Higher Incidence Of Hip Fracture Research Articles

Alzheimer's Disease Correlates with Greater Risk of Hip Fracture in Older People: A Cohort in Taiwan

To the Editor: Alzheimer's disease and hip fracture are two common disorders in older people, and both result in severe socioeconomic burden. Growing evidence has demonstrated that individuals with Alzheimer's disease have 2.1 to 3.2 times greater risk of hip fracture.1-3 Little evidence is available about the relationship between Alzheimer's disease and risk of hip fracture in older people in Taiwan, so this cohort study was conducted to explore this question by analyzing the Taiwan National Health Insurance program database. Information about the program can found in previous studies.4, 5 In this cohort study, the diagnosis of Alzheimer's disease and hip fracture was based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes. Nine hundred thirty-six individuals aged 65 and older with newly diagnosed Alzheimer's disease (ICD-9 code 331.0) were chosen as the Alzheimer's disease group (429 men, 507 women, mean age 78.2 ± 6.8, mean follow-up 3.5 ± 2.9 years) and 3,744 without Alzheimer's disease as the control cooperator group (1,716 men, 2,028 women, mean age 77.1 ± 7.1, mean follow-up 4.4 ± 3.2 years) from 2000 to 2010. The index date was defined as the date of diagnosis of Alzheimer's disease. Both groups were matched according to sex, age, and index year. Both groups were followed up to determine the incidence of hip fracture (ICD-9 code 820) until a subject received a diagnosis of hip fracture or until December 31, 2010. Subjects with hip fracture, other dementia (ICD-9 codes 290.0, 290.1, 290.2, 290.3, 290.4, and 294.1), or mental retardation (ICD-9 codes 317–319) diagnosed before index date were excluded. The Alzheimer's disease group had a significantly higher incidence of hip fracture than the non-Alzheimer's disease group (27.8 vs 11.7 per 1,000 person-years, 95% confidence interval (CI) = 2.02–2.80). The incidence rates, as stratified according to sex, age, and follow-up period, were all significantly higher in the Alzheimer's disease group. Women with Alzheimer's disease had a higher incidence of hip fracture (30.8 per 1,000 person-years) than men (24.0 per 1,000 person-years). Subjects with Alzheimer's disease aged 75 to 84 had the highest incidence of all subgroups (incidence rate 37.8 per 1,000 person-years). The stratified analysis according to follow-up period showed a higher risk of hip fracture within 2 years of Alzheimer's disease diagnosis (incidence rate ratio = 3.30, 95% CI = 2.78–3.92). Overall, 59.3% (54/91) of hip fracture cases in the group with Alzheimer's disease occurred within 2 years after index date, as opposed to 36.8% (70/190) in the group without Alzheimer's disease (Table 1). Epidemiological studies have reported that Alzheimer's disease correlates with greater risk of hip fracture in western countries.1-3 The present study found that the incidence rate ratio of hip fracture was 2.38 in individuals with Alzheimer's disease compared with the group without Alzheimer's disease. It also found that the incidence rates of hip fracture in individuals with and without Alzheimer's disease (27.8 and 11.7, respectively, per 1,000 person-years) were higher than that in a previous study in the United Kingdom in 2011 (17.4 and 6.6, respectively, per 1,000 person-years).3 This indicates that the quality of care of older people should be further improved in Taiwan. It was also found that the incidence of hip fracture was higher within 2 years after index date, indicating that individuals with newly diagnosed Alzheimer's disease should be closely followed during the first 2 years because of their risk of hip fracture. Alzheimer's disease is associated with 2.4 times greater risk of hip fracture in older people in Taiwan. Preventive falling strategies should be adopted in older people with Alzheimer's disease to reduce the risk of hip fracture. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. This study was supported in part by Taiwan Department of Health Clinical Trial and Research Center of Excellence (DOH102-TD-B-111–004) and China Medical University Hospital (Grant number 1MS1). Author Contributions: Lai S.-W.: conception of article, conducted study, interpreted data, initiated draft of article, critically revised article. Chen Y.-L.: conducted study, interpreted data, initiated draft of article, critically revised article. Lin C.-L.: conducted statistical analysis, critically revised article. Liao K.-F.: conducted study, critically revised article. Sponsor's Role: The funding agency did not influence the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

THU0370 Hip Fractures in Portugal: 2006-2010 an Epidemiologic Analysis

BackgroundHip fractures are considered to be the most devastating consequence of osteoporosis. They require long hospitalizations and high health-care costs and represent an important cause of morbidity, disability, and mortality,...

