The incidence and factors of hip fractures and subsequent morbidity in Taiwan: An 11-year population-based cohort study

Reamed versus unreamed proximal femoral nailing for intertrochanteric fractures in geriatric patients. A retrospective case control study

Cephalomedullary nail is the gold standard treatment for intertrochanteric fracture in geriatric population. The aim of the study was to investigate the differences of the reamed versus the unreamed short proximal femoral nailing (PFN), in terms of the duration of surgery and the outcome. The impact of patients and fracture characteristics to the outcome was also evaluated. A retrospective analysis of 158 elderly patients, who sustained intertrochanteric fracture of the femur, with a minimum follow up of one year, was performed. 78 patients underwent a reamed proximal femoral nailing (PFN) whereas 80 patients underwent an unreamed PFN. The duration of surgery, the outcome and the complications between the reamed and the unreamed nailing were compared. A logistic regression was also conducted to estimate the risk factors affecting mortality. The mean duration of surgery for reamed and unreamed G nail was 48,87 min (C.I.: 47,30-50,44) and 42,45 min (C.I.: 41,30-43,60) respectively. No statistically significant difference regarding the need for transfusion and complications, such as wound healing problems and screw cut out was identified between the two types of nailing. The most important factors affecting mortality were the ASA (beta coefficient: 3,127, p-value: 0,002) and the need for transfusion (beta coefficient: 1,367, p-value: 0,05). The only difference found between the reamed and the unreamed PFN was the operation time, which was less for the later one. Both types of fixation were similar in terms of outcome and complications.

Prognostic Factors of Hip Fracture in Elderly: A Systematic Review

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors.

Incidence of fragility hip fracture across the Asia-pacific region: A systematic review

PURPOSE

This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions.

METHOD

A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518).

RESULTS

Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China.

CONCLUSION

Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning.

Persistent Mesodermal Differentiation Capability of Bone Marrow MSCs Isolated from Aging Patients with Low-Energy Traumatic Hip Fracture and Osteoporosis: A Clinical Evidence

A low-energy hit, such as a slight fall from a bed, results in a bone fracture, especially in the hip, which is a life-threatening risk for the older adult and a heavy burden for the social economy. Patients with low-energy traumatic bone fractures usually suffer a higher level of bony catabolism accompanied by osteoporosis. Bone marrow-derived stem cells (BMSCs) are critical in osteogenesis, leading to metabolic homeostasis in the healthy bony microenvironment. However, whether the BMSCs derived from the patients who suffered osteoporosis and low-energy traumatic hip fractures preserve a sustained mesodermal differentiation capability, especially in osteogenesis, is yet to be explored in a clinical setting. Therefore, we aimed to collect BMSCs from clinical hip fracture patients with osteoporosis, followed by osteogenic differentiation comparison with BMSCs from healthy young donors. The CD markers identification, cytokines examination, and adipogenic differentiation were also evaluated. The data reveal that BMSCs collected from elderly osteoporotic patients secreted approximately 122.8 pg/mL interleukin 6 (IL-6) and 180.6 pg/mL vascular endothelial growth factor (VEGF), but no PDGF-BB, IL-1b, TGF-b1, IGF-1, or TNF-α secretion. The CD markers and osteogenic and adipogenic differentiation capability in BMSCs from these elderly osteoporotic patients and healthy young donors are equivalent and compliant with the standards defined by the International Society of Cell Therapy (ISCT). Collectively, our data suggest that the elderly osteoporotic patients-derived BMSCs hold equivalent differentiation and proliferation capability and intact surface markers identical to BMSCs collected from healthy youth and are available for clinical cell therapy.

Influences of Cognitive Function and Depressive Symptoms on Pain Trajectories During the First Year Following Hip Fracture Surgery: A Prospective Cohort Study

OBJECTIVES

The purposes of this study were to explore trajectories for patterns of postoperative pain intensity during the first year following hip fracture surgery and the relationships between pain trajectory groups, cognitive impairment, and depressive symptoms.

