Higher Incidence Of Hip Fracture Research Articles

OR13-02 Ethnic Variation In Non-vertebral Major Osteoporotic Fractures Among US Asian/Pacific Islander Men

Abstract Disclosure: C.E. Chu: None. M. Chandra: None. N.P. Gordon: None. D.W. Zeltser: None. C. Lee: None. J.A. Darbinian: None. J.C. Lo: None. Background: Our recent characterization of hip fracture incidence among Asian/Pacific Islander (PI) adults compared Chinese, Japanese, Filipino, and South Asian adults and found that South Asian men had a higher incidence of hip fracture compared to Chinese men, but Japanese and Filipino men did not. However, published data pertaining to major osteoporotic fracture (MOF) risk remain limited. We now further examine the incidence of non-vertebral MOF among Asian/PI men, including findings by Asian subgroup. METHODS: We used data from a previously reported retrospective cohort of 188,328 Asian/PI men in an integrated healthcare delivery system who were age ≥50y during 2000-2019. Asian/PI subgroups examined included 41,862 Chinese, 45,779 Filipino, 13,322 South Asian, and 7,838 Japanese men (the four largest Asian/PI subgroups among men and women), with the remaining 79,527 Asian/PI men comprising 8,293 Vietnamese, 3,500 other Southeast Asian, 6,629 Native Hawaiian/PI (NHPI), 3,132 Korean, 451 Central Asian, and 57,522 of multiple or unspecified Asian/PI ethnicity. Incident non-vertebral MOF was defined as the first hip, humerus, or wrist fracture identified by ICD diagnosis codes during follow up to 2021. Age adjusted fracture incidence [with 95% CI] was calculated using weights from the 2010 US Census. Log-Poisson regression was used to determine fracture incidence rate ratios (IRR) with Chinese adults as reference, adjusting for age and calendar year. RESULTS: Among 188,328 Asian/PI men (aged 55.3 ± 7.8 years at entry), 1501 experienced hip (43.3%), humerus (16.3%), or wrist (37.4%) fracture, or >1 of these non-vertebral MOFs (3.0%) during follow-up, with mean age 71.0 ± 13.0 years at the time of incident fracture. The age-adjusted incidence of non-vertebral MOF for Asian/PI men was 1.18 [1.12-1.25] per 1000 person-years overall but varied among the major Asian/PI subgroups: 1.19 [1.08-1.29] for Chinese, 1.00 [0.88-1.12] for Filipino, 1.51 [1.28-1.77] for Japanese, and 2.01 [1.67-2.41] for South Asian men per 1000 person-years. Compared to Chinese men, the IRR for non-vertebral MOF were 0.83 [0.72-0.95] for Filipino, 1.21 [1.01-1.44] for Japanese, and 1.84 [1.54-2.20] for South Asian, and 0.89 [0.77-1.03] for all other Asian/PI men, including those with unspecified ethnicity. Conclusions: The majority of non-vertebral MOF occurred at the hip and wrist among men. When comparing fracture incidence across major Asian/PI subgroups, the largest difference in non-vertebral MOF incidence was seen among South Asian men compared to their Chinese counterparts, consistent with previous hip fracture findings. Japanese men also had somewhat higher incidence of MOF, while Filipino men had lower incidence. Future studies are needed to examine whether differences are evident in other Asian/PI subgroups and whether there are differences in clinical outcome after non-vertebral MOF fracture. Presentation: Friday, June 16, 2023

Analyzing the Risk Factors of Mortality after Osteoporotic Hip Fractures Using the National Health Insurance Service Sample Cohort 2.0 Database.

PurposeThe purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database.Materials and MethodsData from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models.ResultsPatient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601).ConclusionMale gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.

Anti-osteoporosis medication dispensing by clinical commissioning groups in England - an ecological study of variability in practice and of the effect of the Covid-19 pandemic.