Temporal Trends in the Incidence, Treatment, and Outcomes of Hip Fracture in Older Patients Initiating Dialysis in the United States

Patients with ESRD experience a fivefold higher incidence of hip fracture than the age- and sex-matched general population. Despite multiple changes in the treatment of CKD mineral bone disorder, little is known about long-term trends in hip fracture incidence, treatment patterns, and outcomes in patients on dialysis. Fourteen annual cohorts (1996-2009) of older patients (≥67 years) initiating dialysis in the United States were studied. Eligible patients had Medicare fee-for-service coverage for ≥2 years before dialysis initiation and were followed for ≤3 years for a first hip fracture. Type of treatment (internal fixation or partial or total hip replacement) was ascertained along with 30-day mortality. Cox and modified Poisson regressions were used to describe trends in study outcomes. This study followed 409,040 patients over 607,059 person-years, during which time 17,887 hip fracture events were recorded (29.3 events/1000 person-years). Compared with patients incident for ESRD in 1996, adjusted hip fracture rates increased until the 2004 cohort (+41%) and declined thereafter. Surgical treatment included internal fixation in 56%, partial hip replacement in 29%, and total hip replacement in 2%, which remained essentially unchanged over time; 30-day mortality after hip fracture declined from 20% (1996) to 16% (2009). Hip fracture incidence rates remain higher today than in patients reaching ESRD in 1996, despite multiple purported improvements in the management of CKD mineral bone disorder. Although recent declines in incidence and steady declines in associated short-term mortality are encouraging, hip fractures remain among the most common and consequential noncardiovascular complications of ESRD.

Is There Relationship between Brain Atrophy and Higher Incidence of Hip Fracture in Old Age? -A Preliminary Study-

PurposeThe studies on the correlation between incidence of fall and brain atrophy have been going on to find out the cause of fall and its prevention. The purpose of this study was to explore the relationship between incidence of hip fracture and brain volume, measured by magnetic resonance image.Materials and MethodsA total of 14 subjects with similar conditions (age, height, weight, and past history) were selected for this study. Fracture group (FG) was consisted of 5 subjects with intertrochanteric fracture. Control group (CG) had 9 subjects without intertrochanteric fracture. MRI-based brain volumetry was done in FG and CG with imaging software (V-works, CyberMed Co., Korea). Total brain (tBV), absolute cerebellar volumes (aCV) and relative cerebellar volumes (rCV) were compared between two groups. Student t-test was used to statistically analyze the results.ResultsIn FG, average tBV, aCV and rCV were 1034.676±38.80, 108.648±76.80 and 10.50±0.72 cm3, respectively. In CG, average tBV, aCV and rCV were found to be 1106.459±89.15, 114.899±98.06 and 10.39±0.53 cm3, respectively, having no statistically significant difference (p>0.05).ConclusionThere was no significant difference between the fracture and control groups. Patients with neurologic disease such as cerebellar ataxia definitely have high incidence of fall that causes fractures and have brain changes as well. However, FG without neurologic disease did not have brain volume change. We consider that high risk of fall with hip fracture might decrease brain function which is not obvious to pickup on MRI.

