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Trousdale WH, Abdel MP, Viste A, Trousdale RT, Callaghan JJ, Berry DJ. Seasonality of Periprosthetic Femur Fractures in 12,700 Primary and Revision Total Hip Arthroplasties. J Arthroplasty 2017; 32:2000-2004. [PMID: 28341277 DOI: 10.1016/j.arth.2017.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic femur fractures after primary and revision total hip arthroplasty (THA) are one of the most common long-term reasons for reoperation after THA. Previous investigations have analyzed the incidence and risk factors of these fractures. No previous study, however, has analyzed a variation in periprosthetic femur fractures between meteorologic seasons. The aim of this study was to compare the incidence of periprosthetic femur fractures after primary and revision THAs depending on the meteorologic season. METHODS We identified 8920 patients (10,672 hips) who underwent primary THAs and 1830 patients (1998 hips) who underwent revision THAs at our institution between 1995 and 2011. All patients resided in the Upper Midwest at the time of surgery. Patients who experienced periprosthetic femur fractures were identified and categorized based on the meteorologic season. A Cox model was used to assess the association of seasonality with the risk of fracture. RESULTS During the study period, 165 primary THAs and 80 revision THAs sustained a periprosthetic femur fracture. Using winter as a reference, the risk of a periprosthetic femur fracture after primary THA was not statistically higher in the spring (hazard ratio [HR] = 1.3; P = .2), autumn (HR = 1.4; P = .2), and summer (HR = 1.415; P = .1). Similarly, the risk of periprosthetic femur fracture after revision THA was not statistically higher in the spring (HR = 0.9; P = .6), autumn (HR = 0.6; P = .1), and summer (HR = 0.9; P = 1.0). CONCLUSION The risk of periprosthetic femur fracture after primary and revision THA does not significantly differ between meteorologic seasons.
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Affiliation(s)
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony Viste
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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CORRELATION BETWEEN TIME UNTIL SURGICAL TREATMENT AND MORTALITY AMONG ELDERLY PATIENTS WITH FRACTURES AT THE PROXIMAL END OF THE FEMUR. Rev Bras Ortop 2015; 46:189-94. [PMID: 27027009 PMCID: PMC4799177 DOI: 10.1016/s2255-4971(15)30238-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 10/05/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. RESULTS The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. CONCLUSION There was no association between the time spent waiting for surgery and mortality.
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Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 2008; 39:1157-63. [PMID: 18653186 DOI: 10.1016/j.injury.2008.03.022] [Citation(s) in RCA: 283] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 03/09/2008] [Accepted: 03/11/2008] [Indexed: 02/02/2023]
Abstract
Hip fractures are an ever increasing cause of morbidity and mortality. Treatment of this condition requires an all-encompassing approach from prevention to post-operative care. It is important in such a situation to gather data on the incidence and trends of hip fractures to aid in the future treatment planning of this important condition. A review of all articles published on the outcome after hip fracture over a four decade period (1959-1998) was undertaken to determine any changes that had occurred in the demographics of patients and mortality over this time period. The mean age of patients sustaining hip fractures was found to be steadily increasing over the study period at a rate of 1 year of age for every 5-year time period. The mean age in the 1960s was 73 years to a mean of 79 years in the 1990s. No notable differences were seen in the proportion of male patients over the years but a definite downward trend was noticed with regard to intracapsular fractures. The mortality at 6 and 12 months after injury remained essentially unchanged over the four decades reviewed. Mortality after a hip fracture remains significant, being 11-23% at 6 months and 22-29% at 1 year from injury. Geographical variations exist in the mortality after hip fracture. More detailed international comparisons are required to determine if these differences in outcome are accounted for by the variations in the demographics of patients or due to diversities in treatment methods.
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Affiliation(s)
- S Haleem
- Royal Sussex County Hospital, United Kingdom.
