Incidence of Subsequent Hip Fracture and Mortality in Elderly Patients: A Multistate Population-Based Cohort Study in Eastern Spain

Risk factors and characteristics of preoperative heart failure in elderly patients with hip fracture and the influence of anemia on prognosis

BACKGROUND

Patients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.

METHODS

A retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan-Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.

RESULTS

Out of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309-2.313), coronary artery disease (OR 1.417, 95% CI 1.017-1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757-9.152), admission anemia (OR 1.433, 95% CI 1.051-1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new-onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.

CONCLUSION

Older patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.

Examining the relationships between patients' multimorbidity trajectories and prognostic outcomes after the initial hip fracture

Hip fractures significantly affect patients' health and quality of life. Despite therapeutic treatments, many patients continue to experience poor prognoses that include recurrent fractures and mortality, especially the older ones. Therefore, understanding important factors associated with post-fracture prognoses is critical. This study focuses on patients' multimorbidity trajectories and examines how the trajectory's time span, number of coexisting chronic diseases, and sequential disease patterns relate to distinct prognostic outcomes. From the National Health Insurance Research Database in Taiwan, we obtain a sample of 128,822 patients who suffered an initial hip fracture between 1996 and 2011. We use this sample to analyze the relationships between multimorbidity trajectories and prognostic outcomes after an initial hip fracture. The results reveal that a patient's multimorbidity trajectory's time span and number of chronic diseases significantly associate with his or her post-fracture prognosis. In addition, essential sequential patterns of chronic diseases relate to post-fracture prognoses too. We then leverage the discovered relationships to develop a cross-attention neural network method for estimating patients' post-fracture prognoses and demonstrate its predictive utilities relative to several prevalent machine leaning methods. This study underscores the importance of leveraging the time span, number of chronic diseases, and sequential disease patterns in patients' multimorbidity trajectory profile to estimate their prognoses within three years of an initial hip fracture, which can support physicians' clinical decisions and patient management.

Prevalence and Risk Factors of Hip Fracture at Tertiary Hospital in Mogadishu, Somalia

Purpose

This study aims to determine the frequency of hip fractures and associated risk factors among patients receiving care at the Somalia Turkish Training and Research Hospital in Mogadishu.

Patients and Methods

A retrospective study of patients treated at the Somalia Turkish Training and Research Hospital in Mogadishu was carried out. 96 of the 108 patients who were admitted met the inclusion criteria. Analyzing the medical records of individuals diagnosed with hip fractures between January and December 2023 allowed for the collection of data on demographics, hip fracture type, and medical history and also conducted follow-ups to identify other potential contributing factors that may not be available in medical records. The main conclusions have been established using descriptive statistical analysis.

Results

About 8.67% of all fracture cases were hip fractures, Elderly people (60+) represented the largest group at 64.6%, followed by younger people (17-39) and Middle-aged people (40-59) at 15.6%, and children (3-16) at 4.2%. Females comprised 56.3% of cases, while males made up 43.8%. Most patients (78.1%) had low physical activity. Falls were the primary cause of fractures (83.3%), followed by other traumas (13.5%), and pathological fractures (7.3%). 32.3% of patients had comorbidities, 8.3% had a family history, and 22.9% had prior fractures. The most prevalent hip fractures (81.3%) were those of the femur neck, followed by subtrochanteric and intertrochanteric fractures (10.4% and 8.3%, respectively).

Conclusion

This study emphasizes the frequency of hip fractures in Mogadishu, Somalia, as well as the significance of fall prevention, age, gender, and comorbidity treatment. We suggest comprehensive risk assessments, gender-specific bone health programs, fall prevention programs, focused prevention for the elderly, and public education campaigns to reduce the burden of hip fractures and encourage healthier people in our community by putting these measures into practice.

Development and Validation of Objective and Subjective Osteoporosis Knowledge Instruments Among Chinese Orthopaedic Surgeons

BACKGROUND

Clinicians must be knowledgeable about osteoporosis so that they can convey information regarding the prevention of fragility fractures to their patients. The purposes of this study were to develop objective and subjective knowledge instruments for osteoporosis and fragility fractures and then test their reliability and validity among Chinese orthopaedic surgeons.

METHODS

A 2-round procedure was used to develop the objective and subjective knowledge instruments. A cross-sectional online survey was distributed to 293 orthopaedic surgeons; 189 surgeons returned the questionnaires. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity; we also compared the subjective knowledge level with the objective knowledge level among surgeons.