Sex- and age-specific incidence of non-traumatic fractures in selected industrialized countries

Various methodological approaches have estimated the incidence of osteoporosis-related fractures, making comparisons difficult. This study estimated the incidence rates of non-traumatic fractures in 12 countries using standard definitions. Applying these rates to the 2010 population figures of these countries, a total of 5.2 million non-traumatic fractures were estimated, mostly in women. The purpose of this study was to estimate annual country-, sex-, and age-specific incidence of non-traumatic hip, vertebral, and other fractures for women aged ≥50 and men ≥60 years and the number of fractures expected in 12 countries based on these incidence rates. Electronically indexed medical literature and relevant web sites were reviewed to identify studies reporting age- and sex-specific fracture incidence rates to obtain estimates of the proportion of fractures considered to be non-traumatic and to gather relevant census data. From these data, we extrapolated to estimate the number of fractures in 12 countries in North America, Europe, Japan, and Australia. Annual non-traumatic hip fracture incidence rates were highest for women in Sweden, Denmark, and Finland. In women, vertebral fractures were more common than hip fractures. The incidence of vertebral fractures was highest among Scandinavian and Canadian women. In men, Scandinavians had the highest incidence of hip fractures, while Australian men had the highest incidence of vertebral fractures. Hip and vertebral fracture incidence increased steeply with age for both women and men. Age appears to exert less influence on the incidence of fractures at sites other than hip and vertebrae. In 2010, 5.2 million non-traumatic fractures were expected in the 12 countries studied, of which 2.8 million were at the hip or spine. Women accounted for most of the total non-traumatic fracture burden (77 %). Non-traumatic fractures pose a significant burden, affecting millions of women and men in countries around the world each year.

Hip fracture and urinary incontinence – use of indwelling catheter postsurgery

Norway has a higher incidence of hip fractures than any other country. For older individuals, a hip fracture may cause dramatic changes in health status like incontinence and daily activities. Patients with hip fractures are at high risk of urinary incontinence (UI) after surgical repair. A urinary indwelling catheter (UIC) is inserted preoperatively, but should be removed within 24 hours. Our aims were to identify indicators that might predict clinical challenges related to urinary incontinence 1 year after hip fractures. Inclusion criteria were patients with hip fracture age 65 years or older. They were admitted form their own home to two acute-care hospitals during 2004-2006. We used the Resident Assessment Instrument for Acute Care. A total of 331 patients were included. Thirty-five (11%) had UIC 72 hours after surgery. These patients had more frequently experienced delirium, urinary tract infection, cognitive impairment and discouragement than their counterparts. After 12 months, patients with previous UI had lower functioning levels than those with no previous UI. They had moved four times more frequently to a nursing home and had over twice the mortality. Patient with UI should be followed up with a multidisciplinary team after discharged from hospital.

Age-related loss of proximal femoral strength in elderly men and women: The Age Gene/Environment Susceptibility Study — Reykjavik

The risk of hip fracture rises rapidly with age, and is particularly high in women. This increase in fracture risk reflects both the age-related change in the risk of falling and decrements in the strength of the proximal femur. To better understand the extent to which proximal femoral density, structure and strength change with age as a function of gender, we have carried out a longitudinal analysis of proximal femoral volumetric quantitative computed tomographic (vQCT) images in men and women, analyzing changes in trabecular and cortical bone properties, and using subject-specific finite element modeling (FEM) to estimate changes in bone strength. In the AGES-Reykjavik Study vQCT scans of the hip were performed at a baseline visit in 2002–2006 and at a second visit 5.05±0.25years later. From these, 223 subjects (111 men, 112 women, aged 68–87years) were randomly selected. The subjects were evaluated for longitudinal changes in three bone variables assessed in a region similar to the total femur region quantified by DXA: areal bone mineral density (aBMD), trabecular volumetric bone mineral density (tBMD) and the ratio of cortical to total tissue volume (cvol/ivol). They were also evaluated for changes in bone strength using FEM models of the left proximal femur. Models were analyzed under single-limb stance loading (FStance), which approximates normal physiologic loading of the hip, as well as a load approximating a fall onto the posterolateral aspect of the greater trochanter (FFall). We computed five-year absolute and percentage changes in aBMD, tBMD, cvol/ivol, FFall and FStance. The Mann–Whitney Test was employed to compare changes in bone variables between genders and the Wilcoxon Signed Rank Test was used to compare changes in bone strength between loading conditions. Multiple (linear) regression was employed to determine the association of changes in FFall and FStance with baseline age and five-year weight loss. Both men and women showed declines in indices of proximal femoral density and structure (aBMD: men −3.9±6.0%, women −6.1±6.2%; tBMD: men −14.8±20.3%, women −23.9±26.8%; cvol/ivol: men −2.6±4.6%, women −4.7±4.8%, gender difference: p<0.001). Both men and women lost bone strength in each loading condition (FStance: men −4.2±9.9%, women −8.3±8.5%; FFall: men −7.0±15.7%, women −12.8±13.2%; all changes from baseline p<0.0001). The gender difference in bone strength loss was statistically significant in both loading conditions (p<0.001 for FStance and P<0.01 for FFall) and FFall was lost at a higher rate than FStance in men (p<0.01) and women (p<0.0001). The gender difference in strength loss was statistically significant after adjustment for baseline age and weight loss in both loading conditions (p<0.01). In these multi-linear models, men showed increasing rates of bone loss with increasing age (FFall: p=0.002; FStance: p=0.03), and women showed increasing bone strength loss with higher degrees of weight loss (FStance: p=0.003). The higher loss of FFall compared to FStance supports previous findings in animal and human studies that the sub-volumes of bone stressed under normal physiologic loading are relatively better protected in aging. The gender difference in hip bone strength loss is consistent with the higher incidence of hip fracture among elderly women.

