Declining trends in the incidence of hip fractures in people aged 65years or over in years 2000-2011

The increasing complexity of femoral fragility fractures: incidence, fracture patterns and management over a 10-year period

INTRODUCTION

The purpose of this study was to determine whether there have been changes in the numbers and complexity of femoral fragility fractures presenting to our department over a period of 10 years.

METHODS

Patients >60 years presenting with femoral fragility fractures to our institution in 2018-2019 (397 fractures) were compared with respect to demographic data, incidence rates, fracture classification and surgical management with a historical cohort from 2009-2010 (335 fractures). Pathological and high velocity fractures were excluded.

RESULTS

The gender proportion and average age (83.1 vs. 82.7 years) was unchanged. The number of femoral fractures increased by 19% but the overall incidence in people >60 years fell by 6% (p = 0.41). The proportion of unstable trochanteric fractures (31A2 and A3) increased from 22% to 55% (p < 0.001). The proportion of displaced intracapsular fractures increased from 53% to 72% (p < 0.001). The incidence of stable trochanteric fractures fell from 12.4 to 7.3/10,000 patients>60 years (p = 0.0006) while the incidence of unstable trochanteric fractures (31A2 and 31A3) increased from 3.5 to 8.9/10,000 patients >60 years (p < 0.0001). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 9% to 35% (p = 0.0001). The number of shaft and distal femoral fractures increased by 41% although the incidence did not change significantly. Periprosthetic fractures comprised 70% of femoral shaft fractures in both cohorts.

CONCLUSIONS

The increasing number and complexity of femoral fragility fractures, especially unstable trochanteric fractures and periprosthetic fractures, is likely to have an impact on implant use, theatre time and cost.

Discordance in Secular Trends of Bone Mineral Density Measurements in Different Ages of Postmenopausal Women

BACKGROUND

Age-adjusted bone mineral density (BMD) in postmenopausal women decreases in developed countries whereas incidence of osteoporotic fracture decreases or remains stable. We investigated secular trends of bone density from 2008 to 2017 among different age groups of postmenopausal women.

METHODS

We analyzed BMD data obtained from health check-ups of 4,905 postmenopausal women during three survey cycles from 2008 to 2017. We divided them into 3 groups by age (50-59 years, 60-69 years, and 70 years or more) and observed the transition of lumbar and femoral BMD in each group, before and after adjusting for variables that may affect BMD.

RESULTS

Age-adjusted BMD, bone mineral content (BMC), and T-score demonstrated a declining trend over the survey period at lumbar spine (-2.8%), femur neck (-3.5%) and total femur (-4.3%), respectively. In the analysis for the age groups, the BMD, BMC, and T-score presented linear declining trend (-6.1%) in younger postmenopausal women while women aged over 70 or more showed linear increasing trends (+6.3%) at lumbar spine during the survey period. Femoral neck and total femur BMD demonstrated a declining linear trend only in the 50-59 and 60-69 years groups (-5.5%, -5.2%, respectively), but not in the 70 years or more group.

CONCLUSION

BMD in younger postmenopausal women has decreased considerably but has increased or plateaued in elderly women. This discordance of BMD trends among different age groups may contribute to decreased incidence of osteoporotic fracture despite a recent declining BMD trend in postmenopausal women.

The incidence of musculoskeletal injuries: a systematic review and meta-analysis

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.

Results

The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures.

Conclusion

The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.

Screening tool for identification of hip fractures in the prehospital setting

Objectives

This study aims to develop a screening tool that will help first responders identify patients with proximal femur fractures, commonly referred to as hip fractures, on site and direct these patients to hospitals with orthopaedic surgery services.

Study Design

Prospective survey.

Methods

Literature and expert opinion defined parameters for the Collingwood Hip Fracture Rule (CHFR) which predict a patient's likelihood of hip fracture. The study population included adults presenting to Collingwood General and Marine Hospital with lower extremity injuries between December 1, 2019 and March 10, 2020. Excluded patients had previous hip replacement, previous hip fracture on the side of the injury, or a high energy mechanism of injury. Patients were assessed with the CHFR before receiving x-ray imaging. The parameters were scored based on their predictive powers and analyzed by a receiver operating characteristic curve.