RESULTS

Our results showed that the Subjective Knowledge Scale (SKS) regarding Osteoporosis and Fragility Fractures had a high Cronbach alpha coefficient (0.915), and the objective Osteoporosis Knowledge Test for Clinicians (OKTC) had an adequate Kuder-Richardson 20 coefficient (0.64). Item analyses were conducted, and a short version of the OKTC (the OKTC-SF) was developed. The SKS, the OKTC, and the OKTC-SF all showed good test-retest reliability, criterion validity, and discriminant validity. The percentage of surgeons with a high subjective knowledge level was higher than the percentage of surgeons who selected the correct answer for several corresponding questions related to objective knowledge.

CONCLUSIONS

The SKS, the OKTC, and the OKTC-SF all demonstrated good reliability and validity. However, the orthopaedic surgeons may have overestimated their knowledge level regarding osteoporosis. Targeted continuing medical education that is based on individual knowledge level is needed to improve the undertreatment of osteoporosis among patients with fragility fractures.

Multivariate analysis of blood parameters for predicting mortality in patients with hip fractures

The present retrospective cross-sectional study aimed to evaluate the predictive value of blood parameters and ratios for predicting mortality in patients with hip fractures. In total, 758 patients with hip fractures attending the Department of Orthopedics and Traumatology, Kütahya Health Sciences University Faculty of Medicine (Kütahya, Turkey) between January 2016 and January 2023 were included in the present study. Patients were then divided into two groups, namely the mortality (n=464; 61.2%) and survivor (n=294; 38.8%) groups. Patients in the mortality group were further sub-divided into the following three subgroups: i) Those who succumbed in <1 month (n=117; 25.2%); ii) those who succumbed between 1 and 12 months (n=185; 39.9%); and iii) those who succumbed >12 months later (n=162; 34.9%). In addition, the RDW coefficient of variation, mean platelet volume (MPV), MPV/platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio and monocyte-to-eosinophil ratio means were all found to be significantly higher in the mortality group (P<0.05). MPV (P<0.01), HGB (P<0.05), eosinophil, EOS (P<0.01), HRR (P<0.01), and PLR (P<0.05) were all revealed to exert significant effects on mortality. An age cut-off of 74.50 years had a sensitivity of 81.5% and specificity of 37.1%, whereas an MPV cut-off of 8.85 yielded a sensitivity of 73.5% and specificity of 36.1%. By contrast, an HGB cutoff of 11.05 had a sensitivity of 55.6% and specificity of 35.7%, an eosinophil cut-off of 0.065 had a sensitivity of 47.6% and specificity of 35.4%, whilst a HRR cut-off of 0.7587 had a sensitivity of 55.2% and specificity of 30.3%. Furthermore, a PLR cut-off of 152.620 had a sensitivity of 67.2% and specificity of 41.8% for hip fracture-associated mortality. An age cut-off of 79.50 years had a sensitivity of 70.9% and specificity of 41.5%, while an age cut-off of 83.50 years had a sensitivity of 46.2% and specificity of 64.0% for mortality occurring <1 month after hip fractures. To conclude, results from the present study suggested that HRR has potential predictive value for hip fracture-associated mortality and 30-day mortality, whereas the PLR could only predict hip fracture-associated mortality.

Effect of Oral Bisphosphonate Drug Holiday on Mortality Following Hip Fracture

CONTEXT

Current clinical guidelines recommend a drug holiday after extended use of oral bisphosphonates. However, no studies have investigated the effect of drug holidays before hip fractures on postfracture mortality.

OBJECTIVE

This work aimed to investigate the effect of a drug holiday on postfracture mortality in patients with extended use of oral bisphosphonates.

METHODS

This retrospective, population-based cohort study took place among all patients with hip fractures in Victoria, Australia, from 2014 to 2018. Patients were adherent to oral alendronate or risedronate for 5 years or more prior to hip fracture. Group-based trajectory modeling categorized patients into different bisphosphonate usage after 5-year good adherence. The main outcome measure was postfracture mortality.

RESULTS

We identified 365 patients with good adherence (medication possession ratio ≥80%) to oral alendronate/risedronate for 5 years or more. Most patients (69%) continued to use oral bisphosphonates until admission for hip fracture; 17% had discontinued for 1 year and 14% had discontinued for 2 years. Postfracture mortality was higher in patients who had discontinued risedronate for 1 year (hazard ratio [HR] 2.37; 95% CI, 1.24-4.53) and 2 years (HR 3.08; 95% CI, 1.48-6.41) prior to hip fracture. No increase or decrease in postfracture mortality was observed in patients who had discontinued alendronate for 1 year (HR 0.59; 95% CI, 0.29-1.18) or 2 years (HR 1.05; 95% CI, 0.57-1.93) prior to hip fracture.

