Absolute Number Of Hip Fractures Research Articles

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults.

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults.

Analysis of Hip Fractures in France During the First COVID-19 Lockdown in Spring 2020

The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P < .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01; P = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92; P < .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71; P < .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79; P < .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54; P < .001) in private for-profit hospitals. In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.

Internal fixation implants for intracapsular hip fractures in older adults.

Internal fixation implants for intracapsular hip fractures in older adults.

Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study.

Hip fracture is a public health concern because of its considerable morbidity, excess mortality, great risk of disability, and high societal healthcare costs. China has the largest population of older people in the world and is experiencing rapid population aging and facing great challenges from an increasing number of hip fractures. However, few studies reported the epidemiology, especially at a national level. We aimed to evaluate trends in hip fracture incidence and associated costs for hospitalization in China. We conducted a population-based study using data between 2012 and 2016 from the national databases of Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance in China, covering about 480 million residents. Data from around 102.56 million participants aged 55 years and older during the study period were analyzed. A total of 190,560 incident hip fracture patients (mean age 77.05 years, standard deviation 8.94; 63.99% female) were identified. Primary outcomes included the age- and sex-specific incidences of hip fracture. Associated annual costs for hospitalization were also calculated. Incidence was described as per 100,000 person-years at risk, and 95% confidence intervals were computed assuming a Poisson distribution. Hip fracture incidence overall in China did not increase during the study period despite rapid population aging. Incidence per 100,000 was 180.72 (95% CI 137.16, 224.28; P < 0.001) in 2012 and 177.13 (95% CI 139.93, 214.33; P < 0.001) in 2016 for females, and 121.86 (95% CI 97.30, 146.42; P < 0.001) in 2012 and 99.15 (95% CI 81.31, 116.99; P < 0.001) in 2016 for males. For both sexes, declines in hip fracture incidence were observed in patients aged 65 years and older, although incidence was relatively stable in younger patients. However, the total absolute number of hip fractures in those 55 years and older increased about 4-fold. The total costs for hospitalization showed a steep rise from US$60 million to US$380 million over the study period. Costs for hospitalization per patient increased about 1.59-fold, from US$4,300 in 2012 to US$6,840 in 2016. The main limitation of the study was the unavailability of data on imaging information to adjudicate cases of hip fracture. Our results show that hip fracture incidence among patients aged 55 and over in China reached a plateau between 2012 and 2016. However, the absolute number of hip fractures and associated medical costs for hospitalization increased rapidly because of population aging.

Internal fixation implants for intracapsular hip fractures in adults

Internal fixation implants for intracapsular hip fractures in adults

Trend in the Age-Adjusted Incidence of Hip Fractures in South Korea: Systematic Review.

BackgroundThe incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures.MethodsWe have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study.ResultsThree eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001–2004, 2005–2008, and 2006–2010, respectively).ConclusionsThe age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.

Trends in hip fracture rates in Taiwan: a nationwide study from 1996 to 2010.

Fractures of the proximal femur remain a major cause of mortality and morbidity. We aimed to examine recent trends in hip fracture rates, in-hospital mortality rates, and length of hospital stay (LOS) due to hip fractures in people aged 55 and over in Taiwan. This is a time-trend study. We used data from the National Health Insurance Research Database between 1996 and 2010 in Taiwan. Insurants aged 55 and over were included. The outcome measures were age-adjusted hip fracture rates, age-adjusted in-hospital mortality rates, and LOS due to hip fractures. We classified hip fractures into femoral neck, trochanteric, and subtrochanteric fractures. We identified 250,919 hospitalizations for hip fractures. The total number of hip fractures increased steadily from 12,479 to 19,841 cases. There was a trend towards initial increase and then later decrease in hip fracture rates (from 457.9 to 390.0 fractures per 100,000 people per year). LOS decreased by 46.5% (17.53 to 9.38days). By contrast, mortality rates for hip fractures decreased initially, but re-emerged later with a total decrement of 15.5% (2.26 to 1.91 deaths per 100 hip fracture admissions). Women outnumbered men in all types of hip fractures, but men had higher in hospital mortality rates. LOS was similar between genders and among age groups. The turning point for change in trends was year 2003. While LOS shortened gradually since 1996, the absolute number of hip fractures in Taiwan continues to rise. There is still room for improvement in reducing mortality due to hip fractures.