DESIGN

A prospective cohort correlational study.

SETTING AND PARTICIPANTS

A total of 325 patients aged 60 years or older who had received hip fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020.

METHODS

Data were collected before hospital discharge and at 1, 3, 6, and 12 months postdischarge. Pain intensity was measured using a numeric rating scale; cognitive function was measured with the Taiwan version of the Mini-Mental State Examination; and depressive symptoms were measured by the Geriatric Depression Scale-Short Form. Patients with similar postoperative pain trajectories were categorized into groups and compared with group-based trajectory modeling. Cognitive impairment and depressive symptoms associated with each group were identified by logistic regression.

RESULTS

Three different pain trajectory groups were identified: drastic decline-minimum pain (47.7%), gentle decline-mild pain (45.5%), and slight decline-moderate pain (6.8%). Patients with cognitive impairment [odds ratio (OR) 11.01, 95% CI 2.99-10.51] and at risk for depression (OR 49.09, 95% CI 10.46-230.30) were more likely to be in the moderate pain group than the minimum pain group. Patients with cognitive impairment (OR 2.07, 95% CI 1.25-3.42) were more likely to be in the mild pain group than the minimum pain group. Patients at risk for depression (OR 9.68, 95% CI 3.16-29.63) were more likely to be in the moderate pain group than the mild pain group.

CONCLUSIONS AND IMPLICATIONS

Identifying postoperative pain trajectories can provide insight into the most appropriate pain management for older persons following hip fracture surgery. Attention should focus on assessments for cognitive impairment and risk of depression to prevent persistent postoperative pain. Future studies of older patients with clinically diagnosed cognitive impairment and depression are suggested.

Predictors of one-year mortality following hip fracture surgery in elderly

Background

Understanding mortality risk factors is critical to reducing mortality among elderly hip fracture patients. To investigate the effects of admission and post-operative levels of distribution width of red blood cells (RDW), albumin, and RDW/albumin (RA) ratio on predicting 1-year mortality following hip fracture surgery.

Methods

A retrospective study was conducted on 275 elderly patients who underwent hip fracture surgery in a tertiary hospital between January 2018 and January 2022. Deaths within one year of hip fracture were defined as the deceased group. The survivors were defined as those who survived for at least one year. The relationship between admission and post-operative levels of RDW, albumin, RA, and mortality within one year after hip surgery was assessed statistically, including binary logistic regression analysis. The study also assessed other factors related to mortality.

Results

One-year mortality was 34.7%. There was a 3.03-year (95% CI [1.32-4.75]) difference between the deceased (79.55 ± 8.36 years) and survivors (82.58 ± 7.41 years) (p < 0.001). In the deceased group, the mean hemoglobin (HGB) values at admission (p = 0.022) and post-operative (p = 0.04) were significantly lower. RDW values at admission (p = 0.001) and post-op (p = 0.001) were significantly lower in the survivor group. The mean albumin values at admission (p < 0.001) and post-operative (p < 0.001) in the survivor group were significantly higher than in the deceased group. A significant difference was found between the survivor group and the deceased group in terms of mean RA ratio at admission and post-operative (p < 0.001). Based on binary logistic regression analysis, presence of chronic obstructive pulmonary disease (COPD) (OR 3.73, 95% CI [1.8-7.76]), RDW (OR 1.78, 95% CI [1.48-2.14]), and albumin (OR 0.81, 95% CI [0.75-0.87]), values at admission were found to be independent predictors of 1-year mortality in elderly patients with hip fracture.

Conclusion

Based on this study, presence of COPD, higher RDW, and lower albumin levels at admission were independent predictors of 1-year mortality following hip fracture surgery in the elderly.

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

PURPOSE

This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults.

METHODS

Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach.

RESULTS

In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year.