To investigate whether the rate of Anti-Osteoporosis Medication (AOM) dispensing was related to prevalence of risk factors and hip fracture incidence in the local population. The Open Prescribing database was used to analyse dispensed AOM at the level of Clinical Commissioning Groups (CCGs) in England. Male Healthy Life Expectancy (MHLE), Female Healthy Life Expectancy (FHLE), the prevalence of smoking and active adults, the incidence of hip fracture and of alcohol related hospital admissions, and local dispensing of a comparator drug (atorvastatin) were considered as predictor variables. Linear and multilinear regression were performed. Using atorvastatin as a comparator, AOM dispensing was compared after the start of the Covid-19 pandemic with the same quarter the previous year. Rates of AOM per 1000 people aged over 65 years in a CCG area varied between 379.2 and 1129.1, with a mean of 670.3. Population risk factors were individually related to the amount of AOM dispensed in an area. Collectively, local activity levels in adults (p=0.042) and local hip fracture incidence (p=0.003) were significantly negatively correlated with rates of AOM dispensed. Rates of alendronate dispensing fell significantly at the start of the Covid-19 pandemic (p < 0.001), whilst atorvastatin dispensing rates significantly increased (p < 0.001). Lower rates of AOM dispensing were seen in areas with a higher proportion of active adults and higher incidence of hip fracture. Multidisciplinary services should be developed to address this care gap with consideration given to local population risk factors. Community pharmacists are ideally placed to play a vital role in osteoporosis management.

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.

The effect of physical and social isolation due to the COVID-19 pandemic on the incidence of hip fractures among senior citizens

This study aimed to explore the effects of the lockdown due to the coronavirus disease 2019 pandemic on the incidence and characteristics of hip fracture in older adults. Data from the three-month lockdown period and the corresponding period in the previous year were obtained from the computerized medical records of a large acute-care hospital. No significant differences were observed in the absolute and relative numbers of hip fractures. There were no significant differences in terms of socio-demographic and clinical characteristics, which are considered risk factors for falls. Similarly, there was no difference in the length of time between admission and surgery and the mean length of hospital stay. Compared to the previous year, there was a significantly higher incidence of hip fractures in older adults living alone during the lockdown. Health policy should provide social support and monitoring of healthcare, particularly to older adults living alone.

Contemporary view of medical care of the elderly people with proximal femur fractures

Fractures of the proximal femur are a severe, life-threatening injury with enormous social, medical and economic consequences. Even with a well-organized system of medical care, up to 12-17% of patients die within the first year after injury, and the long-term risk of death doubles. Specially designed population-based studies in the Russian Federation have shown a high incidence of hip fractures in patients at the age of 50 and older. However, there is currently no unified system of medical care organization for all regions of Russia, which allows hospitalization and operation of patients with hip fractures during the first hours after trauma. Hip fracture in an elderly person is an absolute indication for the hospitalization. However most patients have severe comorbidities, osteoporosis, an increased risk of falls and mortality because of any reason. The main surgical treatments for hip fractures include osteosynthesis of the fracture or hip arthroplasty. It is well known that after the occurrence of any fragility fracture the risk of subsequent fractures increases by 2-3 times. To ensure the continuity of patient management, provide prescription of anti-osteoporotic drugs and long-term follow-up of patients it is necessary to manage them within the special Fracture Liaison Services (FLS). The article is devoted to the organization of medical care in patients of older age groups who have received hip fractures. A review of modern approaches to the treatment and organization of care for elderly patients with hip fractures is based on the methodological recommendations «Complex measures aimed at preventing falls and fractures in the elderly» developed in the framework of the federal project «The Older Generation», the draft national clinical guidelines «Fractures of the proximal femur», as well as the results of our own research.

High Risk of Hip and Spinal Fractures after Distal Radius Fracture: A Longitudinal Follow-Up Study Using a National Sample Cohort.