Problematiche delle fratture da fragilità ossea. La nostra esperienza nella gestione delle fragilità ossee nella Regione Piemonte

Osteoporosis-related fractures are extremely common among elderly people throughout the world and Piedmont makes no exception, with an high incidence of hip fractures (HF) (126.13/100,000) in people aged more than 60 years. HFs cause a decrease of the patient’s life expectancy and high costs for the National Health Service. Almost all cases require a surgical treatment that is chosen according to the type of bone fracture and the functional requirements of the patient. The choice is between arthroplasty (PHA or THA) and osteosynthesis (intramedullary nail, cannulated screw, DHS). It is interesting that in our Region the incidence of new fractures in patients that sustained a prior HF within 3 years was 13.01%, but only 1% of them was taking an appropriate anti-osteoporotic therapy, underlining its importance.

Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007

hip fractures result in a significant burden to the patient, their caregivers and the health care system. Patients with Alzheimer's disease (AD) have a higher incidence of hip fracture compared with other older people without AD, although it is not clear if AD is an independent risk factor for hip fracture. a retrospective cohort study was conducted using anonymised electronic medical records from primary care practices in the United Kingdom. Proportional hazards regression modelling with adjustment for potential confounders was used to evaluate AD as an independent risk factor for predicting hip fractures. the incidence of hip fracture among patients with and without AD was 17.4 (95% CI, 15.7-19.2) and 6.6 (95% CI, 5.8-7.6) per 1,000 person years, respectively. Patients with AD had a hazard that was 3.2 (95% CI, 2.4-4.2) times that of non-AD patients after controlling for potential confounders. AD patients who experienced a hip fracture also had an increased mortality rate compared with non-AD patients who experienced a hip fracture (hazard ratio = 1.5; 95% CI, 1.1-1.9). patients with AD and their caregivers should be advised on how to prevent hip fractures and more attention should be given to AD patients who are undergoing rehabilitation following a hip fracture.

大腿骨頸部骨折に関連する神経症状の検討―29年間のSMON検診における縦断的研究―

Hip fracture in elderly people is a major risk factor in the deterioration of activities of daily living (ADL). The aim of this study was to investigate the incidence of hip fractures and the neurological symptoms contributing to hip fracture in patients with subacute myelo-optic-neuropathy (SMON), a drug-induced neurological disease manifesting various symptoms. We investigated the incidence of hip fracture in 3,269 SMON patients with 24,187 medical check-ups from 1979 through 2007 by the SMON Research Committee in Japan. Neurological symptoms were evaluated in 80 patients who had undergone clinical examinations within 2 years before the fracture (hip-fracture group: age at examination = 75.7 ± 8.8 years (mean ± SD)), and the control group (160 SMON patients without a history of hip fracture; 76.5 ± 10.4) were matched for age, gender, and duration of illness. Incidence of hip fracture in SMON as well as severity of visual acuity, motor and sensory symptoms, and ADL were investigated. A total 230 hip fractures occurred in 208 patients (6.4%) with a men-to-women ratio of 21 : 187. In comparison with the Japanese general population, SMON patients showed a statistically high incidence of hip fracture in the 50s and 60s age groups in women (p < 0.002 in both), and in those under 40 (p < 0.02) and in their 50s (p < 0.002) in men. In those with neurological symptoms related to gait, the percentage of subjects who could walk with crutches was significantly higher in the hip-fracture group (43.8%) than in the control group (28.1%) (p < 0.05). Analysis of the vibratory sensation revealed that the hip-fracture group showed a significantly higher percentage of severe impairment (51.9%) than the control group (32.0%) (p < 0.025). There were no significant differences in variance between the two groups in other clinical symptoms or ADL. Impairment of vibration sense, a deep sensation, is more likely to be associated with falling and hip fracture than visual acuity or other neurological symptoms in SMON patients. Those persons with vibration sense disturbance, such as elderly or patients with neurological diseases, should be particularly cautious of falling.