CONCLUSION

Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

This retrospective study aimed to determine the predictive value of radiologically measured psoas muscle area (PMA) for intraoperative hypotension (IOH) using receiver operating characteristic (ROC) curves in older adult patients with hip fractures. The cross-sectional axial area of the psoas muscle was measured by CT at the level of the 4th lumbar vertebrae and normalized by body surface area (BSA). The modified frailty index (mFI) was used to assess frailty. IOH was defined as an absolute threshold of mean arterial blood pressure (MAP) < 65 mmHg or a relative decrease in MAP > 30% from baseline MAP. Among the 403 patients, 286 (71.7%) had developed IOH. PMA normalized by BSA in male patients was 6.90 ± 0.73 in the no-IOH group and 4.95 ± 1.20 in the IOH group (p < 0.001). PMA normalized by BSA in female patients was 5.18 ± 0.81 in the no-IOH group and 3.78 ± 0.75 in the IOH group (p < 0.001). The ROC curves showed that the area under the curve for PMA normalized by BSA and modified frailty index (mFI) were 0.94 for male patients, 0.91 for female patients, and 0.81 for mFI (p < 0.001). In multivariate logistic regression, low PMA normalized by BSA, high baseline systolic blood pressure, and old age were significant independent predictors of IOH (adjusted odds ratio: 3.86, 1.03, and 1.06, respectively). PMA measured by computed tomography showed an excellent predictive value for IOH. Low PMA was associated with developing IOH in older adult patients with hip fractures.

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.

Validation of Operational Definition to Identify Patients with Osteoporotic Hip Fractures in Administrative Claims Data

As incidences of osteoporotic hip fractures (OHFs) have increased, identifying OHFs has become important to establishing the medical guidelines for their management. This study was conducted to develop an operational definition to identify patients with OHFs using two diagnosis codes and eight procedure codes from health insurance claims data and to assess the operational definition’s validity through a chart review. The study extracted data on OHFs from 522 patients who underwent hip surgeries based on diagnosis codes. Orthopedic surgeons then reviewed these patients’ medical records and radiographs to identify those with true OHFs. The validities of nine different algorithms of operational definitions, developed using a combination of three levels of diagnosis codes and eight procedure codes, were assessed using various statistics. The developed operational definition showed an accuracy above 0.97 and an area under the receiver operating characteristic curve above 0.97, indicating excellent discriminative power. This study demonstrated that the operational definition that combines diagnosis and procedure codes shows a high validity in detecting OHFs and can be used as a valid tool to detect OHFs from big health claims data.

Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital

Objective

Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital.

Methods

The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications.

Results

The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ² = 301.699, p < 0.001), osteoporosis (χ² = 375.463, p < 0.001), injury time of day (χ² = 114.913, p < 0.001), injury cause (χ² = 748.187, p < 0.001), injury location (χ² = 490.153, p < 0.001), fracture side (χ² = 57.000, p < 0.001), fracture site (χ² = 806.650, p < 0.001), associated injuries (χ² = 322.921, p < 0.001), coma after injury (χ² = 147.814, p < 0.001), non‐surgery‐related complications (χ² = 7.895, p = 0.019), and surgery‐related complications (χ² = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications.

Conclusions

Traumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.

Influence of Nutritional Status on a Family-Centered Care Intervention for Older Adults with Cognitive Impairment following Hip-Fracture Surgery: Secondary Data Analysis of a Randomized Controlled Trial

OBJECTIVES

In Taiwan, older adults with cognitive impairment who undergo hip-fracture surgery are routinely cared for by family members. This study aimed to determine if nutritional status influenced the effects of a family-centered intervention for older adults with cognitive impairment recovering from hip-fracture surgery.

DESIGN

Secondary data analysis of data from a randomized controlled trial was conducted to examine the influences of nutritional status 1 month after hospital discharge on the effects of a family-centered care intervention model, which was designed for older adults with hip fracture and cognitive impairment. Outcomes were compared among participants according to nutrition status (well-nourished/poorly-nourished) and treatment approach (control/intervention).