CONCLUSION

Postfracture mortality is higher in people who discontinue risedronate, but not alendronate, for 1 or 2 years after being adherent to treatment for at least 5 years. The type of bisphosphonate may be a factor to consider when planning drug holidays.

Epidemiological characteristics of traumatic spinal fractures among the elderly in China

The exploration of traumatic spinal fractures (TSFs) within the senior demographic has not been thoroughly scrutinized, particularly with respect to variations across genders, age groups, seasonal periods, and causative factors. This retrospective analysis aimed to dissect differences in the prevalence and characteristics of TSFs among the elderly, factoring in gender, age, seasonal timing, and causation. A retrospective analysis was conducted on the medical and imaging records of 1,415 patients, all aged 60 years or older, who were diagnosed with TSFs from 2013 to 2019. This study categorized the data by gender, age groups (60-70, 70-80, and 80 years or older), seasons, and the cause of injuries, including road traffic crashes (RTCs), falls from low heights (LHF), falls from high heights (HHF), and injuries incurred during everyday activities and agricultural labor (DFI). Male patients exhibited notably higher incidences of RTCs, high-height falls (HHFs), outdoor incidents, comas post-injury, fractures of the lower limbs (LLFs), pelvic fractures (PFs), rib fractures (RFs), intra-thoracic injuries (ITIs), intra-abdominal injuries (IAIs), cervical fractures, and spinal cord injuries (SCIs). With advancing age, there was a marked decline in occurrences of RTCs, HHFs, outdoor incidents, RFs, craniocerebral injuries (CCIs), ITIs, cervical fractures, and SCIs, while the incidences of DFIs, indoor incidents, and thoracic and lumbar (T + L) fractures notably increased. During autumn, LLF occurrences were significantly reduced, whereas the winter season saw an increase in thoracic fractures. Spring time was associated with a higher frequency of lumbar fractures and noncontiguous spinal fractures (NSFs). Significant distinctions were observed in the age distribution, injury circumstances, associated injuries, and SCIs between high-energy impacts (RTCs and HHFs) and low-energy traumas (LHFs and DFIs). In the elderly demographic, TSFs exhibited discernible distinctions based on gender, age, seasonal variations, and etiological factors, impacting the nature and circumstances of injuries, associated traumas, complications, fracture sites, and the occurrence of SCIs.

Effects of body mass index on mortality in elderly patients with hip fractures

Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.

Impact of diabetes on the risk of subsequent fractures in 92,600 patients with an incident hip fracture: A Danish nationwide cohort study 2004-2018

PURPOSE

We investigated the incidence rates of a subsequent hip fracture (HF) and other subsequent fractures than HF after first incident HF, comparing patients with and without diabetes.

METHODS

Using Danish medical databases, we identified 92,600 incident HF patients in the period 2004-2018. Diabetes exposure was examined overall, by type of diabetes (T2D and T1D), and by presence of diabetes complications. We estimated cumulative incidence of subsequent HFs and fractures other than HF within two years of the incident HF. Using Cox regression, adjusted hazard ratios (aHRs) with 95 % confidence interval (CI) were calculated.

RESULTS

Among incident HF patients, 11,469 (12 %) had diabetes, of whom 10,253 (89 %) had T2D and 1216 (11 %) had T1D. The 2-year incidence rates for a new subsequent HF were 4.8 % (95 % CI: 4.6-4.9) for patients without diabetes (reference group), 4.1 % (95 % CI: 3.8-4.6) for T2D, and 4.3 % (95 % CI: 3.3-5.6) for T1D. Corresponding aHRs were 1.01 (95 % CI 0.90-1.14) for T2D and 1.17 (95 % CI 0.87-1.58) for T1D. There was effect modification by sex, as women with T1D had an aHR of 1.52 (95 % CI: 1.09-2.11) for subsequent HF, and by specific diabetes complications (for example, patients with T2D and prior hypoglycemia had an aHR of 1.75 (95 % CI: 1.24-2.42) for subsequent HF, while patients with T1D and neuropathy had an aHR of 1.73 (95 %: 1.09-2.75), when compared with patients without diabetes). For fractures other than HF, the 2-year incidence rates were 7.3 % (95 % CI: 7.2-7.5) for patients without diabetes, 6.6 % (95 % CI: 6.1-7.1) for T2D, and 8.5 % (95 % CI: 7.0-10.1) for T1D, with corresponding aHRs of 1.01 (95 % CI 0.92-1.11) for T2D and 1.43 (95 % CI: 1.16-1.78) for T1D. T2D was only a risk factor for other subsequent fractures among HF patients of high age (age 86-89 years: aHR 1.22 (95 % CI 0.99-1.55), age 90+ years: aHR 1.37 (95 % CI 1.08-1.74)), whereas T1D was robustly associated with increased risk of fractures other than HF in all subgroups.

