High Risk Of Hip Fracture Research Articles

Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña

ObjectiveTo evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics. DesignRetrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006–2014. SiteAll primary care teams in Catalonia of the Catalan Health Institute (ICS). ParticipantsPatients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed.Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR). ResultsThe hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34–1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75–7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39–4.92) and depression (HR: 1.51; 95% CI: 1.21–1.88). ConclusionsPatients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.

Hip fracture in patients with non-dialysis chronic kidney disease stage 5

Hip fracture is a significant health problem and is associated with increased mortality. Patients with chronic kidney disease (CKD) are more at risk of hip fracture than the general population, but the hip fracture risk is not evident among non-dialysis CKD stage 5 patients. This study aims to assess the risk of hip fracture in patients with non-dialysis CKD stage 5 comparing to those with CKD stages 1–4. Patients with non-dialysis CKD stage 5 and CKD stages 1–4 were retrieved from Taiwan longitudinal health insurance database 2011–2014. All patients were followed to the end of 2018 for the development of hip fractures. We analyze the risk of hip fracture of propensity score-matched patients with CKD stage 5 compared to patients with CKD stages 1–4 using stepwise Cox regression and competing risks regression. We analyzed 5649 propensity score-matched non-dialysis CKD 1–4 patients and non-dialysis CKD 5 patients between 2011 and 2014. All patients were followed to the end of 2018, 229 (4.1%) of CKD 1–4 patients in 21,899 patient-year, and 290 (5.1%) of CKD 5 patients had hip fractures in 18,137 patient-year. CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1–4. The adjusted HR was 1.53 (95% CI 1.08–1.54) in the Cox regression with adjustments for age, gender, comorbidity, and history of fracture. In the competing risks regression, the subdistribution hazard ratio was 1.29 (95% CI 1.08–1.54). Female gender, age, history of fractures, and Charlson–Deyo comorbidity index were independently associated with increased hip fracture risks. Non-dialysis CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1–4. This association is independent of patients’ age, female gender, history of fractures, and comorbidities.

Prediction of imminent fracture risk in Canadian women and men aged 45years or older: external validation of the Fracture Risk Evaluation Model (FREM).

The FREM is a tool developed from Danish public health registers (hospital diagnoses) to identify individuals over age 45years at high imminent risk of major osteoporotic fractures (MOF) and hip fracture (HF). In this study, our aim was to examine the ability of FREM to identify individuals at high imminent fracture risk in women and men from Manitoba, Canada. We used the population-based Manitoba Bone Mineral Density (BMD) Program registry, and identified women and men aged 45years or older undergoing baseline BMD assessment with 2years of follow-up data. From linked population-based data sources, we constructed FREM scores using up to 10years of prior healthcare information. The study population comprised 74,828 subjects, and during the 2years of observation, 1612 incident MOF and 299 incident HF occurred. We found significant fracture risk stratification for all FREM scores, with AUC estimates of 0.63-0.66 for MOF for both sexes and 0.84 for women and 0.65-0.67 for men for HF. FREM performed better than age alone but not as well as FRAX® with BMD. The inclusion of physician claims data gave slightly better performance than hospitalization data alone. Overall calibration for 1-year MOF prediction was reasonable, but HF prediction was overestimated. In conclusion, the FREM algorithm shows significant fracture risk stratification when applied to an independent clinical population from Manitoba, Canada. Overall calibration for MOF prediction was good, but hip fracture risk was systematically overestimated indicating the need for recalibration.