SETTING

The original study was conducted at a 3000-bed medical center from July 2015 to October 2019.

PARTICIPANTS

Participants were older adults with cognitive impairment who had undergone hip-fracture surgery. Participants were assessed as poorly-nourished or well-nourished with the Mini-Nutritional Assessment (MNA) 1-month post-discharge and were then randomly assigned to either the intervention group or control group.

INTERVENTION

A family-centered intervention model for family caregivers of older adults with cognitive impairment recovering from hip-fracture surgery was implemented. The intervention was delivered by geriatric nurses, which included instructions for family caregivers in overseeing exercises for strengthening the hip, understanding dietary requirements, and managing behavioral problems associated with cognitive impairment.

MEASUREMENTS

Outcome measures included activities of daily living (ADLs), instrumental ADLs, hip range of motion, hip muscle strength, depression, measured with the Geriatric Depressive Scale, and physical and mental health related quality of life, measured with the Short Form Survey (SF-36), Taiwanese version. Participants were assessed at 1-, 3-, 6-, and 12-months post-discharge.

RESULTS

Most of the 134 participants were assessed as poorly nourished (n = 122); 57 were the control group and 65 received the intervention. For the well-nourished participants (n = 12), four were in the intervention group and eight were controls. There were no significant differences in any outcome variables for poorly nourished participants who received the intervention compared with controls. For the sample of well-nourished participants, those who received the intervention performed significantly better in outcomes of IADLs (b = 1.74, p < .05), hip muscle strength (b = 9.64, p < .01), and physical health related quality of life (b = 10.47, p < .01).

CONCLUSION

The family-centered care intervention was only effective for older adults with cognitive impairment recovering from hip-fracture surgery who were well-nourished at 1 month following hospital discharge, but not for those at risk of malnutrition. Interventions should focus on enhancing nutritional status following hip surgery which could allow the family-centered in-home intervention to be beneficial for more older adults with cognitive impairment recovering from hip-fracture surgery.

Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies

Individuals with low socio-economic status (SES) have a more than 25% higher risk of fragility fractures than individuals with high SES. Body mass index and lifestyle appear to mediate the effect of SES on fracture risk. Strategies to prevent fractures should aim to reduce unhealthy behaviours through tackling structural inequalities.

INTRODUCTION

This systematic review and meta-analysis aimed to evaluate the impact of socio-economic status (SES) on fragility fracture risk.

METHODS

Medline, Embase, and CINAHL databases were searched from inception to 28 April 2021 for studies reporting an association between SES and fragility fracture risk among individuals aged ≥50 years. Risk ratios (RR) were combined in meta-analyses using random restricted maximum likelihood models, for individual-based (education, income, occupation, cohabitation) and area-based (Index of Multiple Deprivation, area income) SES measures.

RESULTS

A total of 61 studies from 26 different countries including more than 19 million individuals were included. Individual-based low SES was associated with an increased risk of fragility fracture (RR 1.27 [95% CI 1.12, 1.44]), whilst no clear association was seen when area-based measures were used (RR 1.08 [0.91, 1.30]). The strength of associations was influenced by the type and number of covariates included in statistical models: RR 2.69 [1.60, 4.53] for individual-based studies adjusting for age, sex and BMI, compared with RR 1.06 [0.92, 1.22] when also adjusted for health behaviours (smoking, alcohol, and physical activity). Overall, the quality of the evidence was moderate.

CONCLUSION

Our results show that low SES, measured at the individual level, is a risk factor for fragility fracture. Low BMI and unhealthy behaviours are important mediators of the effect of SES on fracture risk. Strategies to prevent fractures and reduce unhealthy behaviours should aim to tackle structural inequalities in society thereby reducing health inequalities in fragility fracture incidence.