CONCLUSION

Among HF patients, we found no strong overall association of T2D or T1D with increased risk of subsequent HF, but diabetes patients with prior hypoglycemic events or neuropathy were at increased risk. In contrast, patients with T1D had a clearly increased risk of subsequent fractures other than HF.

Risk factors for subsequent fractures in hip fracture patients: a nested case-control study

BACKGROUND

The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures.

METHODS

We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures.

RESULTS

A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures.

CONCLUSIONS

This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.

Trajectories of oral bisphosphonate use after hip fractures: a population-based cohort study

Bisphosphonates prevent future hip fractures. However, we found that one in six patients with hip fractures had a delay in bisphosphonate initiation and another one-sixth discontinued treatment within 12 months after discharge. Our results highlight the need to address hesitancy in treatment initiation and continuous monitoring.

PURPOSE

Suboptimal antiresorptive use is not well understood. This study investigated trajectories of oral bisphosphonate use following first hip fractures and factors associated with different adherence and persistence trajectories.

METHODS

We conducted a retrospective study of all patients aged ≥ 50 years dispensed two or more bisphosphonate prescriptions following first hip fracture in Victoria, Australia, from 2012 to 2017. Twelve-month trajectories of bisphosphonate use were categorized using group-based trajectory modeling. Factors associated with different trajectories compared to the persistent adherence trajectory were assessed using multivariate multinomial logistic regression.

RESULTS

We identified four patterns of oral bisphosphonate use in 1811 patients: persistent adherence (66%); delayed dispensing (17%); early discontinuation (9%); and late discontinuation (9%). Pre-admission bisphosphonate use was associated with a lower risk of delayed dispensing in both sexes (relative risk [RR] 0.28, 95% confidence interval [CI] 0.21-0.39). Older patients ( ≥ 85 years old versus 50-64 years old, RR 0.38, 95% CI 0.22-0.64) had a lower risk of delayed dispensing. Males with anxiety (RR 9.80, 95% CI 2.24-42.9) and females with previous falls had increased risk of early discontinuation (RR 1.80, 95% CI 1.16-2.78).

CONCLUSION

Two-thirds of patients demonstrated good adherence to oral bisphosphonates over 12 months following hip fracture. Efforts to further increase post-discharge antiresorptive use should be sex-specific and address possible persistent uncertainty around delaying treatment initiation.

Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report

Background

This healthcare quality improvement report focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall.

Method

Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the trauma and orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics; screening eligibility and outcome; ophthalmology referrals made; ophthalmology appointment attendance; and outcome.

Results

Of the 3321 patients admitted with a hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. Furthermore, 784 (51%) of the patients screened had an ocular abnormality requiring an ophthalmology referral, or a sight test at an optician. Only 144 of the 383 (38%) who required an ophthalmology referral via the GP were successfully referred, and only 107 of the 186 (58%) patients who were given appointments attended them. Additionally, 98 of 107 had pathology, with cataracts the most common finding (51%), and 61 of 98 (62%) patients had treatable vision impairment.

Conclusions

We found a large proportion of fragility hip fracture patients with impaired vision, much of which was treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.

Correlation between admission hypoalbuminemia and postoperative urinary tract infections in elderly hip fracture patients

PURPOSE

This study aimed to evaluate the correlation between hypoalbuminemia upon admission and the incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures.

METHODS

A retrospective analysis was performed on the medical records of elderly patients who underwent surgical treatment for hip fractures at a level I trauma center from 2013 to 2023. Serum albumin levels were measured upon admission, and hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression and propensity score matching analysis were utilized to control and reduce potential confounding factors, aiming to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CI) for UTIs to determine the strength of the association.

RESULTS

This observational cohort study included 1279 patients, among whom 298 (23.3%) developed UTIs. Patients with albumin levels < 35 g/L had significantly greater odds of developing UTIs compared to those with albumin levels ≥ 35 g/L (OR 1.86, 95% CI 1.28-2.70). Further analysis, dividing albumin levels into quartiles, demonstrated that patients in the Q2 group (38.0-40.9 g/L; OR 1.38, 95% CI 0.88-2.17), Q3 group (35.0-37.9 g/L; OR 1.69, 95% CI 1.06-2.71), and Q4 group (15.3-34.9 g/L; OR 2.67, 95% CI 1.61-4.43) had notably higher odds of developing UTIs compared to those in the Q1 group (41.0-52.0 g/L).

