Risk Factors For Hip Fracture Research Articles

Dementia is Associated with an Increased Risk of Hip Fractures: A Nationwide Analysis in Korea.

Background and PurposeDementia has been reported to be associated with an increased risk of hip fracture, but few case-control studies have been performed to actually confirm this. This study investigated the association between dementia and hip fracture by comparing the risk of hip fracture between subjects with and without dementia.MethodsWe examined a population-based matched cohort from the National Health Insurance Service-Senior Cohort data set that covers approximately half a million recipients of medical insurance in South Korea. Subjects with new clinically verified dementia during 2003–2007 were included, and five subjects without dementia were matched for age, sex, and index year to each subject with dementia as the controls. The risk of hip fracture for dementia was evaluated up to 2015 using Cox regression analysis.ResultsDuring the 12-year follow-up period, 284 subjects with dementia (10.66%) and 603 subjects without dementia (4.53%) experienced hip fractures. Dementia was independently associated with a higher risk of hip fracture [hazard ratio (HR)=2.840, 95% CI=2.449–3.293] and the adjusted HR for hip fracture in the subjects with dementia was highest within 2 years after the initial diagnosis (HR=2.862, 95% CI=2.053–3.990).ConclusionsThis study found that dementia could be an independent risk factor for hip fracture even at the early stage. This necessitates consideration of the future risk of falls and balance deficits in terms of physical activity after a diagnosis of dementia.

Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening

BackgroundElderly hip fracture (HF) patients are at very high risk of developing deep vein thrombosis (DVT), which increases their perioperative mortality. However, data focusing on the admission prevalence of DVT in elderly Chinese patients with hip fracture are limited. Venography and ultrasonography are not suitable for most elderly HF patients; there is also controversy about the prognostic value of D-dimer in elderly patients. Thus, our primary goal was to clarify the prevalence of and risk factors for DVT in elderly Chinese HF patients at admission. Our secondary goal was to evaluate the diagnostic value of a new predictor of DVT based on the risk factors for elderly HF patients.MethodsThis retrospective study was conducted in the West China Hospital, Sichuan University. Between January 2015 and January 2017, 248 elderly Chinese HF patients (> 60 years) were enrolled in this study. The subjects were diagnosed with DVT using ultrasonography or venography. All the patients’ clinical data were obtained, including demographic variables, medical history, comorbidities, and laboratory results. A stepwise multiple logistic regression analysis was used to identify the risk factors contributing to the occurrence of DVT. The value of the new DVT predictor was calculated using a formula based on the coefficient regression and independent variables. A receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of different factors.ResultsOf the study patients, 74 (29.8%) were diagnosed with DVT, including sixty-five (87.8%) with distal peripheral, five (6.8%) with proximal central and four (5.4%) with mixed DVT. A multivariate logistic regression analysis showed that five risk factors increased the occurrence of DVT at admission, including gender, age, time from injury to admission, fibrinogen, and D-dimer. The new DVT predictor was calculated using the following formula: 1.131× (female = 1, male = 0) + 0.071 × age (years) + 0.571 × time from injury to admission (days) + 1.028 × fibrinogen(g/L) + 0.123 × D-dimer(g/L). The diagnostic value of the new predictor was highest among those risk predictors whose AUC (area under the ROC curves) value was 0.852.ConclusionsThe results of this study revealed a high prevalence of DVT in elderly Chinese HF patients at admission. Moreover, the new predictor, based on risk factors, was a good method to improve the diagnosis of DVT.

Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study

BackgroundThe high prevalence of diabetes is associated with body mass index (BMI), and diabetes can cause many complications, such as hip fractures. This study investigated the effects of BMI and diabetes on the risk of hip fractures and related factors.MethodsWe retrospectively reviewed data from 22,048 subjects aged ≧ 40 years from the National Health Interview Survey in Taiwan (NHIST) in 2001, 2005, and 2009. We linked the NHIST data for individual participants with the National Health Insurance Research Database (NHIRD), which includes the incidence of hip fracture from 2000 to 2013. We defined five categories for BMI: low BMI (BMI < 18.5), normal BMI (18.5 ≦ BMI < 24), overweight (24 ≦ BMI < 27), mild obesity (27 ≦ BMI < 30), and moderate obesity (BMI ≧ 30). The Cox proportional hazards model was used to analyze the effects of BMI and diabetes on risk of hip fracture.ResultsThe Cox proportional hazards model shows that hip fracture risk in participants with diabetes was 1.64 times that of non-diabetes patients (95% confidence interval [CI]:1.30–2.15). Participants with low BMIs showed a higher hip fracture risk (HR: 1.75) than those with normal BMI. Among the five BMI groups, compared with non-diabetes patients, only diabetes patients with a normal BMI showed a significantly higher risk on hip fracture (HR: 2.13, 95% CI: 1.48–3.06). In participants with diabetes, compared with those with normal BMI, those with overweight or obesity showed significantly lower hip fracture risks (HR: 0.49 or 0.42). The hip fracture risk in participants who expend ≧ 500 kcal/week in exercise was 0.67 times lower than in those who did not exercise.ConclusionsDiabetes and low BMI separately are important risk factors for hip fracture. There was an interaction between diabetes and BMI in the relationship with hip fracture (p = 0.001). The addition of energy expenditure through exercise could effectively decrease hip fracture risk, regardless of whether the participants have diabetes or not. The results of this study could be used as a reference for health promotion measures for people with diabetes.

Risk Factors for Vertebral, Hip, and Femoral Fractures Among Patients With Parkinson's Disease: A 5-Year Follow-up in Korea

ObjectivesTo investigate the prevalence and incidence of Parkinson's disease (PD) and provide evidence for preventive strategy of vertebral, hip, and femoral fractures (VF, HF, and FF) in PD patients. DesignRetrospective cohort study. Setting and ParticipantsUsing a nationwide medical service utility database from 2009 to 2014, we enrolled PD patients with diagnosis of G20 as per ICD-10 who used medical services. Overall, the number of PD patients was 97,311, 106,072, 115,762, 127,647, 137,782, and 144,757 through 2009-2014, respectively. We followed 35,663 patients diagnosed with PD in 2010 without prior fracture. MeasuresWe estimated the annual PD prevalence and incidence and used Cox proportional hazards model to estimate the hazards ratio (HR) for factures based on demographic characteristics, underlying disease, and socioeconomic status according to fracture type (osteoporosis-related fracture, VF, HF/FF). Furthermore, we investigated the cumulative incidence of those fractures by month during the 5-year follow-up. ResultsThe standardized PD prevalence increased from 238 to 279 between 2009 and 2014, and its incidence decreased from 86 to 72 between 2010 and 2014 per 100,000 population based on 2015 census data. We followed 35,663 PD patients: women, 20,732 (58.1%); aged ≥60 years, 29,264 (82.1%); with osteoporosis, 6542 (18.3%); VF experience, 4242 (11.9%); and HF/FF experience, 2112 (5.9%). Osteoporosis was a significant risk factor for VF [HR 1.75, 95% confidence interval (CI) 1.64-1.87] and HF/FF (HR 1.37, 95% CI 1.24-1.51). The cumulative incidence of VF and HF/FF was the highest at 6 months and increased more than half in the coming 2 years after PD diagnosis. Conclusions/ImplicationsVF and HF/FF are common among PD patients. VF and HF/FF risks were high for female PD patients aged ≥60 years with osteoporosis. Fracture prevention strategies should be focused on older, women, and osteoporosis patients within 3 years of PD diagnosis.

Incidence and risk factors for hip fracture in elderly patients undergoing lumbar spine surgery: a nationwide database study with 11-year follow-up.

Spinal surgeries are performed to treat spondylolisthesis, fractures, scoliosis, or other deformities. Impaired balance mechanisms and functional movement may occur after spinal surgery. Fall episodes may cause hip fractures, which have negative impacts on quality of life and increase mortality. The incidence of hip fracture after spinal surgery is still unknown. The aim of this study was to examine the association between various types of spinal surgeries and hip fractures in the elderly by using a nationwide database. We hypothesized that the spinal surgeries may increase hip fracture risk in the elderly. We used the National Health Insurance Research Database (NHIRD) to identify 3345 patients undergoing spinal surgery and a random dataset to identify 6690 age-, sex- and Charlson comorbidity index (CCI)-matched controls to compare the incidence of hip fractures in an 11-year follow-up period. We also enrolled 82,730 patients with spinal surgeries from the inpatient dataset to investigate the impact of different types of spinal surgeries. Patients who received spinal surgeries had higher risks of hip fractures, especially patients aged 60 to 79years and female patients. The patients with long-segment thoracolumbar spinal fusions had a significantly higher risk of hip fracture than those with only discectomies. Short segmental lumbar spine fusions also slightly increased the risk of hip fracture compared with discectomies. Fall prevention for the elderly undergoing lumbar spinal surgery is necessary due to the highly increased hip fracture risk.