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

SummaryThe aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness.IntroductionThe absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients.MethodsThe population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data.ResultsData of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %.ConclusionsThe main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-016-3484-z) contains supplementary material, which is available to authorized users.

Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010.

SummaryThe probability of initiating with anti-osteoporosis therapy increased from 7 % in 2000 to 46 % in 2010. This improvement was greater for patients over the age of 75 years. Men, those overweight, having dementia or exposed to antipsychotics, sedatives/hypnotics or opioid analgesics were significantly less likely to receive anti-osteoporosis drugs.IntroductionThe objective of this study was to examine trends and determinants of anti-osteoporosis drug prescribing after hip fracture in the UK between 2000 and 2010.MethodsData were extracted from the UK Clinical Practice Research Datalink for patients ≥50 years who had a first hip fracture between 2000 and 2010 and who did not currently (≤6 months prior) receive anti-osteoporosis drugs (bisphosphonates, strontium ranelate, parathyroid hormone, calcitonin and raloxifene) (n = 27,542). The cumulative incidence probability of being prescribed anti-osteoporosis drugs within 1 year after hip fracture was estimated by Kaplan-Meier life-table analyses. Determinants for treatment initiation were estimated by Cox proportional hazards models.ResultsThe probability of being prescribed any anti-osteoporosis drug after hip fracture increased from 7 % in 2000 to 46 % in 2010. This trend was more marked in patients ≥75 years. The increase in prescribing of anti-osteoporosis drugs was complemented by a similar increase in vitamin D/calcium provision. Cumulative incidence of receiving anti-osteoporosis therapy was greater at any given point in time in women (8 % in 2000, 51 % in 2010) compared to men (4 % in 2000, 34 % in 2010). In addition to male gender, multivariable Cox regression identified reduced likelihood of receiving anti-osteoporosis drugs for those being overweight, having dementia and exposed to psychotropic drugs (antipsychotics, sedatives/hypnotics) or opioid analgesics.ConclusionAlthough the prescribing of anti-osteoporosis drugs after hip fracture has increased substantially since 2000, the overall rate remained inadequate, particularly in men. With the continuing increase in the absolute number of hip fractures, further research should be made into the barriers to optimise osteoporosis management.

Nationwide cohort study of hip fractures: time trends in the incidence rates and projections up to 2035.

A growing elderly population is expected worldwide, and the burden of hip fractures on health care system will continue to increase. By 2035, there will be a 2.7-fold increase in the number of hip fractures in Taiwan. The study provides quantitative basis for the future distribution of medical resources. Hip fractures have long been recognized as a major public health concern. The study aimed to determine time trends in the incidence of hip fractures and to forecast the number of hip fractures expected in Taiwan up to 2035. A nationwide survey was conducted using data from the Taiwan National Health Insurance Research Database from 2004 to 2011. A total of 141,397 hip fractures were identified, with a mean of 17,675 fractures/year. Annual incidences of hip fractures were calculated and tested for trends. Projections of the incidence rates of hip fractures and bed days associated with hip fractures were calculated using Poisson regression on the historical incidence rates in combination with population projections from 2012 to 2035. The incidence rates of hip fracture during 2004-2011 were 317 and 211 per 100,000 person-years among women and men, respectively. Over this 8-year period, the age-standardized incidence of hip fracture decreased by 13.4% among women and 12.2% among men. Despite the decline in the age-standardized incidence, the absolute number of hip fractures increased owing to the aging population. The number of hip fractures is expected to increase from 18,338 in 2010 to 50,421 in 2035-a 2.7-fold increase. The number of bed days for 2010 and 2035 was estimated at 161,248 and 501,995, respectively, representing a 3.1-fold increase. The socioeconomic impact of hip fractures will be high in the near future. This study provides a quantitative basis for future policy decisions to serve this need.