Does inadequate diet during childhood explain the higher high fracture rates in the Southern United States?

Southern states have the highest age-adjusted hip fracture rates among older adults in the United States. Regional hip fracture rates in the United States in 1986-1993 correlate with death rates from rickets in the 1940s. Historical patterns of bone nutrition early in life might explain contemporary geographic patterns in bone fragility. State of residence early in life is a better predictor of the risk of hip fracture after age 65 than state of current residence. Therefore, the geography of rickets mortality in the United States before 1950 was compared with the geography of hip fracture rates among older adults in the United States during 1986-1993. Vital statistics data for the US white population for 1942-1948 allowed calculation of the ratio of deaths from rickets to live births for each geographic division of the USA. These ratios were correlated with previously published, standardized hip fracture rates among whites 65-89 years old during 1986-1993 by census division. During 1942-1948, the rickets mortality ratio among whites was 3.11 in the South, 1.91 in the Northeast, 1.75 in the Midwest, and 1.04 in the West. The correlation of mortality with risk of hip fracture was 0.71 (p = 0.03) for both sexes combined and 0.86 (p = 0.01) for women. Inadequate nutrition during skeletal formation early in life might explain the higher incidence of hip fracture among older adults in the South.

Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007

Background: hip fractures result in a significant burden to the patient, their caregivers and the health care system. Patients with Alzheimer’s disease (AD) have a higher incidence of hip fracture compared with other older people without AD, although it is not clear if AD is an independent risk factor for hip fracture. Methods: a retrospective cohort study was conducted using anonymised electronic medical records from primary care practices in the United Kingdom. Proportional hazards regression modelling with adjustment for potential confounders was used to evaluate AD as an independent risk factor for predicting hip fractures. Results: the incidence of hip fracture among patients with and without AD was 17.4 (95% CI, 15.7–19.2) and 6.6 (95% CI, 5.8–7.6) per 1,000 person years, respectively. Patients with AD had a hazard that was 3.2 (95% CI, 2.4–4.2) times that of non-AD patients after controlling for potential confounders. AD patients who experienced a hip fracture also had an increased mortality rate compared with non-AD patients who experienced a hip fracture (hazard ratio = 1.5; 95% CI, 1.1–1.9). Conclusion: patients with AD and their caregivers should be advised on how to prevent hip fractures and more attention should be given to AD patients who are undergoing rehabilitation following a hip fracture.

Risk factors for hip fracture in Japanese elderly women with osteoporosis: Applicability of biochemical markers in bone turnover