The purpose of the present study was to estimate the risk of hip and spinal fracture after distal radius fracture. Data from the Korean National Health Insurance Service—National Sample Cohort were collected between 2002 and 2013. A total of 8013 distal radius fracture participants who were 50 years of age or older were selected. The distal radius fracture participants were matched for age, sex, income, region of residence, and past medical history in a 1:4 ratio with control participants. In the subgroup analysis, participants were stratified according to age group (50–59, 60–69, or ≥70 years) and sex (male or female). Distal radius fracture patients had a 1.51-fold and 1.40-fold higher incidence of hip fracture and spinal fracture in the adjusted models, respectively. Among males, patients of all ages had a significantly higher incidence of hip fracture, and those who were 50 to 69 years of age had a significantly higher incidence of spinal fracture. Among females, those older than 70 years had a significantly higher incidence of hip fracture, and patients of all ages had a significantly higher incidence of spinal fracture. Previous distal radius fracture has a significant impact on the risk of subsequent hip and spinal fractures.

Direct oral anticoagulants and the risk of osteoporotic fractures in patients with non-valvular atrial fibrillation.

Background:The incidence of osteoporotic fracture increases with age, particularly in elderly populations with atrial fibrillation (AF). However, direct oral anticoagulants (DOACs) have less effect on osteoporotic fracture than vitamin K antagonists, it is unclear whether the risk of osteoporotic fracture is affected by different types and doses of DOACs in AF patients.Methods:This nationwide population-based cohort study included AF patients prescribed DOACs between 2011 and 2016 taken from the Taiwan National Health Insurance database. Adjusted hazard ratios (aHRs) for the risk of osteoporotic, hip, and spine fractures between DOAC users were compared using the Fine and Gray subdistribution hazard model to adjust for possible confounders.Results:A total of 56,795 patients who were prescribed DOACs were included in the present study. Among them, 24,597 patients received dabigatran, 26,968 received rivaroxaban, and 5230 received apixaban. After 2 years’ follow up, there was no significant difference in the incidence of osteoporotic, spine, or hip fracture among those receiving dabigatran, rivaroxaban, or apixaban. Subgroup analysis showed that patients taking dabigatran had a higher incidence of osteoporotic and hip fracture than those taking rivaroxaban and apixaban in cases with concomitant peripheral artery disease (PAD) or a history of hip fracture (p for interaction: 0.004 and 0.030, respectively). However, dabigatran users had a lower incidence of osteoporotic fracture and spine fracture in those receiving standard-dose DOACs compared with rivaroxaban and apixaban; whereas, they had a higher incidence of hip fractures when administered at low dose.Conclusion:AF patients with different DOACs did not have different risks of osteoporotic fracture overall. However, additional concomitant morbidities, such as PAD or a history of hip fracture, and standard/low doses might be associated with different risks for different DOACs. These findings should be taken into consideration in the clinic when the DOAC is being chosen.Plain language summary Different direct oral anticoagulants had different impact on osteoporotic fracture Anticoagulation therapy is an essential therapy in atrial fibrillation (AF) patients, but osteoporotic fracture is another important issue in these patients prescribed with anticoagulants. However, no study has been conducted to evaluate the impact of different DOACs on different types of osteoporotic fractures. In our findings, although different DOACs had no significantly different impact on osteoporotic fractures, dabigatran users had a slightly higher incidence of osteoporotic and hip fractures among different DOACs, particularly in those have simultaneously had peripheral artery disease, a history of hip fracture. In addition, when AF patients taking low-dose DOACs, dabigatran users also have higher incidence of hip fracture than those taking other DOACs.

Contribution of elevation and residential proximity to the coast in explaining geographic variations in hip fracture incidence. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) study.