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Morosano M, Masoni A, Sánchez A. Incidence of hip fractures in the city of Rosario, Argentina. Osteoporos Int 2005; 16:1339-44. [PMID: 15841335 DOI: 10.1007/s00198-005-1839-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2004] [Accepted: 12/13/2004] [Indexed: 02/07/2023]
Abstract
In order to determine the incidence of hip fractures (HFx) in the city of Rosario, Argentina, (population, about 900,000), all HFx admitted to 26 medical centers from August 2001 to July 2002 were surveyed. Exclusion criteria were pathological fractures, violent trauma, and fractures in patients living outside urban limits. Demographical data were obtained from the 2001 national census, and the 1991 national census with projections made by the city's statistics department. In the study period, there were 763 HFx in persons aged 50 or older (608 in women and 155 in men). The annual incidence among inhabitants over the age of 50 years was 290 per 100,000 (405 for women, and 137 for men; female/male ratio: 2.96). In the population aged 65 or older, the global incidence was 646 per 100,000 (847 for women, and 343 for men; ratio: 2.47). The mean age (+/-SD) of fractured patients was 79.5+/-9.2 years; median age was 81 years (range: 50-104). Fractured men were younger (76.2+/-9.8 years vs 80.7+/-8.3 years; p <0.0001) and leaner (body mass index [BMI], 24.5+/-3.0 kg/m(2) vs 26.0+/-2.8 kg/m(2); p <0.0001) than fractured women. Most fractured patients either had normal BMI (35%) or were overweight (BMI, 25.1-30.0 kg/m(2); 47.5%). The incidence of fractures increased exponentially with advancing age. Relative risks of HFx (females/males) were calculated for each decade of life; the risk in individuals below the age of 69 was the same in both sexes; in those aged 70 or more the risk was significantly higher among women. Parental origin of fractured patients was mainly Spanish or Italian, reflecting the city's ethnic composition. Most fractures (72.5%) occurred in houses; 20% in apartments, and 7.5% in nursing homes. HFx were trochanteric in 54.4% of cases. Female patients with trochanteric fractures were older than those with cervical ones (80.0+/-9.4 years vs 78.2+/-11.4 years; p <0.01); their weights and BMIs did not differ significantly. The majority of HFx were treated surgically (91.8%); in-hospital mortality was 1.4%. In conclusion, incidence rates of HFx were somewhat higher in Rosario than those found in two other cities of central Argentina one decade earlier.
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Affiliation(s)
- Mario Morosano
- School of Medical Sciences, National University of Rosario, Center for the Study of the Climacteric, Centenario Provincial Hospital, Rosario, Argentina
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Abstract
Studies in the 1980s, including one from central Norway, in most cases showed that the incidence of hip fractures was increasing. In the 1990s, however, studies from Sweden and the United States indicated that the increase may have stopped. We report the current incidence of hip fractures in subjects in central Norway and compare it with that previously reported. The number of cervical and trochanteric fractures in a defined region of Central Norway in 1992 to 1993 and in 1997 to 1998 was found by a thorough search and collation of the hand written surgery reports, the reports from radiology departments, and hospital discharge reports. One thousand three hundred twelve hip fractures were sustained during 1997 to 1998, 10% more than in the preceding period. This was almost entirely attributable to aging of the population. In contrast to the highly statistically significant increase in the actual incidence of 2% per year previously reported between 1972 to 1973 and 1983 to 1984, there was no statistically significant increase in incidence between 1983 to 1984 and 1997 to 1998 (0.55% per year). The incidence of hip fractures was 18% higher in subjects in urban areas than in subjects in rural areas in 1992 to 1993, and 33% higher in 1997 to 1998. Whereas the proportion of trochanteric fractures was 32% in 1972 to 1973 and in 1983 to 1984, it increased to 44% in 1992 to 1993 and to 68% in 1997 to 1998. There has been an insignificant increase in hip fracture incidence since 1983 to 1984. The lower incidence of hip fractures in subjects in rural areas persists, and there has been a dramatic increase in the proportion of trochanteric fractures.