Results

The study included 101 patients (mean age 66.3 years), and 25.7% had a hip fracture confirmed on imaging. The sensitivity, specificity, positive predictive value, and negative predictive value helped score each parameter. Factors receiving 1 point are: age 65 to 79 years, female, mechanical fall, unable to weight-bear, knee pain. Factors receiving 2 points are: bruising at greater trochanter, age >80 years. Factors receiving 3 points are: pain with hip rotation, leg shortened and externally rotated. Score is the summation of all the factors' points. The receiver operating characteristic curve (0.953; P value < .0001) demonstrated scores of 7 had sensitivity:specificity of 84.6%:94.7%.

Conclusion

The CHFR screening tool score of 7 can be used by first responders in the prehospital setting to identify patients who sustain a hip fracture and make appropriate triage decisions. This will improve patient outcomes and decrease institutional costs.

The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic

The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased.

INTRODUCTION

Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management.

METHODS

Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Śląskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated.

RESULTS

The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation.

CONCLUSION

During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.

Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: A prospective registry-based study

INTRODUCTION

This study investigated which patient and injury characteristics are associated with 12-month mortality rates and living independently after isolated hip fracture.

METHODS

Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E.

RESULTS

4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability.

CONCLUSIONS

Characteristics that are associated with social disadvantage, frailty, poor health and reduced independence before injury were associated with increased rates of death and reduced odds of living independently 12 months after isolated hip fracture.

A 1-year prospective monocentric study of limb, spinal and pelvic fractures: Can monitoring fracture epidemiology impact injury prevention programmes?

OBJECTIVES

The aim of this study was to assess fractures of extremities, spine and pelvis in patients with respect to mechanism, time of the incident and demography of patients in order to propose preventive measures.

METHODS

A mono-centric (Level I Trauma Centre, predominantly urban population) prospective study was carried-out during the one-year period from 1 January to 31 December 2012. Patients with bone fractures of extremities, spine and pelvis were studied. Demography, mechanism and time of the injury were analysed.

RESULTS

The study group consisted of 3,148 patients, 53% being women and treated for 3,909 fractures. The mean age of patients was 53 years. The most traumatised patients were of the 3rd and 4th decade, a further increase in the incidence of fractures was seen in the 7th and 9th decade. Multiple fractures were significantly higher in men (p = 0.002). A car crash or fall from a height was more common cause of spinal fracture or pelvic fracture than fracture to the upper or lower limbs (p < 0.001). Most of the fractures occurred during the day between 9 a.m. and 6 p.m., on Saturdays and during the winter season. The bones most often broken were the radius (739 patients, 18.5%) and femur (436 patients, 11.1%).

CONCLUSIONS

Our study highlights the need for injury prevention focused on sex, age and types of activities performed. Among younger individuals, such programmes should primarily be targeted toward men who, as observed in our sample, have a higher fracture frequency compared to women. Conversely, injury prevention programmes for individuals ≥ 60 years should primarily be targeted toward women, who have the highest fracture prevalence in this population.

Prior fracture and refracture among patients admitted with hip fracture: Data from a regional hip fracture registry in Sri Lanka

AIM

Fragility hip fracture has become a major global health concern. Data related to recurrent fragility fractures are sparse in the South Asian region.

METHOD

We assessed the prevalence of prior fragility fracture among patients admitted with new hip fracture to a tertiary care hospital in southern Sri Lanka. Also the incidence of refracture was assessed among hip fracture survivors followed up for 24 months after discharge.

RESULTS

Three hundred and nine patients with incident hip fracture were admitted during the study period (June 2014-February 2015) and 11 patients died while in the ward. We detected previous fracture in the contralateral hip in eight patients, while two others had distal radius fracture and one patient clinical vertebral fracture (rate = 3.6%). During the follow up two patients developed fractures in the contralateral hip while either clinical vertebral or distal forearm fractures were not detected (refracture rate = 0.004/person years).