Norway is an elongated country extending north of the Arctic Circle with substantial coast-inland variation in topography and climate. Differences in hip fracture incidence between counties and a distinct seasonal variation have previously been shown. The aim of the current study was to explore these variations further by considering associations of height above sea level (elevation) and distance to the coast with hip fracture incidence. All patients with hip fractures admitted to Norwegian hospitals in the period 2009-2018 were included. Individual residential elevation and distance to the coast was calculated in Geographic Information Systems and combined with individual-level population data on all Norwegians 50years of age or older during the observation period, including hospital information on fractures. Age-standardized incidences rate and incidence rate ratios with 95% confidence intervals (IRR, 95% CI) according to elevation and coastal proximity were estimated. The associations were tested using Poisson models adjusting for sex, urban/rural location of residency, country of birth, and season of hip fracture occurrence. From 2009 to 2018, there were 85,776 first hip fractures. There was an increasing risk with higher residential elevation (above versus below mean) for women: IRR = 1.04, 95% CI: 1.02, 1.05), but not for men (IRR = 1.00, 95% CI: 0.97, 1.02). Incidence of hip fracture increased with distance from the coast. Women residing the farthest away from the coast (above versus below mean distance) had a higher age-adjusted incidence of hip fracture compared to those living closer to the coast (IRR = 1.04 (95% CI: 1.02, 1.06), whereas no association was found in men (IRR = 1.00 (95% CI: 1.00, 1.01). Combining elevation and distance to coast showed a higher incidence in women living at high elevation far from the coast compared with women living at low elevation near the coast (IRR = 1.07, 95% CI: 1.04, 1.10). A similar result was found in men but only for hip fractures occurring during March-May (IRR = 1.07, 95% CI: 1.00, 1.15). The previously shown patterns of county differences and seasonal variations were unchanged when considering geography. We found a somewhat higher incidence of hip fracture in inland residents living in areas of high elevation, as compared to those living in more coastal proximity; however, the geographic variation did not explain county and seasonal differences in fracture incidence in Norway. More in-depth analyses on temperature and climate factors may give further clues.

Peripheral nerve blocks for hip fractures in adults.

This review was published originally in 1999 and was updated in 2001, 2002, 2009, 2017, and 2020. Updating was deemed necessary due tothe high incidence of hip fractures, the large number of official societies providing recommendations on this condition, the possibility that perioperative peripheral nerve blocks (PNBs) may improve patientoutcomes, and the major role that PNBs may play in reducing preoperative and postoperative opioiduse for analgesia. To compare PNBs used as preoperative analgesia, as postoperative analgesia, or as a supplement to general anaesthesia versus no nerve block (or sham block) for adults withhip fracture.Outcomes werepain on movement at 30 minutesafter block placement, acute confusional state, myocardial infarction, chest infection, death, time to first mobilization, and costs of an analgesic regimen for single-injection blocks. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2019); Embase (Ovid SP, 1974 to November 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to November 2019), as well as trial registers and reference lists of relevant articles. We included randomized controlled trials (RCTs) assessing use of PNBs compared with no nerve block (or sham block) as part of the care provided for adults16 years of age and older with hip fracture. DATA COLLECTION AND ANALYSIS: Two review authors independentlyscreened new trials for inclusion, assessed trial quality using the Cochrane Risk of Bias-2 tool, and extracted data. When appropriate, we pooled results of outcome measures. We rated the certainty of evidence using the GRADE approach. We included 49 trials (3061 participants; 1553randomized to PNBs and 1508 to no nerve block (or sham block)). For this update, we added 18 new trials. Trials were published from 1981 to 2020.Trialists followed participants for periods ranging from 5 minutes to 12 months.The average age of participants ranged from 59 to 89 years. People with dementia were often excluded from the included trials. Additional analgesia was available for all participants. Results of 11 trials with 503 participants show that PNBsreduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.05, 95% confidence interval (CI) -1.25 to -0.86; equivalent to -2.5 on a scale from 0 to 10; high-certainty evidence). Effect size was proportionate to the concentration of local anaesthetic used (P =0.0003). Based on 13 trials with 1072 participants, PNBs reduce the risk of acute confusional state (risk ratio (RR) 0.67, 95% CI 0.50to 0.90;number needed to treat for an additional beneficial outcome(NNTB) 12,95% CI 7 to 47; high-certainty evidence). For myocardial infarction, there wereno events in one trial with 31 participants (RR not estimable; low-certainty evidence). From three trials with 131 participants, PNBs probably reduce the risk for chest infection(RR 0.41, 95% CI 0.19 to 0.89; NNTB7, 95% CI 5 to 72; moderate-certainty evidence).Based on 11 trials with 617 participants, the effects of PNBs on mortality within six months are uncertain due to very serious imprecision (RR 0.87, 95% CI 0.47 to 1.60; low-certainty evidence). From three trials with 208 participants, PNBs likely reduce time to first mobilization (mean difference (MD) -10.80 hours, 95% CI -12.83 to -8.77 hours; moderate-certainty evidence).One trial with 75 participants indicated there may be a small reduction in the cost ofanalgesic drugs with a single-injection PNB (MD -4.40 euros, 95% CI -4.84 to -3.96 euros; low-certainty evidence). We identified 29 ongoing trials, of which 15 were first posted or at least were last updated after 1 January 2018. AUTHORS' CONCLUSIONS: PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization. There may be a small reduction in the cost of analgesic drugs for single-injection PNB. Wedid not find a difference for myocardial infarction and mortality, but the numbers of participants included for these two outcomes were insufficient.Although randomized clinical trials may notbe the best way to establish risks associated with an intervention,our review confirmslow risks of permanent injury associated withPNBs, as found by others. Some trials are ongoing, but it is unclear whether any further RCTs should be registered, given the benefitsfound.Good-quality non-randomized trials with appropriate sample size may help to clarify the potential effects of PNBs on myocardial infarction and mortality.

