Annual Hip Fracture Incidence Research Articles

Trends in hip fracture rates in US male veterans.

In the United States, the annual incidence of osteoporotic hip fracture is estimated to be 250,000 to 300,000; the one-year mortality in some studies has been as high as 32%. Reports that hip fracture rates in US women 65years and older may no longer be declining led to this investigation of hip fracture in men, a less studied population. We assessed the trends in the incidence of hip fracture in US male veterans 50years and older of age as well as the rates of diagnosis and treatment in such men. We assessed the recent trends of hip fracture incidence in a nation-wide male veteran population 50years and older of age. Using data from the US Veterans Affairs Informatics and Computing Infrastructure (VINCI) 2002-2019, we calculated the annual age-standardized hip fracture incidence. Secondary objectives included evaluating the annual proportion of hip fracture patients who underwent dual-energy X-ray absorptiometry (DXA) before or after the fracture and/or received osteoporosis medication after the hip fracture over the study period. Hip fracture incidence increased in male veterans from 2006 to 2019. Fewer than 6% of men underwent a DXA scan and fewer than 0.5% received osteoporosis medications up to two years after a hip fracture. Despite available screening methods such as DXAs and medications for primary and secondary prevention of osteoporotic fractures, hip fracture incidence is not decreasing in older male veterans. Our study highlights a need for closerattention to fracture risk in men.

Epidemiology of hip fractures in Thailand.

To examine the annual incidence of hip fractures over 10years (2013-2022), hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50years and older within the Universal Health Coverage System. A retrospective study was conducted. Hip fracture hospitalizations were identified using ICD-10. Data on the number of hip fracture hospitalizations, population aged ≥ 50years, and hospitalization costs were obtained. The primary outcome was the annual incidence of hip fractures. The secondary outcomes were hip fracture incidence by 5-year age group, the annual hospitalization costs for hip fractures, and the number of hip fractures in 6 regions of Thailand. The hip fracture incidence increased annually from 2013-2019 and then plateaued from 2019-2022, with the crude incidence (per 100,000 population) increasing from 112.7 in 2013 to 146.7 in 2019 and 146.9 in 2022. The age-standardized incidence (per 100,000 population) increased from 116.3 in 2013 to 145.1 in 2019 and remained at 140.7 in 2022. Increases in the crude incidence were observed in both sexes (34% in females and 21% in males; p < 0.05). The annual hospitalization costs for hip fractures increased 2.5-fold, from 17.3 million USD in 2013 to 42.8 million USD in 2022 (p < 0.001). The number of hip fractures increased in all six regions of Thailand across the 10-year study period. Osteoporotic hip fractures are a significant health concern in Thailand. The incidence and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022.

Incidence and geographic characteristics of the population with osteoporotic hip fracture in Egypt- by the Egyptian Academy of Bone Health.

To assess the incidence of hip fracture in Egypt, with special emphasis on the geographic and demographic variation among the Egyptian population. The incidence of hip fractures treated in two Egyptian FLS centers was calculated for the period of February 2022-February 2023. Demographic information was recorded for every patient on the national register. All patients completed a baseline questionnaire, had clinical evaluation, fracture risk, falls, and sarcopenia risk assessment. A DXA scan was carried out for every patient. The annual incidence of low-energy hip fracture in individuals aged 40years or more in Egypt in 2022-2023 was 123.34 per 100,000 in women and 55.19 per 100,000 in men. The incidence of hip fractures was higher in south Egypt (113.62) versus north Egypt (64.8). This was consistent for both genders. Bone mineral density was significantly (p < 0.01) lower in south Egypt at both the spine, distal forearm, as well as hip trochanters, whereas there was no significant difference between both locations in terms of the total hip and neck of the femur. Yet, falls risk, sarcopenia, as well as functional disability rates were significantly (p < 0.001) higher in the north. In Egypt, the hip fracture incidence was higher in the south compared to the north. Several modifiable factors contribute to fragility fracture risk independent of BMD, creating complex interrelationships between BMD, risk factors, and fracture risk.