Risk Factors, Post-operative Complications and outcome of management of Hip Fracture in Arar, Northern Saudi Arabia

Background: Hip fractures are defined as any fracture of the femur between the articular cartilages of the hip joint to 5 cm below the distal point of the lesser trochanter. Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. Up to 30 % of the elderly patients with a hip fracture die within the first year. Objective: to show the risk factors and post-operative complications of hip fracture in cases attending orthopedic department of Arar Central Hospital in Arar city. Methods: a cross sectional study conducted during the period from 1 December 2017 to 31 March 2018. A predesigned questionnaire was used for data collection, and included inquiries about sociodemographic data of the studied patients, performing muscular exercise, osteoporosis, diminished vision and disorders in equilibrium, causes of fracture, type and site of fracture, occurrence of complications of surgery, postoperative care and the final outcome of treatment. Results: Most (70.1%) of the studied population aged 22-59 years, males constituted 59.8%. Causes of hip fracture were accident in 66.7% and fall in 25.0%. Among hip fracture cases, 43.9% were obese, 13.1% have osteoporosis, and 17.8% have disorders in equilibrium. Males reported insignificant higher percentage of hip fracture than females (25.0% Vs. 18.6%). Osteoporosis, diminished vision, chronic diseases, continuous use of medications and smoking showed significant relation with hip fracture (P<0.05). While BMI, disorders in equilibrium and performing muscular exercise showed insignificant relation. Complications after surgery was osteomyelitis in 12.6%, early fixation failure in 4.2%, wound infections in 8.4% and hospital acquires pneumonia in 4.2%. Only two thirds of the cases were completely cured. Conclusion: in our study population in Arar city, males reported insignificant higher percentage of hip fracture than females. Osteoporosis, diminished vision, chronic illnesses, continuous use of medications and smoking were significant risk factors of hip fracture. Complications after surgery was included, osteomyelitis, early fixation failure, wound infections and hospital acquire pneumonia. Only two thirds of the cases were completely cured, the rest of cases showed disability and movement limitation.

A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population

Osteoporotic hip fractures are a major healthcare problem. Fall severity and bone strength are important risk factors of hip fracture. This study aims to obtain a mechanistic explanation for fracture risk in dependence of these risk factors. A novel modelling approach is developed that combines models at different scales to overcome the challenge of a large space–time domain of interest and considers the variability of impact forces between potential falls in a subject. The multiscale model and its component models are verified with respect to numerical approximations made therein, the propagation of measurement uncertainties of model inputs is quantified, and model predictions are validated against experimental and clinical data. The main results are model predicted absolute risk of current fracture (ARF0) that ranged from 1.93 to 81.6% (median 36.1%) for subjects in a retrospective cohort of 98 postmenopausal British women (49 fracture cases and 49 controls); ARF0 was computed up to a precision of 1.92 percentage points (pp) due to numerical approximations made in the model; ARF0 possessed an uncertainty of 4.00 pp due to uncertainties in measuring model inputs; ARF0 classified observed fracture status in the above cohort with AUC = 0.852 (95% CI 0.753–0.918), 77.6% specificity (95% CI 63.4–86.5%) and 81.6% sensitivity (95% CI 68.3–91.1%). These results demonstrate that ARF0 can be computed using the model with sufficient precision to distinguish between subjects and that the novel mechanism of fracture risk determination based on fall dynamics, hip impact and bone strength can be considered validated.

Analysis of the prognostic factors influencing the time elapsing until the contralateral hip fracture

Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543-1547.