141 Fall-Risk Increasing Drugs use in Elderly with Fall-Related Fractures

Abstract Introduction Elderly populations are at the highest risk of fatal falls and fracture is one of the fall-related injuries which results in high morbidity and mortality. A group of drugs have been identified as the fall risk increasing drugs (FRIDs) and listed as one of the modifiable extrinsic risk factors for falls. This study aimed to determine the use of FRIDs in fall-related fractures among elderly patients. Method Patients aged 65 years and above admitted to a tertiary teaching hospital due to falls were included. Falls were identified through a case-mix system using the ICD-10 codes of W01 and W18 (fall at the same level). Patient medical records were reviewed retrospectively and drugs use before the falls were analysed. Results Among the patients included (n=124), majority of them had fall-related fractures (83.1%) and hip fractures were among the highest type of fractures (67%). The older old (≥ 80 years) had recorded a significant higher incidence of hip fractures compared to the younger individuals (p=0.009). About 75% of the patients with fall-related fractures had recorded use of at least one FRID before the admission. The younger individuals had significantly higher use of FRIDs compared to the older old, particularly the anti-hypertensive drugs (p=0.017). Most of them (&amp;gt;80%) still received FRIDs at discharge and deprescribing was commenced in less than one quarter of the patients. Furthermore, 32.6% of them had either an addition of new FRIDs or increased of the FRIDs dose at discharge. Conclusion In conclusion, fracture was the major reason of admissions among the elderly with falls. The older old recorded higher incidence of fall-related hip fractures. There was high usage of FRIDs before and after fall-related fractures. Deprescribing was not widely practiced in the elderly after the fall incidence.

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.

Diabetes Mellitus and Gender Have a Negative Impact on the Outcome of Hip Fracture Surgery-A Pilot Study.