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Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway
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Frassetto LA, Todd KM, Morris RC, Sebastian A. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 2000; 55:M585-92. [PMID: 11034231 DOI: 10.1093/gerona/55.10.m585] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip fracture, a major health problem in elderly persons, varies in incidence among the populations of different countries and is directly related to animal protein intake, a finding that suggests that bone integrity is compromised by endogenous acid production consequent to the metabolism of animal proteins. If that is so, vegetable foods might provide a countervailing effect, because they are a rich source of base (bicarbonate) in the form of metabolizable organic anions, which can neutralize protein-derived acid and supply substrate (carbonate) for bone formation. METHODS We analyzed reported hip fracture incidence (HFI) data among countries (N = 33) in women aged 50 years and older, in relation to corresponding country-specific data on per capita consumption of vegetable and animal foods as reported by the United Nations Food and Agriculture Organization. RESULTS HFI varied directly with total (r = +.67, p < .001) and animal (r = +.82, p < .001) protein intake and inversely with vegetable protein intake (r = .37, p < .04). The countries in the lowest tertile of HFI (n = 11) had the lowest animal protein consumption, and invariably, vegetable protein (VP) consumption exceeded the country's corresponding intake of animal protein (AP): VP/AP > 1.0. By contrast, among the countries in the highest tertile of HFI, animal protein intake exceeded vegetable protein intake in nearly every case (10 of 11 countries). Among all countries, HFI correlated inversely and exponentially with the ratio of vegetable/animal protein intake (r = -.84, p < .001) and accounted for 70% of the total variation in HFI. Adjusted for total protein intake, vegetable food consumption was an independent negative predictor of HFI. All findings were similar for the subset of 23 countries whose populations are predominantly Caucasian. CONCLUSION The findings suggest that the critical determinant of hip fracture risk in relation to the acid-base effects of diet is the net load of acid in the diet, when the intake of both acid and base precursors is considered. Moderation of animal food consumption and an increased ratio of vegetable/animal food consumption may confer a protective effect.
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Affiliation(s)
- L A Frassetto
- Department of Medicine and General Clinical Research Center, University of California, San Francisco 94143, USA
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Johansson C, Molander U, Milsom I, Ekelund P. Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women. Maturitas 1996; 23:265-71. [PMID: 8794419 DOI: 10.1016/0378-5122(95)00982-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infections (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study. SUBJECTS AND METHODS The sample consisted of 10000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire. RESULTS The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P < 0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P < 0.001), HIST-UI (P < 0.001) and tobacco smoking (P < 0.05), respectively, had an independent explanatory value for fractures. CONCLUSION The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.
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Affiliation(s)
- C Johansson
- Department of Geriatrics, Vasa Hospital, University of Göteborg, Sweden
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Mikhail MB, Vaswani AN, Aloia JF. Racial differences in femoral dimensions and their relation to hip fracture. Osteoporos Int 1996; 6:22-4. [PMID: 8845595 DOI: 10.1007/bf01626533] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
White women have a higher rate of age-specific hip fractures than black women. Recently, femoral dimensions have been implicated in osteoporotic fractures. To study racial differences in femoral dimensions, dual X-ray absorptiometry scans were obtained for two similar groups of 50 white women and 50 black women. We measured the hip axis length (the distance from below the lateral aspect of the greater trochanter to the inner pelvic brim), the neck width and the neck/shaft angle on the scan print-out. The observer was masked to the race of the subject. The results were analyzed using the independent t-test and showed that the hip axis length and the neck width were significantly longer in the white women than in the black women (p values < 0.05 and < 0.02 respectively) but that the neck/shaft angle was not statistically different in the two groups. We conclude that femoral geometry differs among races. Whether this contributes to the lower risk of hip fracture in black women will require prospectively based studies.