Automated bone mineral density prediction and fracture risk assessment using plain radiographs via deep learning

Dual-energy X-ray absorptiometry (DXA) is underutilized to measure bone mineral density (BMD) and evaluate fracture risk. We present an automated tool to identify fractures, predict BMD, and evaluate fracture risk using plain radiographs. The tool performance is evaluated on 5164 and 18175 patients with pelvis/lumbar spine radiographs and Hologic DXA. The model is well calibrated with minimal bias in the hip (slope = 0.982, calibration-in-the-large = −0.003) and the lumbar spine BMD (slope = 0.978, calibration-in-the-large = 0.003). The area under the precision-recall curve and accuracy are 0.89 and 91.7% for hip osteoporosis, 0.89 and 86.2% for spine osteoporosis, 0.83 and 95.0% for high 10-year major fracture risk, and 0.96 and 90.0% for high hip fracture risk. The tool classifies 5206 (84.8%) patients with 95% positive or negative predictive value for osteoporosis, compared to 3008 DXA conducted at the same study period. This automated tool may help identify high-risk patients for osteoporosis.

High Alcohol Intake in Older Men and the Probability of Osteoporotic Fracture According to the FRAX Algorithm.

We aimed to determine the contribution of high alcohol intake to fracture probability, calculated using a fracture-risk assessment tool (FRAX). Participants were 262 men (ages 60–90 y) in the Geelong Osteoporosis Study. Alcohol consumption was documented via a food frequency questionnaire; 46 (17.6%) consumed three or more units per day, fulfilling the criterion for high alcohol intake. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry. We determined FRAX probabilities (%) for major osteoporotic fracture (MOF) and hip fracture (HF), calculated with and without alcohol intake. Thresholds for high FRAX probabilities, calculated with or without BMD, were ≥20% for MOF and ≥3% for HF. Proportions of men with high HF-FRAX probabilities were consistently greater for drinkers compared with non-drinkers. For drinkers, paired differences showed that median MOF-FRAXwithoutBMD probabilities calculated with and without alcohol changed by −2.3, HF-FRAXwithoutBMD by −1.7, MOF-FRAXwithBMD by −1.4, and HF-FRAXwithBMD by −0.9 (all p < 0.001). We estimated that, should drinkers lower their alcohol consumption to <3 units/d, up to 66.7% of those at high risk for MOF and up to 41.0% at high risk for HF would reduce their FRAX probabilities to below the thresholds for high fracture risk. In the context of the Australian environment, these data describe the extent to which older men with high alcohol consumption are at increased risk for fracture.

Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans

Concerns regarding the adequacy of vegetarian diets with respect to fracture risk continue. We aimed to explore the influence of 5 previously defined dietary patterns on hip fracture risk and whether this association is modified by concomitant calcium and vitamin D supplementation. The Adventist Health Study 2 is a prospective cohort study in which participants were enrolled during 2002-2007; proportional hazards regression analyses were used to estimate fracture risk. Participants reside throughout the United States and Canada. A total of 34,542 non-Hispanic white peri- and postmenopausal women and men 45 y and older responded to the biennial hospital history form and were followed for a median of 8.4 y. The study identified 679 incident hip fractures during 249,186 person-years of follow-up. Fracture risk varied according to dietary pattern, with a clear effect modification by concurrent supplementation with both vitamin D and calcium. In multivariable models, including adjustment for calcium and vitamin D supplementation, female vegans had 55% higher risk of hip fracture (HR: 1.55; 95% CI: 1.06, 2.26) than nonvegetarians (NVEGs), whereas there was no association between diet pattern and hip fracture risk in men. When further stratifying females on supplement use with both vitamin D and calcium, vegans taking both supplements were at no greater risk of hip fracture than the subjects with other dietary patterns including the NVEGs. Without combined supplementation of both vitamin D and calcium, female vegans are at high risk of hip fracture. However, with supplementation the excessive risk associated with vegans disappeared. Further research is needed to confirm the adequacy of a vegan diet supplemented with calcium and vitamin D with respect to risk of fracture.

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.

Low dietary calcium intake does not modify fracture risk but increases fall frequency: the results of GO Study.