TELEREHABILITATION AFTER HIP-FRACTURE SURGERY

Hip fracture is one of the most common fractures among the elderly population with high rates of mortality and morbidity. The annual incidence of hip fractures is predicted to be increased by around 16 times by the year 2050. Due to the high cost of traditional rehabilitation after hip fracture surgery and the effect of pandemics, telerehabilitation after hip fracture is gaining more importance in recent years. This review is designed to examine the importance and progress of telerehabilitation after hip fracture surgery. PubMed/MEDLINE, Scopus, and Web of Science for English-language sources were searched from their inception using the keywords telerehabilitation and hip fracture between January 2014 and January 2023. The literature search resulted in 29 non-duplicate records and 8 of them were eligible and were included in this review. Telerehabilitation is a feasible, safe, and effective rehabilitation method after hip fracture surgery. However, the ability of elderly patients and their caregivers to use technology and apply what they see seems to be a big disadvantage. The literature lacks long-term studies with larger patient groups.

Conversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review.

With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly extracapsular hip fractures are treated with either cephalomedullary nails (CMNs) or sliding hip screws (SHS). More recently, there has been a shift toward increased CMN use due to increased training with this fixation method as well as perioperative and biomechanical benefits. Given this shift, orthopedic surgeons need to understand the factors that lead to CMN failure. Failed CMN treatment leaves both patients and surgeons with few management options including revision fixation with or without osteotomy, conversion total hip arthroplasty, and conversion hemiarthroplasty. Surgeons must consider the patient and injury characteristics before deciding the best treatment plan. Conversion total hip arthroplasty is indicated in younger patients without femoral head and/or acetabular articular injury, degenerative joint disease, or avascular necrosis. Conversion total arthroplasty is a technically demanding and resource-intensive surgery associated with lower success rates and outcomes than primary total hip arthroplasty. Orthopedic surgeons should have thorough understanding of preoperative workup needed prior to surgery, implant selection associated with best outcomes, most common surgical approaches used, intraoperative considerations, and complications associated with conversion total hip arthroplasty. A comprehensive understanding of these concepts gives patients the best chance of having a successful outcome.

Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study.

BackgroundElderly hip fractures represent a global health care burden. Several reports expected a massive increase in the incidence of hip fractures by the next few decades. Knowing the epidemiology of hip fractures is crucial for planning health care policies. The purpose of this study is to provide a nationwide epidemiological overview of hip ‎fractures in Jordan and to report the perioperative outcomes that may help to improve the delivered healthcare. ‎.MethodsWe conducted ‎ a retrospective study at 2 university hospitals and 2 major ‎governmental hospitals in Jordan.‎ We reviewed the records for all patients (age >55 years) who were diagnosed with hip fractures ‎over a 3 years duration (2019–2021). ‎We documented the patient’s characteristics and the perioperative data (including preoperative, intraoperative, and postoperative details including the 1-year mortality).‎ResultsThe total number of included patients was 1268; more than half (53.7%) were females.‎ The mean age is ‎75 years (SD 9.7). ‎ The most common fracture type was trochanteric (66.2%)‎. ‎7% of patients had a prior contralateral hip fracture‎. The average time from admission to surgery was 2.96 days (SD 2.63). The surgery was done within 48 ‎hours for ‎56.7%‎ of patients.‎ Approximately, one-third of all patients (34.5%) received a blood transfusion.‎ The average length of hospital stay is 7.44 days (SD 5). The overall rate of postoperative thromboembolic events, readmission within 1 month, and revision ‎for the same surgery are 2.4%‎, 10.7%‎, and 3% respectively.‎ The 1-month, 6-month, and 12-month mortality rates are 4.5%, 9.1%, and 12.8% respectively.ConclusionThe annual incidence of elderly hip fractures in Jordan is approximately 96 per 100,000 individuals. The 1-year mortality rate of hip fractures in Jordan ‎is ‎12.8%‎.‎ Both findings are ‎in the lower range of nearby Arab countries.

An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS).