Role of hypertension for fracture risk in osteoporotic women

Osteoporosis is a risk factor for hip and other fractures. Hypertension is a progressive silent disease affecting bone mass and structure, leading to increased susceptibility to fractures. The aim of this study was to determine the role of hypertension for fracture risk in osteoporotic women. This comparative cross sectional study was conducted among 54 hypertensive and 34 non-hypertensive osteoporotic female patients at two tertiary centers in Dhaka city during the period of 1st January to 31st December, 2017. Data were collected by face-to-face interview using semi-structured questionnaire and checklist. Online assessment of fracture risk probability was done among the two groups by FRAX tool and statistical analysis was performed by Statistical Packages for Social Sciences (SPSS-23). The study revealed that the mean ages were 61.94 ± 9.362 years in hypertensive and 59.18 ± 11.269 years in non-hypertensive patients. Majority were housewives in hypertensive (96.3%) and non-hypertensive (82.4%) patients. It was found that the mean duration of hypertension was 6.41 ± 4.049 years in osteoporotic women where as the mean duration of osteoporosis were 8.80 ± 5.022 years in hypertensive and 7.53 ± 5.920 years in non-hypertensive patients. The difference of major osteoporotic fracture (MOF) risk by age was significantly (X 2 , P ˂ 0.05) higher among the patients belonged to age group 60–79 years as well as comparatively higher in hypertensive patients. MOF risk by hypertension was comparatively higher among the hypertensive patients but it was not statistically significant (X 2 , Thp ˃ 0.05). On the other hand, hip fracture (HF) risk by hypertension was comparatively higher among the hypertensive patients and it was statistically significant (X 2 , P ˂ 0.05). The study reflected that the fracture risk was significantly higher in hypertensive patients.

Association Between Body Mass Index and the Risk of Hip Fracture by Sex and Age: A Prospective Cohort Study.

The association between body mass index (BMI) and hip fracture may differ by ethnic group. We examined the association between BMI and hip fracture according to sex and age and to identify BMI ranges associated with the lowest risk in Korean men and women. We followed up 288,068 Korean adults (aged 50 to 80 years), who underwent health examinations in 2002-03 to 2013; we examined national hospital discharge records. Hazard ratios (HRs) were calculated using Cox proportional hazard models after adjusting for confounders. During a mean follow-up period of 10.5 years, 1502 men and 2432 women suffered a hip fracture. Nonlinear associations were observed between BMI and hip fracture: a U-curve for women and a reverse J-curve for men. Men with BMIs of 27.5 to 29.9 kg/m2 and women with BMIs of 25 to 27.4 kg/m2 showed the lowest incidence of hip fracture. The multivariate-adjusted HRs for hip fracture per 5 kg/m2 decrease in BMI were 2.09 (95% confidence interval [CI] 1.83-2.38) and 1.34 (95% CI 1.19-1.51) in men and women with BMI <25 kg/m2 . The HRs were generally highest in the age group of 50 to 59 years (HR = 3.42 in men and 2.27 in women) and thereafter decreased with age. Among participants with BMI ≥25 kg/m2 , the HRs for hip fracture per 5 kg/m2 increase in BMI were 1.26 (95% CI 1.08-1.47) in women and 0.91 (95% CI 0.62-1.33) in men. In conclusion, the overweight range of BMI was associated with the lowest risk of hip fracture. Lower BMI was a risk factor for hip fracture, whereas obesity was associated with an increased risk of hip fracture, particularly in women. Overweight may be protective against hip fracture in Asian adults but not obesity. © 2018 American Society for Bone and Mineral Research.

Correlation of quality of life with risk factors for first-incident hip fracture in postmenopausal women.

The aim of this study was to identify the correlation between health-related quality of life (HRQOL) and risk factors of first-incidence hip fracture in postmenopausal women. This case-control study included 99 postmenopausal women with first-incident hip fracture and 101 women without hip fracture who were matched according to age. Evaluation consisted of clinical factors, 36-item Short-Form Health Survey (SF-36) and dual-energy X-ray absorptiometry for bone mineral density of hip and spine. The mean age of patients with an accidental first-incident hip fracture was 78.0 years. Patients with hip fractures had significantly lower scores for SF-36 domains at enrollment and 4-month follow up compared with the controls. Mental health also deteriorated significantly 4 months after hip fracture. Aside from lower HRQOL, clinical factors, including increased body height, no experience with estrogen therapy, rheumatoid arthritis, use of walking aids, less weight-bearing exercise, and diuretics use, were significant risk factors for hip fracture in univariate analysis. After multivariate adjustment, only the use of walking aids and decreased physical component summary were independent risk factors of hip fracture. Besides aging, use of walking aids, weight-bearing exercise, and psychological medication were the main factors affecting HRQOL when considering their relationship with hip fractures. The occurrence of first-incidence hip fracture is highly associated with HRQOL. Aside from aging, clinical factors affecting HRQOL correlated with hip fracture incidence. Thus, in elderly women, exercise or physical therapy to improve physical function and mental support is crucial and should be considered the most important factors for first-incidence hip fracture prevention.