The aim of the study was to verify the thesis that dietary calcium intake influences the risk of osteoporotic fractures established by online available calculators. The study was performed in 521 postmenopausal women aged over 55 years, recruited in one osteoporotic outpatient clinic. Mean age was 67.7 ± 8.6 years. Fracture risk was established using FRAX (major and hip fractures, 10 years), Garvan calculator (any and hip fractures, 5 and 10 years), and the Polish algorithm available at www.fracture-risk.pl (any fractures, 5 years). Bone densitometry at the femoral neck was performed using a DPX device (Lunar, GE, USA) to calculate fracture risk by each of those calculators. Calcium intake was established based on a dietary questionnaire. Mean values of fracture risk for all three calculators and T-score value for DXA measurement at the femoral neck did not correlate with calcium intake. A tendency to insignificantly lower calcium intake was observed in the subgroup with high hip fracture risk by FRAX (≥ 3%) vs. low hip FRAX (< 3%): 744 ± 328 mg/day vs. 765 ± 299 mg/day. The same analysis for FRAX major fracture risk revealed a similar tendency: 700 ± 299 mg/day and 760 ± 311 mg/day in high (≥ 20%) and low (< 20%) fracture-risk groups, respectively. Calcium intake did not influence the results obtained in the other two calculators at all. Calcium intake did not differ between subjects with prior falls and those without falls. However, if the number of falls was taken into account, the women who reported three and more falls had significantly lower calcium intake (621 ± 275 mg/day) than subjects with no falls (767 ± 304 mg/day; p < 0.05) or those with one fall (766 ± 317 mg/day; p < 0.05). Calcium intake does not correlate with fracture risk established by calculators available on-line, but low calcium intake may increase the risk of falls.

Biomechanical Computed Tomography Captures Older Men at High Risk of Hip Fracture Despite Low Fracture Risk Calculation by FRAX

Background: Biomechanical computed tomography (BCT) can be applied to hip-containing CT scans to estimate femoral bone strength using finite-element analysis and to measure DXA-equivalent femoral neck (FN) BMD. Current guidelines recommend osteoporosis pharmacotherapy initiation in men with BMD T-score ≤ -2.5 or T-score between -1.0 and -2.5 with 10-year hip fracture risk ≥ 3% by FRAX.1 Estimated femoral strength by BCT is associated with incident hip fractures in men, independent of BMD,2 and can be used in conjunction with clinical risk factors for consideration of therapy initiation per the International Society of Clinical Dosimetry.3Aim: To determine how many men are at increased risk of fractures with fragile bone strength (≤ 3500N) despite normal-to-low BMD (T-score > -2.5) and low 10-year hip fracture risk (< 3%).Methods: 625 men age ≥ 65 with hip-containing CT scans were randomly selected for BCT analysis out of 4209 scans performed from 2017 to 2019 at a single academic hospital. Scans were excluded if an intact femur was not imaged. BCT was performed for 557 men after accounting for un-processable scans. Electronic health records were retrospectively reviewed by investigators blinded to BCT results. 10-year hip fracture risks were calculated by FRAX based on available clinical data and FN BMD T-score from BCT. Chi-squared and t-test were used to investigate differences in clinical parameters between men with and without fragile bone strength.Results: The mean age was 77 (± 7.6 years), and 69% of men were white. Out of 102 men (18.3%) who met criteria for fragile bone strength by BCT, 42 (7.5%) had low FN BMD (T-score between -1.0 and -2.5) and 2 (0.4%) had normal FN BMD (T-score ≥ -1.0). The percentage of men with fragile bone strength and discrepant BMD increased with age (5.4% in age 65–74; 8.2% in age 75–84; 13.0% in age ≥ 85). The average 10-year hip fracture risk by FRAX of men with fragile bone strength was 6.5% (± 4.0%). However, 13 out of 44 men with normal-to-low BMD had 10-year hip fracture risks < 3% despite fragile bone strength presence and did not meet recommendation for osteoporosis pharmacotherapy. Examining men with normal-to-low BMD (n=493), those with fragile bone strength tended to be older, have lower BMI, and of Hispanic ethnicity compared to those with normal-to-low bone strength (p<0.05).Conclusions: Our study showed that fragile bone strength is present in older men with normal-to-low BMD, and that inclusion of 10-year hip fracture risk by FRAX may capture some, but not all, men at increased risk of hip fractures. Skeletal fragility measured by BCT may serve as additional data to assist with clinical decision making for men with osteoporosis, though further prospective research is needed.Reference: 1. Watts et al, J Clin Endocrinol Metab. 2012 Jun;97(6):1802–22. 2. Adams et al, J Bone Miner Res 2018 Jul;33(7):1291–1301. 3. Shuhart et al, J Clin Densitom. 2019 Oct-Dec;22(4):453–471.

Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study.

BackgroundKidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients.Patients-methodPatients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD.ResultsOne hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX.ConclusionExploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Mortality, Falls, and Fracture Risk Are Positively Associated With Frailty: A SIDIAP Cohort Study of 890 000 Patients.

BackgroundFrail subjects are at increased risk of adverse outcomes. We aimed to assess their risk of falls, all-cause mortality, and fractures.MethodWe used a retrospective cohort study using the Sistema d’Informació per al Desenvolupament de l’Investigació en Atenció Primària database (>6 million residents). Subjects aged 75 years and older with ≥1 year of valid data (2007–2015) were included. Follow-up was carried out from (the latest of) the date of cohort entry up to migration, end of the study period or outcome (whichever came first). The eFRAGICAP classified subjects as fit, mild, moderate, or severely frail. Outcomes (10th revision of the International Classification of Diseases) were incident falls, fractures (overall/hip/vertebral), and all-cause mortality during the study period. Statistics: hazard ratios (HRs), 95% CI adjusted (per age, sex, and socioeconomic status), and unadjusted cause-specific Cox models, accounting for competing risk of death (fit group as the reference).ResultsA total of 893 211 subjects were analyzed; 54.4% were classified as fit, 34.0% as mild, 9.9% as moderate, and 1.6% as severely frail. Compared with the fit, frail had an increased risk of falls (adjusted HR [95% CI] of 1.55 [1.52–1.58], 2.74 [2.66–2.84], and 5.94 [5.52–6.40]), all-cause mortality (adjusted HR [95% CI] of 1.36 [1.35–1.37], 2.19 [2.16–2.23], and 4.29 [4.13–4.45]), and fractures (adjusted HR [95% CI] of 1.21 [1.20–1.23], 1.51 [1.47–1.55], and 2.36 [2.20–2.53]) for mild, moderate, and severe frailty, respectively. Severely frail had a high risk of vertebral (HR of 2.49 [1.99–3.11]) and hip fracture (HR [95% CI] of 1.85 [1.50–2.28]). Accounting for competing risk of death did not change results.ConclusionFrail subjects are at increased risk of death, fractures, and falls. The eFRAGICAP tool can easily assess frailty in electronic primary care databases in Spain.

Hip Fracture in Patients with Parkinson’s Disease and Related Mortality: A Population-Based Study in Korea

Introduction: Patients with Parkinson’s disease (PD) are prone to falls, thereby increasing the risk of fractures and mortality. This population-based study investigated the risk of hip fractures and their effect on mortality in patients with PD in Korea. Methods: National Health Insurance Service-National Sample Cohort data were used. Patients newly diagnosed with PD between 2006 and 2015 and age- and sex-matched individuals were classified into the PD group and the comparison group, respectively, with a 1:9 ratio. The Cox proportional hazards model was used to calculate hazard ratios (HRs), and the Kaplan-Meier method to identify survivorship. Results: In total, 26,570 individuals were enrolled in the study: 2,657 in the PD cohort and 23,913 in the matched comparison cohort. The PD group had about a 2 times higher risk of hip fracture than the comparison group (3.95 vs. 1.94%, p < 0.001). According to sex, the difference between the PD and comparison groups for the risk of hip fracture was greater in males than in females. The highest difference in HR for hip fracture between the PD and comparison groups was found in individuals aged between 60 and 69 years. Regarding post-fracture mortality in patients with PD, the mortality risk was twice as high in the patients with hip fracture than in those without. The effect of hip fracture on mortality between these 2 groups was also the highest in individuals aged between 60 and 69 years. Conclusion: The PD group showed an approximately 2 times higher risk of hip fracture compared with the comparison group, and the post-fracture mortality rate was 2 times higher in the patients with PD with hip fracture than in those without. Those aged 60–69 years were associated with the highest risk of hip fracture and post-hip fracture mortality among patients with PD.