To determine the annual incidence of hip fractures in individuals aged 50years and over, living in 3 cities located in different regions of the country. To investigate the age, gender, and regional differences in fracture rates. Based on the obtained data, to estimate the national incidence of hip fractures resulting from osteoporosis, in order to improve prevention strategies. Retrospective, observational study including all patients aged ≥ 50years admitted in hospitals because of a hip fracture in three cities (Belem, Joinville, and Vitoria) from representative geographic areas in Brazil from 2010 to 2012. Data were obtained from medical records in those cities. We analyzed incidence rates (crude and age- and gender-standardized rates) for hip fractures. There were 1025 (310 in men and 715 in women) hip fractures in the over 50-year-old merged population from the three cities. The crude incidence rate for hip fracture was 103.3/100,000 (95% confidence interval [CI = 97.0; 109.7), in men 77.4/100,000 (95% CI = 68.8; 86.0), and in women 125.2/100,000 (95% CI = 116.0; 134.4). Incidence standardized for age and gender was 105.9 cases per 100,000 persons per year (95% CI = 99.4; 112.4); 78.5 cases per 100,000 (95% CI = 69.8; 87.3) in men and 130.6 cases 100,000 in women (95% CI = 121.0, 140.2) per year. Belem, located in the equatorial region (latitude 1° 27' S), had significantly lower crude and age-adjusted incidence than Joinville (latitude 26° 18' S) and Vitoria (latitude 20° 19' S), which were no different from each other. The incidence of fractures increased exponentially with age, and women had about twice the risk of fractures than men. Hip fracture mainly affects elderly women and presents great variability in incidence between the different regions in Brazil. The incidence of hip fractures in Brazil differed markedly from that reported previously, so that national guidelines and the FRAX model for Brazil should be revised.

Incidence of hip fracture among middle-aged and older Chinese from 2013 to 2015: results from a nationally representative study.

To estimate the incidence of hip fracture, between 2013 and 2015, among the middle-aged and older Chinese population. Individuals with hip fractures between 2013 and 2015 were identified from the China Health and Retirement Longitudinal Study. The sex-specific incidence and the associated factors of hip fracture were assessed. Among 19,112 individuals (51.4% women; mean age 60.5years) included in the analysis, 408 (2.13%) had a hip fracture between 2013 and 2015. Moreover, the annual incidence of hip fracture for men and women were 1065 and 1069 per 100,000, respectively. The incidence of hip fracture increased with age (p < 0.001). A history of chronic disease, being unmarried, and individuals without insurance were associated with a higher incidence of hip fracture. Interestingly, the incidence of hip fracture was higher among individuals with fewer years of education (p = 0.002). The North-East regions of China had the lowest incidence of hip fracture (1022 per 100,000) between 2013 and 2015, followed by the North (1602 per 100,000), South-Central (2055 per 100,000), East (2173 per 100,000), and South-West (2537 per 100,000) regions. Finally, the incidence was highest among participants living in the North-West region (3244 per 100,000). Between 2013 and 2015, the incidence of hip fracture is high among the middle-aged and older Chinese population. Furthermore, it varied significantly according to sociodemographic and geographic factors. Therefore, the support of targeted health policies and cost-effective preventive strategies are warranted in China.

Annual incidence of osteoporotic hip fractures in Iran: a systematic review and meta-analysis

BackgroundOsteoporosis (OP) is progressively becoming a global concern with the aging of the world’s populations. Osteoporotic fractures are associated with significantly increased mortality rates and a financial burden to health systems. This Meta-analysis aims to estimate the annual incidence of osteoporotic fractures in Iran.MethodsA comprehensive systematic literature search was performed through Medline (PubMed), Embase, Scopus, Web of Science, and Google Scholar to identify studies which contain an investigation of the incidence of osteoporotic fractures in Iran up to December 3rd 2020, with no time and language restriction. For the risk of bias assessments of studies, the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used. The pooled estimation of the incidence of osteoporotic fractures in population aged≥50 years was calculated using random-effects meta-analysis, and the heterogeneity of included studies was quantified with the I2 statistic.ResultsIn all, 6708 papers were initially retrieved from the electronic databases, among which seven studies were included in the meta-analysis. The pooled standardized annual cumulative incidence of hip fractures was estimated as 138.26 (95% CI: 98.71–193.65) per 100,000 population and 157.52 (95% CI: 124.29–199.64) per 100,000 population in men and women, respectively.ConclusionThis study showed a high incidence rate of osteoporotic hip fractures in Iran. Early detection and treatment of individuals with higher risks of primary fragility fractures at primary health care as well as implementing fracture liaison services to prevent secondary fractures are highly recommended. The results suffer from the following limitations: first, a low number of studies that were eligible for inclusion; second, the lack of population-based studies; and presence of highly heterogeneous studies despite the use of a random effect model.