Epidemiology of hip fracture in nursing home residents with multiple sclerosis

BackgroundHip fracture risk is high in young people with multiple sclerosis (MS), but has not been examined in an institutionalized aging population with MS. ObjectiveWe aimed to compare the hip fracture risk in nursing home (NH) residents with and without MS; and (2) examine risk factors for hip fracture in those with MS. MethodsWe conducted a retrospective cohort study using national NH clinical assessment and Medicare claims data. Participants included age-, sex- and race-matched NH residents with/without MS (2007–2008). Multivariable competing risk regression was used to compare 2-year hip fracture risk, and to examine risk factors. ResultsA total of 5692 NH residents with MS were matched to 28,460 without MS. Approximately 80% of residents with MS vs. 50% of those without MS required extensive assistance in walking at NH admission. The adjusted incidence rate of hip fracture was 7.1 and 18.6 per 1000 person-years in those with or without MS, respectively. Wandering and anxiolytic exposure were the main hip fracture risk factors in transfer independent residents with MS; while pneumonia and antidepressant use were the main factors in dependent residents with MS. ConclusionsIn contrast to prior comparisons from non-NH populations, the incidence of hip fracture was lower in NH residents with MS as compared with matched controls. Residents with MS were much more functionally dependent, which likely explains these findings. Fracture prevention strategies should focus on fall prevention in independent residents; and possibly improvement of health status and facility quality of care in dependent residents.

Vitamin D status, estradiol and bone metabolism in elderly female patients with hip fracture

Aim: In postmenopausal women increased bone turnover is associated with hip fracture apart from bone mineral density. The aim of this study was to evaluate bone metabolism in consideration of vitamin D and hormonal status in elderly female hip fracture patients compared to controls. Material and Methods: Circulating 25-hydroxyvitamin D 3 (25(OH)D), sex hormones, BTM [osteocalcin (OC); propeptide of type-I collagen (PINP); C-terminal telopeptide of type I collagen (CTX-1); tartrate resistant acid phosphatase 5b, (TRAP5b)] and osteoclastogenic cytokines [soluble receptor activator of nuclear factor kB ligand (sRANKL); osteoprotegerin (OPG)] were measured in patients with a low-energy hip fracture and controls without an incident hip fracture (each group n= 47 females). Results: 57.4 % of the patients, but only 10.6. % controls had a severe vitamin D deficiency. T-Score at the lumbar spine was comparable in both groups (-1.8 ± 1.5 vs. -1.6 ± 1.4, p=0.535). In hip fracture patients 25(OH)D (p<0.001), albumin (p<0.001), osteocalcin (OC) (p<0.001) and sRANKL (p<0.001) levels were lower compared to controls, whereas estradiol (p<0.001), cortisol (p<0.001), CTX-1 (p<0.001) and OPG (p<0.001) were higher. Linear regression analysis revealed an independent association between 25(OH)D and CTX-1 in female fracture patients (p=0.023). Higher estradiol levels after hip fracture correlated inversely with OC (p=0.018) and TRAP5b (p=0.004). Multivariable regression analysis demonstrated that 25(OH)D, OC, estradiol (each p<0.001) and albumin (p=0.002) were independently associated with fracture. Higher estradiol levels correlated inversely with OC in fracture patients (p=0.018). Conclusion: 25(OH)D was an independent risk factor of hip fracture and demonstrated an independent association with CTX-1. Unchanged or lower levels of bone formation markers were not associated with 25(OH)D and were partly related to higher of levels estradiol presumably induced by trauma.

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

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

Lower Lean Mass Measured by Dual-Energy X-ray Absorptiometry (DXA) is Not Associated with Increased Risk of Hip Fracture in Women: The Framingham Osteoporosis Study.

