Lifetime Risk Of Hip Fracture Research Articles

A comparitive & prospective analysis of unstable trochanteric fractures fixed with PFN and PFN AII

Introduction: Intertrochanteric (peritrochanteric) fractures include the fractures in the region extending from the extrascapular basilar neck region to the region along the lesser trochanter of femur. Usually occurs in the elderly age group as a result of low-Energy trauma such as accidental fall due to osteoporosis and poor bone quality but high velocity trauma in young individuals can also result in similar fracture. Epidemiological reports by (Gill esult JB, 2007) reported a life-time risk of hip fractures at 50 years of age as 5.6% for men and 20% for women. And, interestingly peritrochanteric fractures constitute around 34% of all hip fractures.Aim of the study: The aim of the study is to compare and analyze the functional outcome of patients with Unstable Trochanteric fractures managed with Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN)Objective of the study: Comparative analysis of functional outcome in the management of unstable trochanteric fractures by Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN).

Epidemiology of hip fracture in Botswana

SummaryA retrospective population-based survey in the Republic of Botswana determined the incidence of fractures at the hip over 3 years. The estimated number of such fractures nationwide for 2020 was 103 and is predicted to increase.ObjectiveThis article describes the epidemiology of hip fractures in the Republic of Botswana.MethodsA retrospective patient chart review was conducted to identify from hospital registers the number of patients diagnosed with hip fracture in 2009, 2010, and 2011. Age- and sex-specific incidence of hip fracture was determined from which lifetime probabilities and future projections for hip fracture were calculated.ResultsThe incidence of hip fracture was low and comparable to rates reported from Tunisia. The remaining lifetime risk of hip fracture at the age of 50 years in men and women was 1.4 and 1.1%, respectively. The incidence of hip fracture suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2020 was 103 and is predicted to increase by more than threefold to 372 in 2050.ConclusionThe hip fracture rates can be used for healthcare planning. Additionally, these data can be used to create a FRAX model to help guide decisions about treatment.

Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival – A nationwide study of the Swedish population 60 years and older

BackgroundHip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. Material and MethodsThe entire Swedish population 60years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. ResultsThe age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5years for men and by 2.2years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. ConclusionsThe age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.

SAT0489 Upper Arm Circumference Measurement Improves Screening for Low Bone Mineral Density in Men

BackgroundFragility hip fractures are associated with increased mortality, especially in men1. As bone mineral density (BMD) determination is the single most important determinant of bone strength, and mass dual-energy X-ray...

Estimation of the lifetime risk of hip fracture for women and men in Canada.

In Canada in 2008, based on current rates of fracture and mortality, a woman or man at age 50 years will have a projected lifetime risk of fracture of 12.1% and 4.6%, respectively, and 8.9% and 6.7% after incorporating declining rates of hip fracture and increases in longevity. In 1989, the lifetime risk of hip fractures in Canada was 14.0% (women) and 5.2% (men). Since then, there have been changes in rates of hip fracture and increased longevity. We update these estimates to 2008 adjusted for these trends, and in addition, we estimated the lifetime risk of first hip fracture. We used national administrative data from fiscal year April 1, 2007 to March 31, 2008 to identify all hip fractures in Canada. We estimated the crude lifetime risk of hip fracture for age 50 years to end of life using life tables. We projected lifetime risk incorporating national trends in hip fracture and increased longevity from Poisson regressions. Finally, we removed the percentage of second hip fractures to estimate the lifetime risk of first hip fracture. From April 1, 2007 to March 31, 2008, there were 21,687 hip fractures, 15,742 (72.6%) in women and 5,945 (27.4%) in men. For women and men, the crude lifetime risk was 12.1% (95%CI, 12.1, 12.2%) and 4.6% (95%CI, 4.5, 4.7%), respectively. When trends in mortality and hip fractures were both incorporated, the lifetime risk of hip fracture were 8.9% (95%CI, 2.3, 15.4%) and 6.7% (95%CI, 1.2, 12.2%). The lifetime risks for first hip fracture were 7.3% (95%CI, 0.8, 13.9%) and 6.2% (95%CI, 0.7, 11.7%). The lifetime risk of hip fracture has fallen from 1989 to 2008 for women and men. Adjustments for trends in mortality and rates of hip fracture with removing second fractures produced non-significant differences in estimates.

Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan

Hip fracture incidence from 2004 to 2006 in the Tottori prefecture of Japan was investigated and compared with previously reported rates. The age- and gender-specific incidence of hip fracture in the Tottori prefecture has not plateaued, as has been reported for populations in Northern Europe or North America. Recent data from Northern Europe and North America indicate that the incidence of hip fracture has plateaued, whereas most reports from Asia indicate that the incidence is increasing. The aims of this study were to investigate the recent incidence of hip fracture in the Tottori prefecture, Japan, and to compare it with previous reports. All hip fractures in patients aged 35 years and older occurring between 2004 and 2006 were surveyed in all of the hospitals from the Tottori prefecture. The age- and gender-specific incidence rates were then calculated. Using these and previously reported data, the estimated number of hip fracture patients was determined using the age- and gender-specific incidence rates in each year from 1986 to 2006. The survey identified 851, 906, and 1,059 patients aged 35 years and older, in 2004, 2005, and 2006 respectively. The residual lifetime risk of hip fracture for individuals at 50 years of age was estimated to be 5.6% for men and 20.0% for women. The estimated number of patients from 1986 to 2006 showed a significant increase over time for both genders. The age- and gender-specific incidence of hip fracture in the Tottori prefecture, Japan has not plateaued for either gender.

Residual Lifetime Risk of Fractures in Women and Men

In a sample of 1358 women and 858 men, > or = 60 yr of age who have been followed-up for up to 15 yr, it was estimated that the mortality-adjusted residual lifetime risk of fracture was 44% for women and 25% for men. Among those with BMD T-scores < or = -2.5, the risks increased to 65% in women and 42% in men. Risk assessment of osteoporotic fracture is shifting from relative risk to an absolute risk approach. Whereas BMD is a primary predictor of fracture risk, there has been no estimate of mortality-adjusted lifetime risk of fracture by BMD level. The aim of the study was to estimate the residual lifetime risk of fracture (RLRF) in elderly men and women. Data from 1358 women and 858 men > or = 60 yr of age as of 1989 of white background from the Dubbo Osteoporosis Epidemiology Study were analyzed. The participants have been followed for up to 15 yr. During the follow-up period, incidence of low-trauma, nonpathological fractures, confirmed by X-ray and personal interview, were recorded. Incidence of mortality was also recorded. BMD at the femoral neck was measured by DXA (GE-LUNAR) at baseline. Residual lifetime risk of fracture from the age of 60 was estimated by the survival analysis taking into account the competing risk of death. After adjusting for competing risk of death, the RLRF for women and men from age 60 was 44% (95% CI, 40-48) and 25% (95% CI, 19-31), respectively. For individuals with osteoporosis (BMD T-scores < or = -2.5), the mortality-adjusted lifetime risk of any fracture was 65% (95% CI, 58-73) for women and 42% (95% CI, 24-71) for men. For the entire cohort, the lifetime risk of hip fracture was 8.5% (95% CI, 6-11%) for women and 4% (95% CI, 1.3-5.4%) for men; risk of symptomatic vertebral fracture was 18% (95% CI, 15-21%) for women and 11% (95% CI, 7-14%) for men. These estimates provide a means to communicate the absolute risk of fracture to an individual patient and can help promote the identification and targeting of high-risk individuals for intervention.

Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study

The vast majority of hip fractures in the 21st century will occur in the developing countries. The rates and life-time hip fracture risk are not known for Mexico, and for this reason, we studied the incidence of hip fractures, and the remaining life-time probability of having a hip fracture at the age of 50 years in Mexican men and women. All hip fracture cases registered during the year 2000 were collected at all the main tertiary-care hospitals in the two major health systems in México City, Instituto Mexicano del Seguro Social (IMSS) and Ministry of Health (SS), and the diagnosis was validated by chart review in all cases. The annual rates of hip fracture were 169 in women and 98 in men per 100,000 person-years. The life-time probability of having a hip fracture at 50 years of age was 8.5% in Mexican women and 3.8% in Mexican men. We conclude that hip fractures are an important health problem in Mexico and that Mexican health authorities should consider public health programs to prevent hip fractures.