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Affiliation(s)
- M B Mikhail
- Division of Endocrinology and Metabolism, Winthrop-University Hospital, New York, USA
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Abstract
There were an estimated 1.66 million hip fractures world-wide in 1990. According to the epidemiologic projections, this worldwide annual number will rise to 6.26 million by the year 2050. This rise will be in great part due to the huge increase in the elderly population of the world. However, the age-specific incidence rates of hip fractures have also increased during the recent decades and in many countries this rise has not leveled off. In the districts where this increase has either showed or leveled off, the change seems to especially concern women's cervical fractures. In men, the increase has continued unabated almost everywhere. Reasons for the age-specific increase are not known: increase in the age-adjusted incidence of falls of the elderly individuals with accompanying deterioration in the age-adjusted bone quality (strength, mineral density) may partially explain the phenomenon. The growth of the elderly population will be more marked in Asia, Latin America, the Middle East, and Africa than in Europe and North America, and it is in the former regions that the greatest increments in hip fracture are projected so that these regions will account for over 70% of the 6.26 million hip fractures in the year 2050. The incidence rates of hip fractures vary considerably from population to population and race to race but increase exponentially with age in every group. Highest incidences have been described in the whites of Northern Europe (Scandinavia) and North America. In Finland, for example, the 1991 incidence of hip fractures was 1.1% for women and 0.7% for men over 70 years of age. Among elderly nursing home residents, the figures can be as high as 6.2% and 4.9%. The lifetime risk of a hip fracture is 16%-18% in white women and 5%-6% in white men. At the age of 80 years, every fifth woman and at the age of 90 years almost every second woman has suffered a hip fracture. Since populations are aging worldwide, the mean age of the hip fracture patients are increasing rapidly, too. Between 1970 and 1991, the mean age of male Finnish patients increased dramatically from 52.9 years to 69.0 years. In women, the corresponding figures were 71.6 and 78.9 years. This change is likely to cause increasing problems in the treatment and rehabilitation of the patients. In 1990, 72% of the hip fractures worldwide occurred in women. All over the world, the hip fracture incidences are about two times higher in women than in men. Women's overrepresentation has been explained by women's lower bone mass and density and higher frequency of falling. Epidemiologic studies show that trochanteric fractures are an increasing problem since compared with cervical fractures their relative number increases progressively with age in women after the age of 60 years and since their incidence has been shown to increase in both sexes and all age groups during the recent decades. This may have direct public health implication since mortality, morbidity, and costs caused by trochanteric fractures are higher than those of the cervical fractures. Reduced bone density (strength) by age and over the recent decades has been the most frequently mentioned reason for the increase of trochanteric fractures. Also, the fall characteristics of the elderly may have changed during the recent decades resulting in increasing numbers of this type of hip fractures since the type of the hip fracture (cervical or trochanteric) also depends on the impact angle of the greater trochanter at the moment of the floor contact.
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Affiliation(s)
- P Kannus
- Accident & Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
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Abstract
The epidemiology of fractures of the proximal femur was studied over a 1-year period in the city of La Plata, Argentina (population 288,000, latitude 35 degrees S). One hundred and ninety-five patients (164 women and 31 men) aged 50 years or over suffered a fracture of the proximal femur. The median age was 80 years in women and 77 years in men. The incidence of hip fractures per 100,000 inhabitants aged 50 years or over was 379.4 in women and 100.9 in men (female/male ratio 3.76). The age-adjusted ratio was 2.90. In women the incidence increased from 11.3 in the sixth to 2807.3 in the ninth decade.
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Affiliation(s)
- A Bagur
- Sección Osteopatías Médicas, Hospital de Clínicas, Buenos Aires, Argentina
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Cöster A, Haberkamp M, Allolio B. [Incidence of femoral neck fractures in the German Federal Republic in comparison to other countries]. SOZIAL- UND PRAVENTIVMEDIZIN 1994; 39:287-92. [PMID: 7871899 DOI: 10.1007/bf01298840] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Reported age-adjusted incidence rates vary markedly in Europe and the US, making the transposition of results from elsewhere questionable. The aim of this study is to fill this gap and to compare the hip fracture incidence between Germany and other countries. Population-based epidemiologic research was conducted in Düren (84251 residents), because its population is representative for West Germany as far as age and social structure are concerned, and because medical care is virtually self-contained within the community. Patient files and discharge statistics of the three local hospitals were thoroughly reviewed. Hip fractures after adequate trauma and pathological fractures were excluded. Between 1987 and 1989 276 inadequate hip fractures were identified among the resident population. There was a highly significant increase in the age-specific incidence of hip fractures in both sexes, but females were more frequently affected (crude average annual incidence rate per 100,000: females 291.3 males 110.2). The age-adjusted incidence rates for Germany in comparison to published international data follow on third position after the high rates reported for Norway and the US. The annual incidence of 70,000 hip fractures for the former Federal Republic of Germany is significantly higher than expected.