Technetium-99m methylene diphosphonate bone scan in evaluation of insufficiency fractures - A pictorial assay and experience from South India

Insufficiency fractures (IFs) can be challenging to diagnose due to varied presentations, and sometimes, it changes the course of treatment, as in cancer patients in whom it has to be differentiated with metastatic disease. We present the role of Technetium 99m methylene diphosphonate (^99mTc-MDP) bone scan, which is a low-cost, simple to perform, whole body diagnostic investigation in the diagnosis of IFs. This is a retrospective analysis of all patients who underwent a ^99mTc-MDP bone scan in a tertiary care teaching hospital during 2013-2017 and were diagnosed as having an IF on bone scan. The bone scans were performed on a dual-head gamma camera using low-energy high-resolution collimators. Of all the bone scan performed during 2013-2017, a total of 138 patients with a mean age of 57.5 ± 14.7 years were diagnosed as having IFs based on bone scan and final clinical diagnosis. Among them, the most common complaint was regional bony pain in 62% of patients, while the most common cause was osteoporosis in 47% of patients, both postmenopausal and senile osteoporosis. In all, 265 sites of fractures were identified with a fracture average of 1.9/patient, the most common site being dorsolumbar vertebrae, followed by ribs and lower limb bones. Many unusual sites were also identified such as talus, sternum, clavicle, and scapula. ^99mTc-MDP bone scan, being noninvasive whole-body imaging, is a useful investigation for evaluation of IFs and in correlation with biochemical analysis and other imaging can be used to determine the etiology of IF.

Low Psoas Lumbar Vertebral Index Is Associated with Mortality after Hip Fracture Surgery in Elderly Patients: A Retrospective Analysis

The psoas-to-lumbar index (PLVI) has been reported as a simple and easy way to measure central sarcopenia. However, only few studies have evaluated the association between PLVI and survival in surgical patients. This study evaluated the association between preoperative PLVI and mortality in elderly patients who underwent hip fracture surgery. We retrospectively analyzed 615 patients who underwent hip fracture surgery between January 2014 and December 2018. The median value of each PLVI was calculated according to sex, and the patients were categorized into two groups on the basis of the median value (low PLVI group vs. high PLVI group). Cox regression analysis was performed to evaluate the risk factors for 1 year and overall mortalities. The median values of PLVI were 0.62 and 0.50 in men and women, respectively. In the Cox regression analysis, low PLVI was significantly associated with higher 1 year (hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.18–2.96, p = 0.008) and overall mortalities (HR: 1.51, 95% CI: 1.12–2.03, p = 0.006). Low PLVI was significantly associated with a higher mortality. Therefore, PLVI might be an independent predictor of mortality in elderly patients undergoing hip fracture surgery.

Real-World Evidence: A Primer

SUMMARY

The insights that real-world data (RWD) can provide, beyond what can be learned within the traditional clinical trial setting, have gained enormous traction in recent years. RWD, which are increasingly available and accessible, can further our understanding of disease, disease progression, and safety and effectiveness of treatments with the speed and accuracy required by the health care environment and patients today. Over the decades since RWD were first recognized, innovation has evolved to take real-world research beyond finding ways to identify, store, and analyze large volumes of data. The research community has developed strong methods to address challenges of using RWD and as a result has increased the acceptance of RWD in research, practice, and policy. Historic concerns about RWD relate to data quality, privacy, and transparency; however, new tools, methods, and approaches mitigate these challenges and expand the utility of RWD to new applications. Specific guidelines for RWD use have been developed and published by numerous groups, including regulatory authorities. These and other efforts have shown that the more RWD are used and understood and the more the tools for handling it are refined, the more useful it will be.

Secular Trends of Hip Fractures in Lebanon, 2006 to 2017: Implications for Clinical Practice and Public Health Policy in the Middle East Region

Country-specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age- and sex-specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.