Diabetes mellitus (DM) is associated with an elevated risk of post-operative complications. The impact it has on patients living with DM following hip fracture surgery (HFS) is not completely understood and may represent a predictor of increased mortality. This study investigates the impact of DM, gender, American Society of Anaesthesiologists (ASA) grade, and fracture location, on the outcome of HFS in Ireland. The Hospital Inpatient Enquiry (HIPE) database records all fragility hip fractures within Galway University Hospital. Retrospective data collection was performed over a 3-year period. Data collected included patient age, gender, date of HFS, anatomical fracture location, type of operation, ASA grade, DM status, and mortality. A database of 650 individuals was created including 461 females and 189 males, with an average group age of 80.2 ± 9.3 years. Results showed a significantly higher incidence of hip fractures in males with DM (19.57%) than females with DM (12.36%) (χ2 test, p = 0.020). Cox regression survival analysis indicated that DM status and ASA grade were the two main independent predictors of patient survival following HFS. Nevertheless, when examining the combined impact of gender and DM status on survival after HFS, results showed that survival post HFS differed significantly with gender and presence of DM (log-rank test, p < 0.001), with males with DM performing worse than females with DM (p = 0.021) or males without DM (p = 0.001). This gender and disease-associated outcome should prompt an early multi-disciplinary team approach to the management of hip fractures in patients with DM. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:834-842, 2020.

Urban-Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study.

ABSTRACTHigher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Age- and sex-related differences in muscle strength and physical performance in older Chinese.

Little is known about muscle strength and physical performance in Chinese. This study aimed to assess the age- and sex-related differences in muscle strength and physical performance in older Chinese. Three hundred and eight healthy participants (110 males and 198 females) age 68.3 ± 6.1 (mean ± SD) years were enrolled in this cross-sectional study. The handgrip muscle strength (HGS) of the dominant hand was measured using a Jamar dynamometer. Physical performance was assessed by the Timed Up and Go test (TUG). The EuroQol five-dimension questionnaire (EQ-5D) was used to evaluate participants' health status. Men showed higher levels of HGS with a smaller percentage having low muscle strength compared with women. No differences were observed in TUG between sexes. No significant association of TUG and age was observed in males. However, older females had increased TUG and hence poorer performance. Good health status was associated with better physical performance but was not related to muscle strength in either sex. In men, there was no correlation between age and TUG, although a negative association with handgrip muscle strength was observed. For women, both muscle strength and physical performance declined with age. The sex-related differences in aging effects on physical performance in our study could partly explain why women have a higher incidence of hip fracture than men. Chinese women may be more vulnerable to severe sarcopenia in old age than men.

Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services

BackgroundHip fracture among older adults is not only a major health issue but also preventable by providing proper care, but there is a lack of studies on the association between type of long-term care (LTC) service and hip fracture. This study aimed to investigate the association between the type of LTC service and the incidence of hip fracture among older adults with dementia receiving long-term care insurance (LTCI), and to investigate how such association differs according to characteristics of beneficiaries and structural characteristic of institutional care.MethodIn this retrospective cohort study, data from 2008 to 2013 were collected from 7112 LTCI beneficiaries having benefit level 1 or 2 with dementia aged 60 years or over in the Korean elderly cohort data set. Type of LTC service was categorized into institutional or home care using the LTCI Claims Database, and the incidence of hip fracture was used as the outcome variable. A survival analysis using a time-dependent Cox regression analysis was performed to examine the association between time-varying LTC service type and hip fracture.ResultsOf the 7112 older adults, 115 (1.6%) had hip fracture during a total of 16,540 person-years. Compared to LTC beneficiaries with home care, those with institutional care had a higher adjusted hazards ratio of incidence of hip fracture (hazards ratio = 4.33, 95% confidence interval, 2.84–6.59). This association was particularly strong among beneficiaries who did not have a danger of hip fracture during the mandatory assessment for benefit eligibility, who were partially ambulatory, who were from rural areas, and females.ConclusionsInstitutional care was more likely associated with a higher incidence of hip fracture than home care. The government need to watch the institutional LTC services quality and promote improvements of the institutional care quality.

Interdisciplinary care of hip fractures.: Orthogeriatric models, alternative models, interdisciplinary teamwork.

Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.

Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review.