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Affiliation(s)
- A Cöster
- Medizinische Universitätsklinik Würzburg
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Abstract
Fractures in the elderly, especially hip fractures, have increased during recent decades in the west. Due to their large number, and often extended demands on hospital resources, older persons with hip fractures make heavy demands on health care resources. The fractures are the result of both increasing skeletal fragility and increasing falling tendency with age. Preventive measures consist primarily of opposing the sedentary life style of modern society. A continued moderate physical activity since youth, combined with sufficient access to calcium and vitamin D, builds up and retains enough bone stock to resist the decay of 1-2% per year that starts from the fifth decade of life onwards. Falling accidents are probably easier to prevent by training of muscular activity and balance compared to the osteoporosis, which needs a long preventive perspective. The rehabilitation prognosis for the individual patient has greatly improved over recent years.
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Affiliation(s)
- K G Thorngren
- Department of Orthopedics, Lund University Hospital, Sweden
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Stewart A, Reid DM, Porter RW. Broadband ultrasound attenuation and dual energy X-ray absorptiometry in patients with hip fractures: which technique discriminates fracture risk. Calcif Tissue Int 1994; 54:466-9. [PMID: 8082047 DOI: 10.1007/bf00334324] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is considerable interest in predicting risk of hip fracture in order to allow targeting of preventive care. This study aimed to determine which of two methods best discriminates a hip fracture population from controls. Fifty women with fractured neck of femur, and 50 control subjects were scanned using dual energy X-ray absorptiometry (DXA) of the spine and hip and broadband ultrasound attenuation (BUA) of the os calcis. Significant differences between the two populations could be found for both DXA and BUA, with BUA showing the largest percentage difference (27%). The mean z-scores showed that BUA had the lowest, with the exception of DXA trochanter. However, no significant difference between BUA and DXA trochanter Z-scores was found. A receiver operator characteristic (ROC) analysis showed that BUA has a superior sensitivity and specificity compared with DXA measurements, with DXA of the hip being better than the spine. This retrospective study shows that BUA is a better discriminator of hip fracture than DXA lumbar spine or DXA hip, which may have important implications for predicting those at risk of future hip fracture.
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Affiliation(s)
- A Stewart
- Rheumatology Department, City Hospital, Aberdeen, Scotland, UK
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Madhok R, Melton LJ, Atkinson EJ, O'Fallon WM, Lewallen DG. Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980-89 in Olmsted County, U.S.A. ACTA ORTHOPAEDICA SCANDINAVICA 1993; 64:543-8. [PMID: 8237321 DOI: 10.3109/17453679308993689] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine if hip fracture incidence rates are greater in urban than in rural areas of the United States, as they appear to be in Scandinavia, we undertook a study in Olmsted County, Minnesota. During the decade 1980-89, the age- and sex-adjusted incidence of proximal femur fractures among urban residents of the central city of Rochester was 36 percent greater than among residents of the rural remainder of Olmsted County. The difference was almost entirely accounted for by an excess of fractures due to moderate trauma in elderly urban women. These first detailed results from the United States confirm earlier observations from Scandinavia that hip fracture rates are lower in rural areas.
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Affiliation(s)
- R Madhok
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN 55905
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Nungu S, Olerud C, Rehnberg L. The incidence of hip fracture in Uppsala County. Change of time trend in women. ACTA ORTHOPAEDICA SCANDINAVICA 1993; 64:75-8. [PMID: 8451954 DOI: 10.3109/17453679308994535] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The incidence of hip fracture in the population over 55 years in Uppsala County was calculated for the years 1980-1991. Specific incidences were calculated for each age, sex, and fracture type group. The time trend for the change in incidence was calculated for each group with linear regression using an exponential model. The overall incidence of hip fracture in both sexes over 55 years, standardized to the 1985 population, remained steady at 6/1000 during the study period. The incidence of cervical fractures in women showed a decrease in all age groups except over 85 years of age, where the incidence was constant. The corresponding incidence in men did not change over time. The incidence of trochanteric fracture increased in men 65-74 years of age and in women over 85 years of age. The incidence of trochanteric fracture in the rest of the age and sex groups remained unchanged.