Risk Factors Associated With Hip Fractures among Adult People in Babylon City, Iraq

BACKGROUND

The fractures of hip joint considered as a serious problem in public health in the medical and socioeconomic issues, the incidence of the fracture neck femur is significantly increased with the increment of general population life span.

AIM

The goal of this study is to highlight and focus on the most important risk factor for the hip fractures in our Babylon society, and to improve our understanding of the medical and social aspects of these predisposing factors.

PATIENTS AND METHODS

A case-control study of older adults (above 60 years old). The study was done on tow samples. First, one consisting of 75 cases those having fracture neck femur considered as cases, and second sample as a control group, consisting of 150 people as a healthy control group having no fracture. A pre-tested questionnaire was prepared to collect data from both samples; the questionnaire included demographic data and information about potential risk factors of hip fracture.

RESULTS

Most of the people in the study samples in both groups were, married women, housekeepers, illiterate and from urban dwellers. There was highly significant association between case-control groups regarding, Continuous using of medication such as cortisone which was found to be a potential risk factor of hip fracture (Unadjusted OR = 3.636), low income was positively associated risk factor of hip fracture in this study (OR = 2.377), low milk intake, low sun exposure, tobacco smoking were positively associated with this health problem (OR = 1.794), while physical exercise was protective factor (OR = 0.489).

CONCLUSION

The highest risk factors associated with increased occurrence of hip fracture were using cortisone, Osteoporosis, tobacco smoking, consuming soft drinks, and less exposure to sunlight.

Socioeconomic and clinical risk factors of hip fracture among the elderly: a case-control study

Background/Aims

The aim of the study was to investigate the socioeconomic and clinical risk factors for hip fracture among a community-dwelling elderly population in Greece. It also aimed to identify characteristics associated with reducing mobility.

Methods

A case-control study was conducted on 202 patients who had a hip fracture and on 202 other members of the elderly population who did not have a hip fracture as the control group.

Results

In the multivariate analysis, the variables related to an increased risk of hip fracture were: gender (odds ration [OR]=10.88; 95%confidence Interval [CI]=2.28–51.98), income (OR=32.50; 95%CI=2.96–356.43), income adequacy (OR=129,34; 95%CI=7,09–2360,88), inability to pay expenses/medication (OR=0.02; 95%CI=0.003–0.09), depression (OR=0.03; 95%CI=0.002–0.35), multimorbidity (OR=0.01; 95%CI=0.001–0.97), number of medication (OR=0.02; 95%CI=0.001–0.28) and history of falls (OR=0.08; 95%CI=0.01–0.40). Factors related to deterioration of mobility were: age (OR=28.43; 95%CI:5.45–148.32), dementia (OR=15.60; 95%CI:1.80–135.27), walking ability (OR=0.20; 95%CI:0.07–0.56), balance (OR=9.10; 95%CI:1.89–43.75), use of walking aid (OR=7.42; 95%CI:2.70–20.39), and length of hospitalisation (OR=3.01; 95%CI:1.27–7.14).

Conclusions

Socioeconomic and clinical factors that lead to an increased risk of hip fracture were identified, as well as factors affecting post-operative functional ability that could guide prevention programmes.

Osteoporosis and vascular calcification: A shared scenario

Osteoporosis is a systemic skeletal disease, characterised by low bone mass and deterioration in the micro-architecture of bone tissue, which causes increased bone fragility and consequently greater susceptibility to fractures. It is the most frequent metabolic bone disease in our population, and fractures resulting from osteoporosis are becoming more common. Furthermore, vascular calcification is a recognised risk factor of cardiovascular morbidity and mortality that historically has been considered a passive and degenerative process. However, it is currently recognised as an active process, which has histopathological characteristics, mineral composition and initiation and development mechanisms characteristic of bone formation. Paradoxically, patients with osteoporosis frequently show vascular calcifications. Traditionally, they have been considered as independent processes related to age, although more recent epidemiological studies have shown that there is a close relationship between the loss of bone mass and vascular calcification, regardless of age. In fact, both conditions share risk factors and pathophysiological mechanisms. These include the relationship between proteins of bone origin, such as osteopontin and osteoprotegerin (OPG), with vascular pathology, and the intercellular protein system RANK/RANKL/OPG and the Wnt signalling pathway. The mechanisms linked in both pathologies should be considered in clinical decisions, given that treatments for osteoporosis could have unforeseen effects on vascular calcification, and vice versa. In short, a better understanding of the relationship between both entities can help in proposing strategies to reduce the increasing prevalence of vascular calcification and osteoporosis in the aging population.

Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database

Introduction:

While the benefits of early mobility for prevention of complications such as pneumonia, thromboembolic events, and improved mortality have been well studied in postsurgical patients, it is unclear which patients may struggle to achieve full weight-bearing on the first postoperative day.

Materials and Methods:

The 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried regarding the ability to achieve weight-bearing on first postoperative day for older adults. Cases that occurred secondary to malignancy were excluded or for which weight-bearing was unachievable on the first postoperative day due to medical reasons were excluded.

Results:

A total of 6404 patients met inclusion and exclusion criteria for the study, with 1640 (25.6%) patients unable to bear weight on the first postoperative day. Following adjusted analysis, nonmodifiable patient factors such as dependent (partial or total) functional health status, dyspnea with moderate exertion (odds ratio [OR]: 1.31 [95% confidence interval, CI: 1.04-1.65]), ventilator dependency, and preoperative dementia on presentation to hospital were associated with lack of achievement of weight-bearing on the first postoperative day. Modifiable patient factors such as presence of systemic inflammatory response syndrome (OR: 1.35 [95% CI: 1.11-1.64]), delirium, and low preoperative hematocrit and modifiable system factors including delayed time to surgery, total postoperative time >90 minutes, and transfer from an outside emergency department were also associated with inability to achieve weight-bearing on the first postoperative day.

Discussion:

Medical teams can utilize the results from this study to better identify patients preoperatively who may be at risk of not achieving early mobilization and proactively employ implement strategies to encourage mobility as soon as possible for hip fracture patients.

Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil

INTRODUCTION

Osteoporosis is a very common disease, and data on its epidemiology is important for health care strategy implementation. Brazil is a developing country; its population is aging, leading to an expected increase in hip fractures and their undesirable consequences.

OBJECTIVE

Assess the incidence of osteoporotic hip fractures and subsequent mortality in Southern Brazil as part of a large epidemiological study aiming to reinforce the data for FRAX Brazil.

STUDY DESIGN

This study evaluated all admissions for fragility hip fractures between April 1, 2010, and March 31, 2012, in the city of Joinville, including both genders of patients 50 years old or older, which corresponded to 19.2% of the local population. Joinville was chosen because it is the third largest city in the south of Brazil, with a representative population predominantly composed of descendants of European immigrants.

RESULTS

There were 213 cases of hip fractures, predominantly in Caucasians (n = 204, 96.7%) whose mean age was 77.7, ± 10.5, of which 143 (67.1%) were women (79.5 ± 9.6 years) and 70 (32.9%) were men (74 ± 11.3 years). The annual incidence of hip fractures was 268.8 for women and 153.0 for men/100,000 inhabitants. In the 60 to 64-year group, the overall incidence was 92.1/100,000, with an age-related increase of 1410.1/100,000 in the 80 to 84-year group. The mortality rate during hospitalization was 7.5%, and 25% died during the 12 months following their fractures.

CONCLUSION

The incidence of hip fractures among the oldest in this predominantly Caucasian population living in Southern Brazil was similar to that of European populations from the northern hemisphere. The annual incidence of fragility hip fractures among people in their 80s was 59 times higher than that among people in their 50s. The mortality rate was 4.3 times higher in the first year after hip fracture than in the age-related local population.