ABSTRACTChronic kidney disease is associated with an increased risk of fracture and cardiovascular mortality. The risk of fracture in hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) patients is higher when compared with the general population. However, there exists a knowledge gap concerning which group has the highest risk of fracture. We aimed to compare the risk of fracture in HD, PD, and KT populations. We conducted a systematic review of observational studies evaluating the risk of fracture in HD, PD, or KT patients. Eligible studies were searched using MEDLINE, Embase, Web of Science, and Cochrane Library from their inception to January 2016, and in grey literature. Incidences (cumulative and rate) of fracture were described together using the median, according to fracture sites, the data source (administrative database or cohort and clinical registry), and fracture diagnosis method. Prevalence estimates were described separately. We included 47 studies evaluating the risk of fracture in HD, PD, and KT populations. In administrative database studies, incidence of hip fracture in HD (median 11.45 per 1000 person‐years [p‐y]), range: 9.3 to 13.6 was higher than in KT (median 2.6 per 1000 p‐y; range 1.5 to 3.8) or in PD (median 5.2 per 1000 p‐y; range 4.1 to 6.3). In dialysis (HD+PD), three studies reported a higher incidence of hip fracture than in KT. Prevalent vertebral fracture (assessed by X‐rays or questionnaire) reported in HD was in a similar range as that reported in KT. Incidence of overall fracture was similar in HD and KT, from administrative databases studies, but lower in HD compared with KT, from cohorts or clinical registry studies. This systematic review suggests an important difference in fracture risk between HD, PD, and KT population, which vary according to the diagnosis method for fracture identification. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Bone and Mineral Metabolism in Hemodialysis Patients. Fragility Fractures in Hemodialysis Patients.

Due to the population aging and improved prognosis of hemodialysis patients, fracture has become one of important clinical outcomes that often degrade patients' quality of life and indirectly increase mortality. As Japanese hemodialysis patients have five to six-fold higher incidence of hip fracture than general population, risk factors and prophylactic interventions for fracture should be investigated. Being one of the eldest countries in the world, Japan should conduct more researches and publish more evidences in this field. The Japanese Renal Data Registry has been playing an important role in generating new evidences on non-classical risk factors of hip fracture that are specific to hemodialysis patients. Yet, the preventative intervention has not been established even in the newly-updated KDIGO CKD-MBD guideline. Notable finding is that the incidence rate of hip fracture has been decreased in Japanese females despite aging. The investigation of the reason may shed light on undetermined therapeutic approaches to hip fracture in hemodialysis patients.

Morbidity and mortality of hospitalized hip fractures in chronic hemodialysis.

Abnormal bone architecture contributes to high incidence of hip fractures in chronichemodialysis (HD) patients. Their clinical epidemiology is incompletely described. We conducted a retrospective cohort study to assess the implications ofhospitalization with hip fracture in HD patients compared to the nonchronic kidney disease population. Thirty-three chronic HD patients admitted with hip fracture overfiveyears were age- and sex-matched on a 1:1 ratio with controls that had hip fracture and normal renal function. Demographic characteristics, deaths, and readmissions atsixmonths,hospitalization length, time to operation, and laboratory resultswere recorded from electronic health files. Datawere compared betweenthe two groups usingpairedt-test for continuous variables and McNemar's test for categoricalvariables. The compositeendpoint of deathand/or readmission at6 months was higher in HD patients (12.1% vs. 6.2%, P<0.001). Furthermore, mean time tooperationwas more delayed due to comorbidities (4.7 vs. 2.9 days, p = 0.04). HD patients had anemia more frequently at presentation (hemoglobin below 10 mg/dL, 32.1% vs. 12.5%, P = 0.003). Finally, they were more likely to be considered toofrail for surgery and not be operated (21.2% vs. 6.2%, P<0.001). Hip fractures are associated with increased morbidity and mortality and represent an important health-care burden for chronic HD patients. Future research is needed to identify definite predictors of adverse outcomes and to implement prevention strategies.