Ten-year hip fracture incidence rate trends in older residents in a large Northern Italian region, 2001–2010

BackgroundWhile the total number of persons affected by hip fractures may be increasing over time in the next decades, due to the progressive aging of the population, incidence rates appear to be declining in most countries. The objective of this study is to describe annual hip fracture incidence rate trends in the Veneto Region, Italy, over a decade (2001–2010). MethodsAll incident hip fractures in men and women above or aged 65years old using ICD-9 diagnosis codes 820–820.9 in the Hospital Discharge Database were identified. Crude, sex- and age-specific and standardized annual incidence rates were calculated. ResultsThe median age of patients has increased from 82 to 84years in the last decade. The absolute number of hip fractures increased by 21%. The age-standardized hip fracture incidence rate for men increased from 304 per 100,000person-years in 2001 to 319 in 2010. For women, incidence declined from 787 in 2001 to 751 in 2010. Hip fracture rates decreased through the study period in the 65–74 age group, especially among females. In the age group 75–84, there was a clear increase up to 2004, then a progressive decline in both genders. Among subjects aged 85years or older, incidence rates were stable in women and showed a non-statistically significant increase in men. ConclusionThe aging of the population, with a rapid increase concentrated particularly in the oldest old segment, implies that the overall number of hip fracture will continue to represent a major public health challenge to health and social systems.

TRENDS IN HIP FRACTURE INCIDENCE RATES AMONG ELDERLY IN SWEDEN 1987–2009

BackgroundFalls are the most common cause of injury related hospital admission among elderly in Sweden and with an ageing population fears have been raised that fall-related admissions will increase, with...

Trends in hip fracture incidence rates among the elderly in Sweden 1987-2009

Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied. Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates. The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

The epidemic of hip fractures: are we on the right track?

BackgroundHip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population.Methods and FindingsSecular trend analysis of all hospitalizations in the older Dutch population (≥65 years) from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change −0.5%, 95% CI: −0.7; −0.3), compared with the period 1981–1993 (percentage annual change 2.3%, 95% CI: 2.0; 2.7). The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities.ConclusionsA trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

Changes in hip fracture rates in southeastern Australia spanning the period 1994–2007

Hip fracture incidence rates appear to be declining in Western populations. Utilizing comprehensive incident hip fracture data from radiology reports, we determined changes in hip fracture rates in southeastern Australia between 1994-1996 and 2006-2007 for residents aged 55 years or older. During this period, the population at risk increased by 47% for men and 40% for women. Although the absolute number of hip fractures increased by 53% in men and 4.4% in women, standardized hip fracture ratios were 0.92 [95% confidence interval (CI) 0.79-1.08] and 0.69 (95% CI 0.62-0.77), respectively. Marked reductions in hip fracture rates were observed for women: 32% for ages 75 to 84 years and 29% for ages 85 years or older. Data from the Geelong Osteoporosis Study were used to identify changes in body composition and lifestyle that might have influenced hip fracture risk in women during this period. Between 1993-1997 and 2004-2008, there was an increase in adiposity, bone mineral density (BMD), healthy lifestyles, and exposure to bone-active drugs; use of hormone therapy declined. Thus hip fracture incidence rates have decreased from the mid-1990 s to the mid-2000 s, the effect being greater among women. Our data also suggest that the recent increase in adiposity and consequent increase in BMD at the hip may have contributed to this decline. However, improved efficacy and increased uptake of antifracture drug treatments, other cohort effects, or other environmental influences cannot be excluded.

The hip fracture incidence curve is shifting to the right

Background The number of hip fractures has doubled in the last 30–40 years in many countries. Age-adjusted incidence has been reported to be decreasing in Europe and North America, but is there a decreasing trend in all age groups?Patients and methods This population-based study included all hip-fracture patients over 50 years of age (a total of 2,919 individuals, 31% of whom were men) admitted to Umeå University Hospital, Sweden, from 1993 through 2005.Results The incidence of hip fracture declined between the periods 1993–1996 and 2001–2005: from 706 to 625 hip fractures per 105 women and from 390 to 317 hip fractures per 105 men. However, there was a 114% increase in the number of fractures in women aged 90 or older (12 and 25 hip fractures/year, respectively, in the two time periods). For the period 2001–05, women ≥ 90 years of age accounted for almost the same numbers of hip fractures as women aged 75–79 (27 fractures/year). The rate increased during this period, from 2,700 per 105 women to 3,900 per 105 women > 90 years. In men there were declining trends for both relative and absolute numbers.Interpretation Although age-adjusted incidence declined in the population > 50 years of age, absolute fracture rate and incidence increased in the very old. Women over 90 now have the same absolute number of hip fractures every year as women aged 75–79 years. There was a right-shift in hip fracture distribution towards the oldest old, probably due to an increased number of octo/nonagenarians, a new population of particularly frail old people that hardly existed earlier. Better health among septuagenarians may also have delayed the age at which fractures occurred. This changing pattern will strain orthopedic and geriatric resources even more.