Association of hip fractures with cardiometabolic-renal risk factors in Southern Chinese patients with type 2 diabetes - the Hong Kong Diabetes Register.

IntroductionDiabetes and bone health are closely related. We examined the incidence and risk factors of hip fractures in Chinese patients with type 2 diabetes (T2D).Materials and MethodsIn this prospective cohort, we consecutively enrolled 22,325 adults with T2D above the age of 40 years in the Hong Kong Diabetes Register between 1994 and 2015 with crude hip fracture incidence rate censored in 2017.ResultsAt baseline, the mean age of this cohort was 60.9 ± 10.5 years (mean duration of diabetes 6 years, 52.4% male). During a mean ± standard deviation (SD) follow‐up period of 8.7 ± 5.2 years with 193,553 person‐years, 603 patients were hospitalized due to hip fractures with an incidence (95% confidence interval, CI) of 315.1 (290.4–341.3) per 100,000 person‐years. On multivariable analysis with competing death risk adjusted, the independent hazard ratios (95% CI) for hip fractures in T2D were 2.01 (1.61–2.51) for female sex, 1.08 (1.07–1.09) for age, 0.93 (0.90–0.95) for body mass index, 1.52 (1.25–1.85) for albuminuria and 1.12 (1.02–1.23) for low density lipoprotein‐cholesterol. In men, the 30‐day, 1‐year and 5‐year post‐hip fracture mortality rate (95% CI) were 5.8 (2.4–9.1) %, 29.2 (22.3–35.5) % and 65.9 (57.3–72.8) % respectively. The corresponding rates in women were 3.4 (1.6–5.1) %, 18.6 (14.7–22.4) %, and 46.8 (40.9–52.1) %.ConclusionsSouthern Chinese patients with T2D have a high risk of hip fracture associated with suboptimal cardiometabolic‐renal risk factors and a high post‐fracture mortality rate. The effects of improving modifiable risk factors on bone health warrants further evaluation.

Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease

PurposePeople living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD.MethodsPatients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD.Results397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00).ConclusionPatients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.

Serum non-esterified fatty acid levels and hip fracture risk: The Cardiovascular Health Study

Serum non-esterified fatty acids (NEFAs) are bioactive metabolic intermediates that can be taken up by bone tissue. Their associations with hip fracture risk have not been previously examined. Thirty-five individual NEFAs in five classes (saturated [SFA], mono-un-saturated [MUFA], poly-unsaturated n-6 and n-3 [PUFA], and trans-FA) were measured in Cardiovascular Health Study participants (n = 2139, mean age 77.8 years) without known diabetes. The multivariable associations of NEFA levels with hip fracture risk were evaluated in Cox hazards models. We documented 303 incident hip fractures during 11.1 years of follow-up. Among the five NEFA classes, total trans FA levels were positively associated with higher hip fracture risk (HR 1.17 [95% CI, 1.04, 1.31; p = 0.01] per one standard deviation higher level). The SFA lignoceric acid (24:0) was positively associated with higher risk (HR 1.09 [1.04, 1.1]; p < 0.001), while behenic (22:0) and docosatetraenoic (22:4 n6) acids were associated with lower risk (HR 0.76 [0.61, 0.94]; p = 0.01; 0.84 [0.70, 1.00]; p = 0.05, respectively). Total plasma trans NEFA levels are related to hip fracture risk, suggesting an unrecognized benefit of their systematic removal from food. Novel associations of individual NEFAs with hip fracture risk require confirmation in other cohort studies.