Incidence of and risk factors for hip fracture in Nagasaki, Japan from 2005 to 2014

SummaryThe annual incidence of new hip fractures increased from 2005 to 2014 in Nagasaki and females were much more affected. High-risk factors were identified as age ≥ 80 years, winter, indoors, living room, Monday, and early morning. Seven days after admission, most patients remained hospitalized and had been treated surgically.IntroductionHip fractures are major osteoporotic fractures that reduce quality of life. In Japan, the incidence of hip fractures increased steadily from 1986 to 2014 and the number of hip fractures could be 7.3–21.3 million by 2050. This study aimed to determine the incidence of hip fractures from 2005 to 2014 in Nagasaki Prefecture and to analyze the characteristics of and risk factors for hip fracture.MethodsHip fractures that occurred in Nagasaki Prefecture between 2005 and 2014 were analyzed using emergency transportation records. Fracture type, age, sex, location in which fracture occurred, and risk factors for hip fracture were clarified.ResultsThe total number of new hip fractures among individuals ≥ 35 years old was 17,395 (mean age, 82.6 years old) and the annual incidence per 100,000 population increased from 147.9 in 2005 to 235.0 in 2014. Females (79.6%) were much more commonly affected than males (20.4%) and cervical fractures were more common than trochanteric fractures in all age groups. Hip fracture tended to be associated with age ≥ 80 years, winter rather than summer, indoors rather than outdoors, and living room rather than the bathroom or toilet. Other high-risk factors were Monday as day of the week, and early morning as the time of day. Seven days after admission, 97.3% of patients were hospitalized and 78.1% of hip fractures had been treated surgically.ConclusionInformation on actual situations and valid preventive measures relevant to hip fracture are urgently needed.

Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China.

The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. We analyzed annual hip fracture incidence using urban hospital data during 2007-2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal-Wallis test. During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p < 0.01) and from 124.83 to 167.19/100,000 in men (p < 0.01) in the age group >60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36-60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011-2018. Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.

Increased incidence, morbidity, and mortality in cirrhotic patients with hip fractures: A nationwide population-based study.

Hip fractures mostly require surgical treatment and are associated with increased health-care costs and mortality rates. Patients with cirrhosis have low bone marrow density and inferior immune status which contribute to a higher fracture rate and higher surgical complication rate. This population-based study evaluated the prevalence, complication, and mortality rates due to hip fractures in cirrhotic patients. Taiwan National Health Insurance Research Database data were used. The study group included 117,129 patients with hip fractures diagnosed from 2004 to 2010, including 4048 patients with cirrhosis. The overall prevalence, morbidity, and mortality rates of the cirrhosis group with hip fractures were compared with the rates of a general group with hip fractures. The cirrhosis group patients were younger than the general group patients (71.2 vs. 73.96 years, p < 0.001). The annual incidence of hip fractures in the cirrhosis and general groups was 46-54 and 7-7.5 per 10,000 person-years, respectively, with an incidence rate ratio of 6.95 (95% confidence interval 6.74-7.18). The rates of infection, urinary tract infection, and peptic ulcer disease were higher in the cirrhosis group (3.46% vs. 1.91%, 9.56% vs. 9.11%, and 8.05% vs. 3.55%, respectively; all p < 0.001). The mortality rate after hip fracture was also higher in the cirrhosis group than in the general group (within 3 months: 8.76-12.64% vs. 4.96-5.30% and within 1 year: 29.72-37.99% vs. 12.84-14.57%). Conclusion: Cirrhotic patients with hip fractures were relatively younger; had a seven times higher annual hip fracture incidence; had higher complication rates of infection, urinary tract infection, and peptic ulcer disease; and had two to three times higher a mortality rate at 3 months and 1 year. Clinicians should pay particular attention to the possibility of osteoporosis and hip fractures in patients with liver cirrhosis. Level III, case-control study.

