The relevance of gender in the care of hip fracture patients

Factors associated with initiation of bone-health medication among older adults in primary care in Ireland

Background

Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common.

Objective

This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care.

Design

This was a retrospective cohort study.

Setting

The study used data from forty-four general practices in Ireland from 2011–2017.

Subjects

The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months.

Methods

Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution.

Results

Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association.

Conclusions

Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.

Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain

OBJECTIVE

To evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville).

SETTING AND PARTICIPANTS

This was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event.

OUTCOME MEASURES

We evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors.

RESULTS

The overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m², renal failure and low plasma proteins.

CONCLUSIONS

Our results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.

Hip fractures among older people in Iceland between 2008 and 2012

INTRODUCTION

Hip fractures are a serious injury especially among older people, mainly caused by falls and women have a higher risk. The authors studied gender differences in hip fractures, marital status, waiting times for surgery and mortality in an older population.

METHODS

Data was obtained for all 67 years and older admitted with hip fractures to an Emergency Department (ED) in Iceland 2008-2012. The associations of covariates with mortality were analyzed using multivariable logistic regression.

RESULTS

The study included 1053 patients; covering 80% of hip fractures in Iceland during the study period, 72% were women. Men were more often married (51% vs. 23%) (P < 0.001). Average waiting time was men vs. women 21.5 h/18.9 h (p = 0.003). Mortality within 12 months was men 36% vs. women 21% (Odds Ratio (OR); 2.30, 95% Confidence Interval (CI); 1.66-3.18). Higher mortality rates were observed in older age-groups compared to 67-79 years old, i.e.80-89 years: OR 1.80 (95% CI 1.25-2.60) and 90-109 years: OR 4.52 (95% CI 2.91-7.01). Waiting time was not associated with 12-months mortality risk after adjustment.

CONCLUSION

Although women constitute the majority of elderly with hip fractures, men had higher mortality in our study. Further reserach that examine factors affecting gender difference will likey be of benefit and associated changes to the care already dleivered in the ED may improve mortality.

Understanding patient and relative/carer experience of hip fracture in acute care: A qualitative study protocol

BACKGROUND

This paper presents a qualitative study protocol focusing on older peoples' experience of recovery in acute care following hip fracture and also the experiences of their family or informal carers. There is limited evidence regarding older people and their relatives'/carers' experiences of recovery in acute care.

AIM

The study had two research questions. First what is the experience of older people who have suffered a fractured hip and secondly what is the relatives'/carers' experience of being alongside a person who has suffered a fractured hip?

METHODS

The methodology chosen is phenomenology using the methods of interviewing and participant observation. It is planned to recruit a purposive sample of up to 40 patients including those with memory loss who have suffered a fractured hip, and up to 30 of their relative/carers, and up to 20 staff may choose to take part in the observation sessions. Analysis will be through drawing out units of meaning, bringing them together to form categories and themes of experience.

CONCLUSION

This study will extend knowledge by exploring what is important to patients and their relatives/carers in the early phase of recovery. Practice based principles that can be integrated into the hip fracture pathway and enhance future care will be developed from the study findings.