year period, from nearly 100 hospitals across three provinces of South Africa. The team were interested to find out how many hip fractures occurred in men and women as they age, so that they could calculate incidence rates (the frequency) of hip fracture, as such data are scarce. Researchers then merged these rates with future population projections for South Africa to calculate the number of people expected to break a hip each year over the coming decades.

The investigation found current rates of hip fracture to be higher than previously thought in South Africa. By 2050 the number of hip fractures occurring each year in South Africa is expected to more than double among both women and men to 18,644 and 7,754, respectively. Rates vary by ethnicity, being approximately 3-fold higher in the White compared to Black ethnic group, although the majority of the overall number of hip fractures occur in those who are Black, given that Black Africans make up 79% of the South Africa’s population of 52 million.

Dr Samuel Hawley, Research Fellow in the Musculoskeletal Research Unit at the University of Bristol in the UK and lead author of the study, explained: “This increase in number of people breaking their hip means fractures at other skeletal sites are almost certainly set to rise too. It reflects the transition underway in Sub-Saharan Africa towards increased age-related comorbidity and non-communicable diseases. It will be very interesting to see the other data being collected as part of the Fractures-E3 programme – particularly those on risk factors for fracture – as these should help in the identification, treatment and prevention of these debilitating injuries.”

Professor Bilkish Cassim, Chief Specialist and Head of Geriatrics at the University of KwaZulu-Natal and an author on the study, explained: “Collection of these hip fracture data has enabled South Africa to launch the new freely-available online South African Fracture risk assessment tools – ‘FRAX’ (, which allows clinicians to assess a patient’s risk of hip fracture over the next 10 years. This important development, to guide treatment, should help us manage and mitigate against these fracture projections”.

Celia Gregson, Professor in Clinical Epidemiology and a Consultant Orthogeriatrician at the Musculoskeletal Research Unit at the University of Bristol in the UK, Honorary Associate Professor at The University of The Witwatersrand, and Chief Investigator of the Fractures-E3 programme, said: “The Fractures-E3 research study is a 5-year international collaborative programme of research that will determine, not just in South Africa, but also in Zimbabwe and The Gambia, the impact on patients, and costs to healthcare systems, of hip fractures. Such data are crucial to inform appropriate healthcare planning for the future”.

This work was supported by the National Institute for Health Research (NIHR) (using the UK’s Official Development Assistance (ODA) Funding) and Wellcome (217135/Z/19/Z) under the NIHR-Wellcome Partnership for Global Health Research.


 ‘Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050’ by Samuel Hawley, Sapna Dela, Anya Burton et al. in Osteoporosis International