Associations of hemoglobin and change in hemoglobin with risk of incident hip fracture in older men and women: the cardiovascular health study.

Hematopoiesis and bone health are interdependent. Anemia has been associated with risk of fracture in humans. To further elucidate this relationship, we hypothesized that decreasing hemoglobin could indicate defective hematopoiesis and would also predict fracture risk. We performed a prospective analysis from study baseline (1992) of the Cardiovascular Health Study, a multi-site longitudinal cohort study. A total of 4670 men and women, ages >65years, who were able to consent and not institutionalized or wheelchair bound, had hemoglobin (Hb) measured in 1992. For 4006 subjects, Hb change from 1989 to 1992 was annualized and divided into sex-specific quartiles. Incident hip fractures were verified against Medicare claims data during a median follow-up of 11.8years. Nested Cox proportional-hazard models estimated association of hip fracture with anemia (men Hb <13g/dL, women Hb <12g/dL) and separately, greatest Hb decrease (versus others). Anemia was associated with increased hip fracture risk in all men (HR 1.59; 95% CI 1.01-2.50) and African American women (HR 3.21; 95% CI 1.07-9.63). In men, an annualized Hb loss of >0.36g/dL/year was associated with a higher risk of hip fracture (HR 1.67; 95% CI 1.10-2.54), which was lessened by anemia at the start of fracture follow-up (HR 1.53; 95% CI 0.99-2.39). Decreasing Hb may be an early marker for subsequent hip fracture risk in men, which may be less informative once an anemia threshold is crossed. Only African American women with anemia had increased hip fracture risk, suggesting a race difference in this relationship.

Physical performance and risk of hip fracture in community-dwelling elderly people in China: A 4-year longitudinal cohort study

BackgroundThis study aims to evaluate the association between the risk of hip fracture and score on the Short Physical Performance Battery (SPPB) and handgrip strength in community-dwelling elderly people in China. MethodsA total of 5,958 community-dwelling Chinese people aged 60 years or more from the China Health and Retirement Longitudinal Study (CHARLS) were surveyed in 2011 (baseline) and followed through to 2016. Score on the SPPB (which comprises tests of balance, walking speed, and repeated chair stands) and handgrip strength were determined at baseline. Binary logistic regression models were used to estimate the risk ratio (RR) and 95 % CI. ResultDuring an average of approximately 4 years of follow-up, 180 (3.0 %) participants experienced incident hip fracture. After multivariate adjustment, the overall SPPB score and repeated chair stands alone distinguished a gradient of hip fracture risks. The risk of hip fracture was 1.65-fold higher in poor SPPB performers (score 0−6) than in good SPPB performers (score 10−12). Participants unable to complete repeated chair stands, and those who took ≥16.7 s or 13.7–16.6 s to complete them, had a higher risk than those who took ≤ 11.1 s to complete them, with RRs of 2.45, 2.12, and 1.93, respectively. Participants unable to complete the balance tests had a higher hip fracture risk than those with scores of 4, with an RR of 2.16. Walking speed and handgrip strength were not associated with increased hip fracture risk. ConclusionAmong community-dwelling elderly Chinese people, overall SPPB score, as well as performance on repeated chair stands and balance tests within the SPPB, were significantly and independently associated with increased hip fracture risk. These indicators could be used to predict hip fracture in clinical settings.