Incidence of hip fracture in the Republic of Ireland and future projections: a population-based study

There are no previously published data for hip fracture incidence rates in the Republic of Ireland. The rates of fracture for the total population aged 50 years and over were 407 and 140 per 100,000 for females and males, respectively. Assuming a stable incidence rate, the absolute number of hip fractures occurring on an annual basis is expected to increase by 100% by the year 2026. Health care providers should accommodate these increases into future strategies. Hip fractures are an important cause of morbidity in the elderly and represent an increasing burden on health service providers. Significant regional and international variation in incidence rates of hip fracture exists. In order for health service providers to be able to commit adequate resources to the care of hip fracture patients, accurate estimates of hip fracture numbers are required now and for the future. To date, there have been no reported incidence rates for hip fracture in the Republic of Ireland. We performed a search of the national hospital in-patient enquiry database for all hip fractures occurring in the Republic of Ireland between 2000 and 2004. Population data was obtained from the 2002 national census data. Population projections were made for the years 2016 and 2026 to allow determination of expected hip fracture numbers for those years. The rates of hip fracture in the Irish population aged 50 years and over were 407 and 140 per 100,000 for females and males, respectively. Annual hip fracture numbers are expected to increase by 100% by the year 2026, assuming a stable incidence rate. Health service providers should take into account the expected increase in hip fracture numbers when allocating resources for the care of these patients in the mid-term future.

Developments of the incidence of osteoporosis in The Netherlands: a PHARMO study

To assess recent and to predict future time trends in the incidence of osteoporosis using routine databases in The Netherlands in the period 1993-2015 and to compare estimations based on hip fractures versus a proxy based on pharmacy and hospitalisation data. The incidence of hip fractures was estimated over the period 1986-2002 using information from the Dutch Medical Registry, covering more than 99% of all Dutch hospitalisations. Additionally, a proxy (hospitalisation for osteoporosis or osteoporotic fractures, treatment with glucocorticosteroids or treatment with anti-osteoporosis drugs) was constructed in order to identify osteoporotic patients in the PHARMO database. Age and gender specific incidences of hip fractures and osteoporosis were calculated and extrapolated to The Netherlands. Results of both studies were extrapolated till 2015 using a power function. The incidence of hip fractures decreased slightly (270 per 100,000 in 1993, 260 per 100,000 in 2002). The incidence of osteoporosis using the constructed proxy decreased from 870 per 100,000 in 1993 to 700 per 100,000 in 2002. The incidence of hip fractures and osteoporosis remained fairly constant when modelled till 2015. Both studies showed the same time trends. Both the estimations based on the hospitalisations for hip fracture and on our proxy for osteoporosis showed that the increase in the incidence of osteoporosis as observed in the 1990s is levelling off. Due to ageing of the population the absolute number of hip fractures will however increase. Our definition of osteoporosis resulted in a higher estimation of the incidence of osteoporosis and may be used in future studies to follow developments in osteoporosis prevalence and incidence.

Proximal Femoral Fractures

The absolute number of hip fractures is large, increasing, and related to osteoporosis as well as other factors. By 65 years of age, 50% of women will exhibit bone mineral below the fracture threshold; by age 85, 100%. Trabecular bone loss, which occurs before cortical bone loss, is characteristic of postmenopausal osteoporosis, while cortical bone loss, which increases with age (especially after the age of 70), is characteristic of senile osteoporosis. Estrogen treatment is reasonable for early postmenopausal osteoporosis, less so for the senile variety. The elderly often lose the renal ability to 1-alpha hydroxylate 25-OH vitamin D and thus lose the ability to absorb calcium; they are refractory to D3 therapy, and may require more expensive therapy with 1,25-(OH)2-vitamin D. "Trivial" trauma with falls caused by loose rugs, electric cords, and the like may often be the primary cause of proximal femoral fractures. Sedative drugs are also hazardous. The polyfactorial problem of proximal femoral fractures requires treatment by a multidisciplinary medical team.