CONCLUSIONS

The presence of hypoalbuminemia upon admission in elderly patients undergoing hip fracture surgery is strongly correlated with the occurrence of postoperative UTIs. Furthermore, this association exhibits a clear dose-response relationship.

A Bayesian multivariate spatial approach for illness-death survival models

Illness-death models are a class of stochastic models inside the multi-state framework. In those models, individuals are allowed to move over time between different states related to illness and death. They are of special interest when working with non-terminal diseases, as they not only consider the competing risk of death but also allow us to study the progression from illness to death. The intensity of each transition can be modelled including both fixed and random effects of covariates. In particular, spatially structured random effects or their multivariate versions can be used to assess spatial differences between regions and among transitions. We propose a Bayesian methodological framework based on an illness-death model with a multivariate Leroux prior for the random effects. We apply this model to a cohort study regarding progression after an osteoporotic hip fracture in elderly patients. From this spatial illness-death model, we assess the geographical variation in risks, cumulative incidences and transition probabilities related to recurrent hip fracture and death. Bayesian inference is done via the integrated nested Laplace approximation.

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

Hip fractures are a major public health concern. Number of hip fractures cases increased by 20% from 2012 to 2018. Factors associated with post-fracture mortality included men, those who are frail, living in a non-metropolitan region, or residing in a residential aged care facility. Our results are useful for planning healthcare interventions.

PURPOSE

Hip fractures are a major public health concern in Australia. Data on hip fracture incidence and mortality are needed to plan and evaluate healthcare interventions. The aims of the study were to investigate (1) the time-trend in absolute number and incidence of first hip fractures, and (2) factors associated with mortality following first hip fractures in Victoria, Australia.

METHODS

A state-wide cohort study of all patients aged [Formula: see text] 50 years admitted to a Victorian hospital for first hip fracture between July 2012 and June 2018. Annual age-standardized incidence rates were calculated using population data from Australian Bureau of Statistics. Multivariate negative binomial regression was used to investigate factors associated with post-fracture mortality.

RESULTS

Overall, 31,578 patients had a first hip fracture, of whom two-thirds were women and 47% were [Formula: see text] 85 years old. Absolute annual numbers of first hip fractures increased by 20%. There was no significant change in age- and sex-adjusted incidence. In total, 8% died within 30 days and 25% within 1 year. Factors associated with 30-day mortality included age (≥ 85 years old versus 50-64 years old, mortality rate ratio [MRR] 8.05, 95% confidence interval [CI] 5.86-11.33), men (MRR 2.11, 95% CI 1.88-2.37), higher Hospital Frailty Risk Scores (high frailty versus no frailty, MRR 3.46, 95% CI 2.66-4.50), admission from a residential aged care facility (RACF) (MRR 2.28, 95% CI 1.85-2.82), and residing in a non-metropolitan region (MRR 1.22, 95% CI 1.09-1.38). The same factors were associated with 1-year mortality.

CONCLUSION

The absolute increase in hip fractures highlights the need for interventions to reduce fracture risk, especially for those at higher risk of post-fracture mortality, including men and those who are frail, living in a non-metropolitan region, or residing in a RACF.

Are there specific clinical risk factors for the occurrence of multiple fractures? The FRISBEE study

This study showed additional clinical risk factors for the occurrence of multiple fractures with regards to a single fracture, with often higher hazard ratios. It would be important to include the risk of the occurrence of multiple fractures in future prediction models.

PURPOSE

To identify clinical risk factors (CRFs) which would specifically increase the risk of multiple fractures.

METHODS

Data of the 3560 postmenopausal women of the FRISBEE study were analysed. The CRFs and the fractures are collected annually. The cohort was divided into three groups: those who had no incident fracture, those who had a single incident fracture and those who had 2 two or more incident fractures (i.e. multiple fractures). Statistical analyses were performed using Cox proportional hazards models.

RESULTS

Among the 3560 subjects (followed for 9.1 (7.2-10.6) years), 261 subjects had two or more validated fractures during follow-up (146 were major osteoporotic fractures (MOFs)), 628 had one fracture (435 MOFs), 2671 had no fracture (2979 had no MOF); 157 subjects had two or more central fractures, 389 had only one and 3014 had none. The risk factors for those with multiple fractures at any site were age, history of fracture, history of fall, total hip bone mineral density (BMD), spine BMD and rheumatoid arthritis. For those with multiple MOFs, significant CRFs were age, history of fracture, parental hip fracture, total hip BMD and rheumatoid arthritis.

CONCLUSION

We found in a prospective cohort study that there were more CRFs and higher hazard ratios for the occurrence of multiple fractures than for a single fracture.