Hip fracture: Risk factors and outcomes

Hip fracture is an important public health and personal burden, and this burden is anticipated to increase over the next several decades. Although white women experience the greatest lifetime risk of hip fracture, risk extends to men and to nonwhite populations. Bone strength, risk of falling, and individual clinical characteristics combine to affect the risk of hip fracture. Nearly $9 billion were expended in 1995 in the United States for the management of hip fractures. Hip fracture has important sequelae, including loss of bone and muscle mass. Mortality is significantly increased after hip fracture, and functional recovery is limited to less than 50% of those who fracture. About 25% of patients reside in long-term care facilities for a year or more after fracture, and the impact of hip fracture on health-related quality of life is considerable and long lasting.

Women’s knowledge of hormone therapy

The aim of this study was to assess women’s knowledge of hormone therapy. Two hundred and seven women were interviewed by telephone. The median score to 24 questions concerning the benefits, risks and side effects of therapy was 54.2%. Almost three-quarters of women knew that hormone therapy may decrease the risk of osteoporosis, but half were unaware that it should be taken for at least 10 years for maximum protection against bone loss. While many women knew that hormone therapy may increase the risk of breast cancer, 13.5% believed that it would decrease their risk. Many women overestimated the potential reduction in lifetime risk of hip fracture and the potential increase in lifetime risk of breast cancer with hormone therapy. Women may have insufficient knowledge to make informed choices about hormone therapy. This has implications for physicians who wish to ensure that women are able to participate in informed decision-making.

Practical geriatrics: age and gender differences of patients with hip fracture and depression.

resources than those without depression. After discharge from medical hospitalization, depressed older adults continue to use more resources than those who are not depressed (9). In this column we review relevant literature about hip fracture with special emphasis on age and gender differences and the impact of depression before and after fracture. Risk of hip fracture The incidence of hip fracture increases with age for both men and women. Osteoporosis plays a central role in pathogenesis. Visual impairment, parkinsonism, stroke, and residence in a nursing home are associated with a greater risk of hip fracture (10). The lifetime risk of hip fracture is about 14 percent for postmenopausal

Management of osteoporosis in patients with hip fractures.

Hip fractures are a major cause of excess mortality, morbidity and health and social service expenditure in elderly people.1 Patients who survive hip fractures are at high risk of further fracture,2,,3 yet most receive no treatment for osteoporosis or advice on reducing falls. A number of guidelines on the management of osteoporosis have been published, but these contain little specific advice on the management of patients with hip fracture.4–,6 A group of physicians from the North‐East of England interested in osteoporosis has therefore met on a number of occasions, to develop practical advice on the management of osteoporosis in patients with hip fractures. Bone is lost with advancing age in both men and women, leading to an increased risk of fractures after minimal trauma. The major osteoporotic fractures are those of the forearm, vertebral body and hip. Each year, about 60 000 hip fractures occur in the UK, causing excess mortality, substantial morbidity and vast health and social service costs. The lifetime risk of hip fracture in the UK been estimated at 14% for a 50‐year‐old woman and 3% for a 50‐year‐old man,1 although these figures may be underestimates, because of declining mortality in the elderly.7 The excess mortality after hip fracture is 10–20%,1,8,,9 which may be related in part to co‐morbidity. There is also considerable morbidity after hip fractures, as 25–50% of patients become more dependent, many of whom require placement in a residential or nursing home.10, ,11The annual cost of osteoporotic fractures in the UK has been estimated at £942m, of which 87% is due to hip fractures.12 The risk of hip fractures is determined not only by bone mineral density (BMD), but also by factors associated with physical frailty and an …

Lifetime risk of hip fractures is underestimated.

Estimates of lifetime risk of osteoporotic fracture have assumed that mortality rates do not change. Since mortality in the elderly is decreasing in all regions of the world we assessed the effect of this on lifetime risks for hip fracture using Sweden as a reference country. Lifetime risks of hip fracture at the age of 50 years were 4.6% and 13.9% in men and women respectively, assuming all survive to current average life expectancy. Estimates increased to 8.1% and 19.5% when based on present mortality and to 11.1% and 22.7% respectively based on predicted mortality. We conclude that lifetime risks of hip fracture have been considerably underestimated.