Physical Rehabilitation Outcomes in Patients with Dementia Following Hip Fracture Surgery: A Review

Background: Dementia patients were reported of having high risk for hip fracture. Rehabilitation programs were still being debated for this vulnerable population and the recovery outcomes in this frail elderly population are varied, thus evidenced-based outcomes for this issue are needed.Objective: To investigate rehabilitation programs, especially on physical function outcomes in patients with dementia following hip fracture surgery.Method: PubMed, Scopus and MEDLINE (EBSCO) databases were searched from January 2000 to June 2020 concerning rehabilitation intervention program in dementia patients who received hip surgical treatment. The studies included have the following criteria, (1) investigating physical outcomes of rehabilitation programs (2) Randomized controlled trials (RCTs) study design, (3) study involving dementia patients following hip fracture surgery (4) English full-text journal.Results: Six studies were included in this review. Most study focused on interdisciplinary or multidisciplinary rehabilitation program. Physical outcomes of rehabilitation programs seem to improve physical function, maintaining physical ability for ambulation, and decrease the risk of falls in mild or moderate dementia patients following hip fracture surgery. However, the physical function of older persons with dementia confirmed to be lower than those without dementia.Conclusion: Rehabilitation may show benefit for physical function in elderlywith mild or moderate dementia following hip fracture surgery, and this population needs to be included in the clinical rehabilitation program. Investigating and establishing the strategies to improve outcomes for dementia population is needed for future study.

Консолидация переломов шейки бедра в зависимости от вида перелома

We study the terms of the femoral neck fracture healing, depending on the type of fractures. Currently, the diagnosis of “hip fracture” occupies a significant place in the work of a traumatologist, since this fracture tends to increase the frequency of cases, especially among people over 60 years old. This problem has long been one of the most urgent in traumatology and orthopedics, includes many facets, among which there is a high risk of complications during the operation of these fractures among elderly and senile people, the growth of people at high risk of hip fracture due to osteoporotic changes in the composition of bone tissue. And one of the sides of this problem is the non-healing and the timing of the femoral neck fracture healing, due to its anatomical features. We present the results of studies conducted at the clinical bases of the Kotovsk City Clinical Hospital and Archbishop Luke Tambov City Clinical Hospital. Aim: to study the terms of the femoral neck fracture healing, depending on the type of fractures. Task: to conduct studies, observations, collect statistical data on the management of patients with femoral neck fracture and, based on the results obtained, to characterize and evaluate the terms of femoral neck fractures healing

Post-hip fracture rehabilitation outcomes of diabetic and non-diabetic elderly patients

Background Although patients with diabetes mellitus (DM) are at higher risk of hip fracture, data regarding the effect of DM on rehabilitation outcomes are limited. Methods A retrospective single-centre study was conducted comparing elderly diabetic and non-diabetic patients with recent hip fracture, admitted to geriatric rehabilitation, 2014–2019. The functional independence measure (FIM) was used to assess physical and cognitive function. Delta-FIM was calculated by subtracting admission FIM from discharge FIM. One-year mortality, hospitalizations and fractures were assessed. Results Six-hundred-thirty elderly patients, post-hip fracture were included, mean age 83 ± 7 years, 70.5% (444) women. Among them, 193 (30.6%) had type 2 DM, HbA1c 6.6 ± 1.25%. They were younger (81.4 vs. 84.3 years, p < .01) and had more co-morbidities including hypertension, chronic kidney disease, ischaemic heart disease and cerebrovascular disease. Baseline cognitive and motor scores were similar between groups. Delta motor-FIM was similar between diabetics and non-diabetics (15.56 ± 8.95 and 14.78 ± 8.79, respectively, p = .35). Multivariate regression analysis showed motor-FIM improvement was associated with higher BMI, male sex, and younger age, but not with DM. Cognitive FIM did not change significantly during rehabilitation in either group. Similar rates of patients were discharged to nursing care facilities. There was no difference in 1-year hospitalization or fracture rates. One-year, all-cause mortality was higher among diabetic patients (10.9 vs. 6.6%, respectively, p = .07). After adjusting for covariates, DM was associated with higher mortality risk (odds ratio = 2.78, 95% CI [1.28, 6.04], p = .01). Conclusions Patients with well-controlled DM have similar post-hip fracture rehabilitation potential compared with non-diabetics, despite more co-morbidities. These results support resource allocation for post-hip fracture rehabilitation among patients with DM. The higher 1-year all-cause mortality in patients with DM reinforces the need for close follow-up and control of co-morbidities in this population.