CONCLUSION

This analysis based on a regional hip fracture registry shows a low prevalence of prior fracture among patients admitted with incident hip fracture and a low rate of refracture among survivors. More studies are needed to assess whether there are geographical variations in the prevalence of prior fracture or refracture among patients with incident hip fracture.

Second Hip Fracture: Incidence, Trends, and Predictors

Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999-2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan-Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7 years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7-13.0%; p < 0.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97-2.02), age (HR 1.03, 95% CI 1.01-1.04), living in a nursing house (HR 1.46, 95% CI 1.10-1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23-20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions that may reduce the risk.

Unparallel gender-specific changes in the incidence of hip fractures in Tangshan, China

This study, which measured the incidence of hip fractures in Tangshan, China, in 2015, shows that compared to data we reported in Tangshan in 2010, the crude incidence of hip fractures in 2015 increased in females and slightly decreased in males. However, the incidences of age-specific hip fracture in females aged over 65 and males aged over 75 are both increasing.

INTRODUCTION

The purpose of this study was to assess the incidence of hip fractures in 2015 in Tangshan, China, and to compare this incidence with that previously reported in Tangshan in 2010.

METHODS

Data were obtained from 15 hospitals within Tangshan that had an orthopedic department, and the medical records and radiographs of all patients who sustained such fractures in 2015 were reviewed. The absolute number of admissions was described, and the incidence rates per 100,000 individuals adjusted by age (-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥85 years) and gender were calculated based on the data of the Tangshan population. The 2015 population of Tangshan was determined to be 3,134,239 (1,573,118 males and 1,561,121 females).

RESULTS

The population over 65 years of age represented 15.43% of the total population and included 477,021 individuals (236,140 males and 240,881 females). In 2015, there were 1645 cervical and trochanteric fractures in 714 males and 931 females, with a male-to-female ratio of 1:1.30. The overall incidence or rate of the hip fractures was 45.39 fractures per 100,000 men per year and 59.64 fractures per 100,000 women per year. Females showed a significantly higher incidence of hip fractures than males in the over 60-and-older groups, but in the youngest group, males had a markedly higher incidence than females. Compared to the incidence measured in 2010 in Tangshan, the crude incidence of hip fractures decreased by 5.04% in males and increased by 18.33% in females. The age-specific incidence increased in the male 75-and-older age groups, and the age-specific incidence increased in the female 65-and-older age groups but decreased in those younger than 65 years.

CONCLUSION

Compared to the results in 2010, the crude incidence of hip fractures in 2015 in Tangshan increased in females but slightly decreased in males. However, the age-specific incidences of hip fracture in females aged over 65 and males aged over 75 are still increasing.

Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey

PURPOSE

Literature data indicate that the proportion of patients with recent hip fracture who receive a prescription for anti-osteoporotic drugs is low and does not seem to increase over time. This study aimed to obtain data on the prescription for anti-osteoporotic drugs in Italian patients discharged after a recent hip fracture and to assess which variables could have influenced the decision for prescribing osteoporosis medication.

METHODS

A total of four Italian centres located in four different geographical areas (Siena, Verona, Naples and Palermo) participated in this retrospective study. In each centre, experienced clinicians gathered the data of up to 200 consecutive patients discharged after a recent low-trauma hip fracture. The analysis was carried out on 697 patients (540 women and 157 men; mean age 81.9 ± 8.6 years).

RESULTS

The percentage of patients who were receiving any type of treatment for osteoporosis before the hip fracture was 8.8% (ranging from 2.4% in Naples to 17.4% in Verona). After the index hip fracture, only 23.2% of patients (namely 10.5% of men and 27.2% of women) received prescription for any pharmacological treatments for osteoporosis. Both female gender and previous use of medications for osteoporosis were positively associated with the likelihood of receiving prescription for anti-osteoporotic treatment at discharge.

CONCLUSIONS

This study showed that less than 25% of the elderly Italian patients discharged after a hip fracture received a prescription for any type of treatment for osteoporosis and highlights the urgent need for implementing new strategies in the management of hip fracture patients.