The purpose of this study was to investigate risk factors for hip fracture in 169 Japanese elderly women. Patients were divided into three groups: 53 patients had osteoporosis with hip fractures (FX-G), 59 patients had osteoporosis without hip fractures (NFX-G) and 57 patients had low back pain with neither osteoporosis nor hip fracture (NOP-G). Bone mineral density (BMD) of lumbar spine, bone-specific alkaline phosphatase (BAP) and deoxypyridinoline (DPD) were compared among the three groups. The mean BMD of FX-G and NFX-G was lower than that of NOP-G, but there was no significant difference between FX-G and NFX-G. Although the mean BAP of FX-G was similar to that of NOP-G, both were lower than NFX-G (P < 0.05). However, the mean DPD of FX-G was higher than the other groups (P < 0.05, vs NFX-G, P < 0.001, vs NOP-G). The percentage of patients who showed BAP levels less than 35 IU/L and DPD levels of 7.5 nmoL/mmol-Cr or more, was highest in FX-G (72.7%). This percentage was lower for NFX-G (30.9%) and NOP-G (16.4%). The odds ratio of hip fracture occurring was 5.77 (95% confidence interval, 2.25-14.66). Bone turnover consisting of increase in bone resorption and decrease in bone formation apart from BMD of lumbar spine resulted in a higher incidence of hip fracture for Japanese elderly women with osteoporosis.

Hip Fractures in Institutionalized Elderly People: Incidence Rates and Excess Mortality

It is assumed that nursing homes are the setting with the highest incidence of hip fractures. This observation is, however, based on very little data. The aim of this study was to analyze hip fracture rates and the associated excess mortality in a large nursing home population. A cohort of >69,000 women and men newly admitted to German nursing homes were used to calculate sex- and age-specific incidence rates of hip fractures. To calculate excess mortality, a retrospective cohort study was conducted. To each patient with a hip fracture (n = 4342), four residents without hip fracture (n = 17,368) were matched by sex, age, and level of care (measure for the need of care). Hazard regression models were applied. During 91,850 person-years, 4342 hip fractures were observed. The crude incidence rates for hip fractures were 50.8/1000 person-years in women and 32.7/1000 person-years in men. The incidence rates increased with increasing age categories and were highest in the first months after admission to the nursing home. Increasing care need reduced the risk of hip fracture. Mortality in patients with a hip fracture was increased (women: hazard rate ratio for the first 3 mo after fracture, 1.72; 95% CI, 1.59-1.86; men: hazard ratio, 2.14; 95% CI, 1.80-2.53), but excess mortality was limited to the first months after injury. Data are presented for hip fracture rates and excess mortality after a hip fracture. Our results have implications on the timing and the allocation of specific measures for hip fracture prevention.

Calcium intake in elderly patients with hip fractures

Background: Dietary calcium intake is assumed important in the prevention and treatment of osteoporosis. However, people in countries with a high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake in the prevention of osteoporotic fracture vary from different studies.Objective: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years.Design: In total 120 patients (mean age 78±8.5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) and interviews on patients’ daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients.Results: The mean daily calcium intake from food and supplementation was 970±500 mg. However, 38% of patients had an intake below the recommended 800 mg/day. There was no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3±0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005.Conclusion: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800 mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex.

Kalzium-Supplementierung in der Menopause: überflüssig, erwünscht oder obligatorisch?

With the menopause, the multiple positive effects of estrogens on bone come to an end, which leads to an increased bone turnover an accelerated bone loss and an increased fracture risk. Although the antifracture effect of calcium alone is questionable, several observations justify the recommendation to avoid calcium deficiency in this age: Very low Calcium intake is related to low BMD and higher hip fracture incidence in several studies; regular Calcium supplementation lowers fracture incidence, when observed over years. Calcium from dairy products, mineral waters and supplements is almost equally well absorbed. But the former contain also other nutrients with positive effects on bone, such as proteins, phosphorus, bicarbonates. The choice goes for the nutrient or supplement with the best acceptance by a given individual.

Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinson disease [RETRACTED

There is a high incidence of hip fractures in patients with Parkinson disease (PD). Bone mineral density (BMD) is decreased in patients with PD, correlating with the immobilization-induced bone resorption and hypovitaminosis D with compensatory hyperparathyroidism. To evaluate the effectiveness of risedronate, an inhibitor of bone resorption, on osteoporosis and the risk of hip fractures in elderly men with PD. This was a 2-year, randomized, double-blind, placebo-controlled trial. In a prospective study of patients with PD, 121 patients received a daily dose of 2.5 mg risedronate and vitamin D2 1,000 IU for 2 years, and the remaining 121 received placebo and vitamin D2 1,000 IU. Incidence of hip fractures was compared between the two groups. Nine patients sustained hip fractures in the placebo group, and three hip fractures occurred in the risedronate group. The relative risk of a hip fracture in the risedronate group vs the placebo group was 0.33 (95% CI, 0.09 to 1.20). BMD increased by 2.2% in the risedronate group and decreased by 2.9% in the placebo group (p < 0.0001). Urinary deoxypyridinoline, a bone resorption marker, decreased by 46.7% in the risedronate group and by 33.0% in the placebo group. Treatment with risedronate and vitamin D2 increases bone mineral density in elderly men with Parkinson disease and reduces the risk of hip fractures.