Osteoporosis as a Candidate for Disease Management

Osteoporosis constitutes a major public health problem through its association with fractures at several skeletal sites, most notably the hip, wrist and vertebra. The lifetime risk of hip fracture in White women and men in the UK from age 50 years is 14% and 3%, respectively. These fractures account for considerable mortality, morbidity and healthcare expenditure. Methods of measuring bone density provide useful clinical tools for the assessment of future fracture risk, and a number of preventive and therapeutic strategies are now available to retard bone loss and reduce the incidence of fracture. The most cost-effective use of these pharmacological agents has become a focus for health economic research in osteoporosis. Such research will better define the setting in which various approaches to prevention and treatment are most effective.

A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect

Objective: To determine the magnitude and importance of the relation between smoking, bone mineral density, and risk of hip fracture according to age.Design: Meta-analysis of 29 published cross sectional studies...

Evaluation of the risk of hip fracture

Hip fracture is the most serious complication of osteoporosis and the incidence is rising worldwide. Bone mineral density measurements can be used not only to diagnose osteoporosis at the hip, but also to give prognostic information on the lifetime risk of hip fracture. A number of additional risk factors enhance the ability of density measurements to assess risk. Candidates include markers of bone resorption, prior fragility fractures, hip axis length, and estimates of postural integrity, each of which improve prognostic value independently of bone mineral assessments. Their use in the stratification of risk will help define intervention thresholds for treatments and improve the design of population screening policies, particularly in elderly women in whom the burden of hip fracture is greatest.

Hip fractures: incidence, risk factors, energy absorption, and prevention

The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled clinical studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially with aging, but the time trend in increasing age-specific incidence may finally reach a plateau. Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture. The relative risk is highest within the first years following the fracture. Nursing home residents have a high risk of hip fracture (annual rate of 5–6%), and their incidence of falls is about 1.5 falls/person per year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 0.29 falls/person per year and about 20% of these traumas lead to hip fracture. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip, even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture and be an important determinant for the development of hip fracture, perhaps even more important than bone strength. External hip protectors were developed and tested in an open randomized nursing home study. The rate of hip fracture was reduced by 50%, corresponding to 9 of 247 residents saved from sustaining a hip fracture. This review points to the essentials in the development of hip fracture: risk of fall; type of fall; type of impact; energy absorption; and last, bone strength, which is the final permissive factor leading to hip fracture. Risk estimation and prevention of hip fracture may prove realistic when these issues are taken into consideration.

Bone mass measurements and risk of fracturein caucasian women: A review of findings from prospective studies

Prospective studies have shown that bone mass, measured by any method and at any site, is inversely related to a woman's risk of fracture. Most types of fractures are more frequent in women with low bone mass. Bone mineral density measured in the proximal femur appears to have a stronger relationship to risk of hip fracture than bone density measured in other sites. On the other hand, measurement of bone mass in the spine does not appear to be substantially superior to measurements of bone mass in other sites. Even after age 80, bone mass measurements have a strong predictive value for most types of fracture. A woman's lifetime risk of hip fracture can be estimated from bone mass measurements made in the perimenopausal period. Although an individual's level of bone mass may vary from site to site, the incremental value of measuring bone mass in more than one site is not certain. Bone mass measurements, perhaps in combination with other risk factors for fracture, help define individuals with a high risk of fracture who stand to benefit most from efforts to prevent fractures.

A nomogram for predicting lifetime hip fracture risk from radius bone mineral density and age

A statistical model for predicting a woman's lifetime risk of hip fracture using her bone mineral density at menopause has been proposed by Black et al. (1992b). We made an additional assumption concerning the correlation of bone mineral density between any two ages among postmenopausal women and applied the modified model to baseline ages between 50 and 85 years and any bone mineral density level likely to be observed in the population. The results are displayed in a form more convenient for application of this model in the clinical setting.

Postmenopausal Osteoporosis in Saudi Women: A Pilot Screening

One hundred and ten radiographs of calcaneum were reviewed for postmenopausal osteoporosis in Saudi women. These patients had presented to the emergency room with unrelated complaints. The mean (+/- SD) age of this group was 58 (+/-8.9) years with a range of 45 to 80 years. Of these eighty-six (76%) patients had osteoporosis; of these, 42 had mild osteoporosis, 31 had frank osteoporosis, and 11 were diagnosed to have sever osteoporosis. Women with severe osteoporosis were significantly older than those with mild (P=0.0417) as those who were normal (P=0.002). This study indicates a high prevalence of postmenopausal osteoporosis in Saudi women and multicenter, large scale screening should be instituted to determine the incidence of postmenopausal osteoporosis among Saudi women.