The Socio-Economic Impact Produced by Patients with Dementia and Hip Fractures

Age is one of the most important parameters influencing the occurrence of hip fractures in patients over the age of 65 but also their mental state is a decisive factor. In the first three months, older adults have eight times higher risk of dying of a hip fracture if compared with people who have not suffered such type of injury. In the last 10 years, several studies showed considerable increase in the well-being of patients who have both pathologies but for the caregivers it proved to be a very hard task. The management of hospitalization costs of dementia and hip fracture patients cannot include only the period of hospitalization, but should also include the 1-year period of recovery. In UK, the annual incidence of hip fracture is 79,243, accident and emergency costs per hip fracture is 297 pounds and hospitalization costs per hip fracture is 13,765 pounds. Health and social care for hip bone fractures in one year amounts to 2 billion euros but specialists expect the number of hip fractures to increase reaching 104,000 cases by 2025.

A healthy decline in age- and sex- specific incidence of hip fractures in the elderly in the Republic of Ireland

AimThe number of patients sustaining hip fractures in the Republic of Ireland was expected to increase by 100% from 2004 to 2026. This has not been seen either in local or international literature. Our aim is to assess the age- and sex-specific incidence of hip fractures in patients over the age of 65 years and to determine whether the projected increase in incidence is mirrored in the reality of the Irish experience. MethodsThis is a retrospective observational cohort study including all patients with a hip fracture from a tertiary referral centre from 2005 to 2015. Population data was obtained from the Central Statistics Office of Ireland. Results3818 hip fractures in the over 65 age group were recorded. The highest incidence of hip fractures occurred in the 85–90 year old age group. For all ages over 65, the incidence of hip fractures in females over the 10 year period is significantly reducing (p < 0.01). There were 955 hip fractures per 100,000 in females in 2010 and 410 per 100,000 in males. In 2014, this had reduced to 668 in females and 332 in males respectively. ConclusionThe annual hip fracture incidence has decreased across both sexes in this study period. This may be associated with preventative measures and introduction of fracture liaison services. This study highlights the importance of investment in preventative strategies for a continued reduction in hip fracture incidence and will help to plan future services.

Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models

SummaryFracture probabilities resulting from the newly generated FRAX model for Belarus based on regional estimates of the hip fracture incidence were compared with FRAX models of neighboring countries. Differences between the country-specific FRAX patterns and the rank orders of fracture probabilities were modest.ObjectiveThis paper describes the epidemiology of hip fractures in Belarus that was used to develop the country-specific fracture prediction FRAX® tool and illustrates its features compared to models for the neighboring countries of Poland, Russia, and Lithuania.MethodsWe carried out a population-based study in a region of Belarus (the city of Mozyr) representing approximately 1.2% of the country’s population. We aimed to identify all hip fractures in 2011–2012 from hospital registers and primary care sources. Age- and sex-specific incidence and national mortality rates were incorporated into a FRAX model for Belarus. Fracture probabilities were compared with those derived from FRAX models in neighboring countries.ResultsThe estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 8250 in 2015 and is predicted to increase to 12,918 in 2050. The annual incidence of fragility hip fractures in individuals aged 50 years or more was 24.6/10,000 for women and 14.6/10,000 for men, standardized to the world population. The comparison with FRAX models in neighboring countries showed that hip fracture probabilities in men and women in Belarus were similar to those in Poland, Russia, and Lithuania. The difference in incidence rates between the surveys including or excluding data from primary care suggested that 29.1% of patients sustaining a hip fracture were not hospitalized and, therefore, did not receive specialized medical care.ConclusionA substantial proportion of hip fractures in Belarus does not come to hospital attention. The FRAX model should enhance accuracy of determining fracture probability among the Belarus population and help guide decisions about treatment.

Hip fracture trends in the United States, 2002 to 2015.

Hip fractures are a major public health concern due to high morbidity, mortality, and healthcare expenses. Previous studies have reported a decrease in the annual incidence of hip fractures in the US beginning in 1995, coincident with the introduction of modern diagnostic tools and therapeutic agents for osteoporosis. In recent years, there has been less bone density testing and fewer prescriptions for osteoporosis treatments. The large osteoporosis treatment gap raises concern of possible adverse effects on hip fracture rates. We assessed hip fracture incidence in the US to determine if the previous decline in hip fracture incidence continued. Using 2002 to 2015 Medicare Part A and Part B claims for women ≥ 65years old, we calculated age-adjusted hip fracture rates, weighting to the 2014 population. We found that hip fracture rates declined each year from 2002 to 2012 and then plateaued at levels higher than projected for years 2013, 2014, and 2015. The plateau in age-adjusted hip fracture incidence rate resulted in more than 11,000 additional estimated hip fractures over the time periods 2013, 2014, and 2015. We recommend further study to assess all factors contributing to this remarkable change in hip fracture rate and to develop strategies to reduce the osteoporosis treatment gap.