Although muscle mass influences strength in older adults, it is unclear whether low lean mass measured by dual-energy X-ray absorptiometry (DXA) is an independent risk factor for hip fracture. Our objective was to determine the association between DXA lean mass and incident hip fracture risk among 1978 women aged 50years and older participating in the Framingham Study Original and Offspring cohorts. Leg and total body lean mass (kg) were assessed from whole-body DXA scans collected in 1992-2001. Hip fracture follow-up extended from DXA assessment to the occurrence of fracture, death, drop-out, or end of follow-up in 2007. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) estimating the relative risk of hip fracture associated with a 1-kg increase in baseline lean mass. Mean age was 66years (range 50-93). Over a median of 8years of follow-up, 99 hip fractures occurred. In models adjusted for age, height, study cohort, and percent total body fat, neither leg (HR 1.11; 95% CI 0.94, 1.31) nor total body (HR 1.06; 95% CI 0.99, 1.13) lean mass were associated with hip fracture. After further adjustment for femoral neck bone mineral density, leg lean mass results were similar (HR 1.10; 95% CI 0.93, 1.30). In contrast, 1kg greater total body lean mass was associated with 9% higher hip fracture risk(HR 1.09; 95% CI 1.02, 1.18). Our findings suggest that in women, lower lean mass measured by DXA is notassociated with increasedrisk of hip fracture.

Evaluation of Risk Factors for Second Hip Fractures in Elderly Patients.

BackgroundHip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures.MethodsBetween 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2).ResultsThe mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were significantly lower in group 2 than in group 1.ConclusionsAlthough there are not certain risk factors for second hip fractures in elderly patients with hip fractures, to prevent second hip fractures, elderly patients should be provided with physical and medical therapy as well as orthotic support and their functional activity should be maintained.

Vitamin D Status, Estradiol and Bone Metabolism in Elderly Female Patients With Hip Fracture

Aim: In postmenopausal women increased bone turnover is associated with hip fracture apart from bone mineral density. The aim of this study was to evaluate bone metabolism in consideration of vitamin D and hormonal status in elderly female hip fracture patients compared to controls. Material and Methods: Circulating 25-hydroxyvitamin D 3 (25(OH)D), sex hormones, BTM [osteocalcin (OC); propeptide of type-I collagen (PINP); C-terminal telopeptide of type I collagen (CTX-1); tartrate resistant acid phosphatase 5b, (TRAP5b)] and osteoclastogenic cytokines [soluble receptor activator of nuclear factor kB ligand (sRANKL); osteoprotegerin (OPG)] were measured in patients with a low-energy hip fracture and controls without an incident hip fracture (each group n= 47 females). Results: 57.4 % of the patients, but only 10.6. % controls had a severe vitamin D deficiency. T-Score at the lumbar spine was comparable in both groups (-1.8 ± 1.5 vs. -1.6 ± 1.4, p=0.535). In hip fracture patients 25(OH)D (p&lt;0.001), albumin (p&lt;0.001), osteocalcin (OC) (p&lt;0.001) and sRANKL (p&lt;0.001) levels were lower compared to controls, whereas estradiol (p&lt;0.001), cortisol (p&lt;0.001), CTX-1 (p&lt;0.001) and OPG (p&lt;0.001) were higher. Linear regression analysis revealed an independent association between 25(OH)D and CTX-1 in female fracture patients (p=0.023). Higher estradiol levels after hip fracture correlated inversely with OC (p=0.018) and TRAP5b (p=0.004). Multivariable regression analysis demonstrated that 25(OH)D, OC, estradiol (each p&lt;0.001) and albumin (p=0.002) were independently associated with fracture. Higher estradiol levels correlated inversely with OC in fracture patients (p=0.018). Conclusion: 25(OH)D was an independent risk factor of hip fracture and demonstrated an independent association with CTX-1. Unchanged or lower levels of bone formation markers were not associated with 25(OH)D and were partly related to higher of levels estradiol presumably induced by trauma.

Serum 25-hydroxyvitamin D, bone turnover markers and bone mineral density in postmenopausal women with hip fractures