Incidence of hip fracture in southeastern Norway

The incidence of hip fracture has been studied extensively, but there is still some doubt whether the age-specific incidence is increasing. The proportion of trochanteric fractures has varied and has also been said to be increasing. We studied data on 1,730 prospectively registered cases from 1998-2003 and computed age- and gender-specific incidence rates for intracapsular and trochanteric fractures. The incidence of hip fracture for women over 50 years was 1,263 and for men 452 per 100,000. The proportion of trochanteric fractures was 38% for women and 41% for men. There was no significant difference in the proportion of trochanteric fractures either between or within the genders, and the proportion did not exceed 50% in any age group. These findings confirm the high incidence of hip fracture in Norway but do not indicate any increase. The proportion of trochanteric fractures also seems to be stable.

Risedronate Sodium Therapy for Prevention of Hip Fracture in Men 65 Years or Older After Stroke

There is a high incidence of hip fractures in patients after hemiplegic stroke. Bone mineral density is decreased on the hemiplegic side in patients after stroke, correlating with the immobilization-induced bone resorption, the degree of paralysis, and hypovitaminosis D. The purpose of this study is to evaluate the effectiveness of risedronate sodium, an inhibitor of bone resorption, on osteoporosis and the risk of hip fractures in men 65 years or older after stroke. We conducted an 18-month randomized double-blind trial. Of 280 male patients 65 years or older who were poststroke, 140 received a daily dose of 2.5 mg risedronate sodium and the other 140 received placebo. Incidence of hip fractures in the 2 groups was compared. Ten patients sustained hip fractures in the placebo group, and 2 hip fractures occurred in the risedronate group. The relative risk of a hip fracture was 0.19 (95% confidence interval, 0.04-0.89). The number of patients needing the treatment was 16 (95% confidence interval, 9-32). Bone mineral density increased by 2.5% in the risedronate group and decreased by 3.5% in the placebo group (P<.001). Urinary deoxypyridinoline, a bone resorption marker, decreased by 58.7% in the risedronate group and by 37.2% in the placebo group. Treatment with risedronate increases bone mineral density and reduces hip fractures in elderly men who are poststroke.

Incidence of hip fracture in Shiraz, Iran

Hip fracture, the most serious complication of osteoporosis, puts the burden of a lot of costs for treatment on any health system. Previous reports on rates of hip fracture in Asian countries differ a lot. The aim of this study was to estimate the incidence rate of hip fracture in Shiraz, Iran. In Shiraz, Iran, all operating-room logs with diagnosis of hip fracture were reviewed for hip fractures caused by a simple fall in patients over 50 years, during March 21, 2000, to March 21, 2003. According to patients' medical records, age, sex, type of fracture (intertrochanteric, neck, subtrochanteric) and patients' regions according to Shiraz municipality divisions were obtained. The age-adjusted incidence rates of hip fracture standardized to the 1985 US white population (325.74/100,000 for men and 519.05/100,000 for women) and to the 1989 US white population (384.61/100,000 for men and 548.17/100,000 for women) were the highest in Asia. The intertrochanteric fractures were significantly higher among females ( p =0.003). The incidence of intertrochanteric and neck fractures were increased with age. In all age groups, females had higher incidence rates, except for ages over 80 years, in which males had higher incidence rates than females. In wealthier regions of the city, the incidence rates were higher than in other regions. High incidence of hip fracture in our population, especially in males over 80 years, shows that preventive strategies for hip fracture and osteoporosis should be considered in males as well as females. Further studies are needed to find incidence rates in other cities, especially in the very urbanized city of Tehran.