Hip fractures

Hip fracture continues to be the most common serious injury in the elderly population, with the United Kingdom National Hip Fracture Database reporting over 64 000 such injuries in the last calendar year.1 The most recent annual registry report reflects and highlights the socioeconomic challenges faced by our, and all healthcare systems, globally. Patients are getting older, but also fitter. Carers of nonagenarians are often themselves in their 70s, and the state is left undertaking the lion’s share of the carer’s responsibility. These significant numbers of injured patients result in the use of 1.5 million bed days and a total care bill of over £1 billion. In the United Kingdom, this equates to a single injury requiring approximately 1% of the total NHS budget.1 Studies estimating future trends have predicted significant increases in annual hip fracture incidence in the context of an ever-ageing population,2-4 with suggested figures as high as 100 000 hip fractures annually in the United Kingdom by 2033, and associated inflation-adjusted costs of up to £5.6 billion in total care.2 This is set against a continuing programme of austerity and value in the majority of developed nations’ healthcare systems. In parallel with rising numbers of cases, there is rising complexity. Baker et al3 found a trend of increasingly complex medical comorbidities and social needs, and surmised that the hip fracture-related healthcare bill would rise disproportionately to incidence changes alone, resulting from the greater cost of treating these higher-demand patients. The last decade has seen the implementation of several NICE quality standards, rigorous audit and best practice tariffs, with the aim of better patient and cost-effective treatment pathways. This investment in care has had the effect of improving outcomes and reducing length of stay while simultaneously cutting total healthcare delivery costs. …

Excess mortality of 1year in elderly hip fracture patients compared with the general population in Beijing, China.

This study aims to assess the incidence and excess mortality of hip fracture patients aged 60years or older from a municipal population database of Beijing. We retrieved the Beijing municipal health insurance database of 2013 to identify beneficiaries who were at least 60years older as total population of this age group and obtained the number of mortalities in a year. Among those people, subjects who have suffered hip fractures during the year were selected and a determination of the number of deaths in this period. Annual incidence of hip fracture, mortality, and excess mortalities was calculated and stratified by gender and age. During 2013, the annual incidence of elderly hip fracture in Beijing was 0.27% and 1-year mortality was 23.44%. Excess mortality odds ratios of males and females in three age groups were as follows: males, 2.23 (60-69years old, 95% CI, 1.43-3.49), 2.99 (70-79years old, 95% CI, 2.57-3.50), and 1.90 (≥80years old, 95% CI, 1.64-2.22 ) and females, 3.12 (60-69years old, 95% CI, 2.04-4.79), 1.93 (70-79years old, 95% CI, 1.64-2.27), and 1.36 (≥80years old, 95% CI, 1.21-1.55). Pulmonary complications were the leading cause of death, which accounts for 52.27% of all. Compared with the control population, hip fractures caused approximately twofold excess mortality rate during 1year 2014 for elderly citizens in Beijing. Future studies are needed to explore the actual mechanism to design the most effective strategies for optimizing recovery from hip fracture.

A process evaluation of the WHiTE Two trial comparing total hip arthroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS?

ObjectivesThe annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS?MethodsWe performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients.ResultsWe have shown that patients are willing to participate in this type of research and that surgeons value being part of a team that has a strong research ethos. However, surgical practice does not currently reflect NICE guidance. Current models of service delivery for hip fractures are unlikely to be able to provide timely total hip arthroplasty for suitable patients.ConclusionsFurther observational research should be conducted to define the population of interest before future interventional studies are performed.Cite this article: C. Huxley, J. Achten, M. L. Costa, F. Griffiths, X. L. Griffin. A process evaluation of the WHiTE Two trial comparing total hip arthroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS? Bone Joint Res 2016;5:444–452. DOI: 10.1302/2046-3758.510.BJR-2015-0008.R1.

Is the Swedish FRAX model appropriate for Swedish immigrants?

The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate. Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden. We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals. Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446-454) for a Swedish-born woman and 239 (95 % CI 223-257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5-0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence. The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living in Sweden.