BackgroundVitamin D and bone turnover markers (BTMs) might have an effect on the occurrence of acute hip fracture, while the current results are conflicting. The purpose of this study is to explore the relationship between serum 25(OH)D, bone turnover markers and bone mineral density in Chinese postmenopausal women with hip fracture. MethodsA total of 277 patients with hip fractures and 272 patients without fractures were included in this study. The serum 25(OH)D, bone formation markers, including N-terminal extension propeptide of type-I collagen (P1NP), alkaline phosphatase (ALP) and osteocalcin(OC), bone resorption markers, including C-terminal telopeptide of type-I collagen (CTX-1), and bone mineral density were collected and analyzed. ResultsWomen with hip fractures had significantly lower concentrations of serum 25(OH)D, higher concentrations of serum CTX-1, P1NP and OC, lower concentrations of femoral neck and total hip bone mineral density (P<0.05). After adjustment for age and other confounding factors, multiple logistic regression analysis showed that serum 25(OH)D (OR=0.878, 95%CI=0.855–0.902, P<0.001), CTX-1 (OR=4.884, 95%CI=2.419–9.861, P<0.001)and total hip BMD (OR=0.141, 95%CI=0.034–0.577, P=0.006) were independent risk factors for hip fractures in postmenopausal women. The receiver operating characteristics curves showed that serum 25(OH)D had a good AUC value (0.830). ConclusionsIn this study, lower concentrations of serum 25(OH)D and total hip bone mineral density were widely existed in Chinese postmenopausal women with hip fractures. Furthermore, bone resorption was more active than bone formation in senile postmenopausal women. Therefore, monitoring the alteration of serum CTX-1 in clinically might be useful for fracture prevention.

Características de las fracturas de fémur proximal

IntroductionHip fractures may occur in the femoral head, neck or intertrocantheric line. Treatment is based on, type and location of the fracture and patient's age and comorbidities. ObjectiveTo describe hip fracture characteristics and risk factors in patients seen at Hospital de San José of Bogotá between January 2014 and June 2016. MethodsA case series study. Adults with primary fractures and a complete medical record were included. Those with prior surgical management of ipsilateral proximal femoral and pathologic fractures were excluded. Data collection was based on clinical records. Results96 patients were included, 66.7% females, mean age 81 years (IQR 29 – 93 years), and comorbidities such as hypertension (58.3%), coronary artery disease (16.7%), diabetes mellitus (8.3%), tobacco smoking (9.4%), Alzheimer's (14.6%) and osteoporosis (4.2%) present in 69.8%. Intertrochanteric fracture (69.8%) caused by a fall from own height (93.8%) was the commonest fracture. The most widely used treatment was fixation (50%) followed by arthroplasty (43.8%). Osteosynthesis by an intramedullary long proximal femoral nail was the most common fixation method used (77.1%). Major complications were postoperative mortality (5.2%), component loosening and reoperations (3.1%), pressure ulcers, pneumonia, pulmonary thromboembolism and periprosthetic fractures in 2.1%. ConclusionsHip fractures associated with significant morbidity and mortality are common in elders. It is essential to provide timely treatment and to count on prevention programs regarding this pathology.

Evaluation of overactive bladder and nocturia as a risk factor for hip fracture in climacteric women: a matched pair case control study

The aim of this study was to investigate whether overactive bladder (OAB) influences hip fractures in climacteric women by comparing the frequency of OAB and nocturia symptoms in patients with hip fractures and their age-matched controls in pre-fracture period. A total of 30 climacteric patients with a history of hip fracture were compared to a control group of 51 women in terms of OAB, nocturia and nocturia-QoL. A questionnaire composed of structured questions and Turkish validated versions of the specific questionnaires for OAB, OAB-Quality of Life (OAB-q) and nocturia-QoL was directed to the two groups. We did not detect statistically relevant differences between the groups for the presence or severity of OAB and OAB-q (p > .05). However, Nocturia-QoL was worse in the group with hip fracture (p = .022). Overactive bladder has no contribution to the overall risk of hip fracture, whereas, the severity of nocturia seems to play a role as a risk factor in the formation of hip fracture. Impact statement What is already known on this subject: Hip fracture is associated with high morbidity, mortality and the cost. Prevention of hip fracture is a high priority for the patients, physicians and the public health. Several studies and consensus opinions have investigated the risk factors for the hip fractures. What the results of this study add: Although urinary symptoms were not evaluated in previous studies as a risk factor, desire of urination makes people stand up and move to their toilet, and may put them in a hurry if it is sudden and uncontrollable one. Therefore, we hypothesised that overactive bladder (OAB) and nocturia may be a risk factor in the formation of hip fractures. Our study showed that Nocturia Quality of Life is worse in patients with the hip fracture. Therefore, overactive bladder may not have a role on the overall risk of hip fracture, but the severity of nocturia seems as a risk factor in the fracture process. What the implications are of these findings for clinical practice and/or further research: The getting up from the bed would probably be harder than getting up from a chair in elderly, and life style modifications such as illumination bedroom and organisation of living place may be helpful to minimise the risks.