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Affiliation(s)
- S Nungu
- Department of Orthopedics, Uppsala University Hospital, Sweden
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Abstract
Between 1 January and 31 December 1987, 1178 hip fractures were recorded in the 28 clinical centres, public and private, of the Picardy region (19443 km2, 1.8 million inhabitants). Patients under 20 years and those with metastatic cancer and myelomatous fractures were excluded. Women sustained 853 fractures (age mean +/- SD: 80.2 +/- 10.4 years) and men 325 (age 69.7 +/- 16.0 years). The crude incidence rate per 10,000 person years was 13.4 for women and 5.4 for men (female/male ratio 2.6). These incidences are among the lowest recorded in Northern Europe. Women with trochanteric fractures were older than those with cervical ones, but no difference was observed for men. After adjusting for age and sex, the incidence of hip fracture was greater in urban (10.5 per 10,000 person years) and semi-rural areas (8.2) than in rural areas (5.3). The mean bed-days per patient (+/- SD) was 21.6 +/- 16.0 (quartiles: 13-17-26 days); no difference was observed between sex or age classes. The in-hospital mortality rate was 8.7%, it increased with age and was higher in men, whatever their age. We review the data in different countries, mostly European, to compare with the Picardy region.
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Affiliation(s)
- C Baudoin
- Unité de Recherches Cliniques et Epidémiologiques, INSERM, U21, Villejuif, France
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Gonin M, Vader JP, Paccaud F. [Quality of data provided by VESKA medical statistics: the case of the fractured proximal femur]. SOZIAL- UND PRAVENTIVMEDIZIN 1992; 37:3-5. [PMID: 1414005 DOI: 10.1007/bf01369095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Within the framework of a retrospective study of the incidence of hip fractures in the canton of Vaud (Switzerland), all cases of hip fracture occurring among the resident population in 1986 and treated in the hospitals of the canton were identified from among five different information sources. Relevant data were then extracted from the medical records. At least two sources of information were used to identify cases in each hospital, among them the statistics of the Swiss Hospital Association (VESKA). These statistics were available for 9 of the 18 hospitals in the canton that participated in the study. The number of cases identified from the VESKA statistics was compared to the total number of cases for each hospital. For the 9 hospitals the number of cases in the VESKA statistics was 407, whereas, after having excluded diagnoses that were actually "status after fracture" and double entries, the total for these hospitals was 392, that is 4% less than the VESKA statistics indicate. It is concluded that the VESKA statistics provide a good approximation of the actual number of cases treated in these hospitals, with a tendency to overestimate this number. In order to use these statistics for calculating incidence figures, however, it is imperative that a greater proportion of all hospitals (50% presently in the canton, 35% nationwide) participate in these statistics.
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Affiliation(s)
- M Gonin
- Institut universitaire de médecine sociale et préventive, Lausanne
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Abelow BJ, Holford TR, Insogna KL. Cross-cultural association between dietary animal protein and hip fracture: a hypothesis. Calcif Tissue Int 1992; 50:14-8. [PMID: 1739864 DOI: 10.1007/bf00297291] [Citation(s) in RCA: 174] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Age-adjusted female hip fracture incidence has been noted to be higher in industrialized countries than in nonindustrialized countries. A possible explanation that has received little attention is that elevated metabolic acid production associated with a high animal protein diet might lead to chronic bone buffering and bone dissolution. In an attempt to examine this hypothesis, cross-cultural variations in animal protein consumption and hip fracture incidence were examined. When female fracture rates derived from 34 published studies in 16 countries were regressed against estimates of dietary animal protein, a strong, positive association was found. This association could not plausibly be explained by either dietary dietary calcium or total caloric intake. Recent studies suggest that the animal protein-hip fracture association could have a biologically tenable basis. We conclude that further study of the metabolic acid-osteoporosis hypothesis is warranted.
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Affiliation(s)
- B J Abelow
- Yale University School of Medicine, New Haven, Connecticut 06510
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22
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Maggi S, Kelsey JL, Litvak J, Heyse SP. Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int 1991; 1:232-41. [PMID: 1790410 DOI: 10.1007/bf03187467] [Citation(s) in RCA: 165] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This paper reviews international data on incidence rates of hip fracture in persons 50 years of age and older, based on a bibliographic search of articles published since 1960. Incidence rates are higher in white populations than in black, Asian, and Hispanic populations. In both sexes and in all ethnic groups and geographic areas, incidence rates increase markedly with age. The steep increase with age, however, occurs later in black, Asiatic and Hispanic populations than in whites. The ratio of female to male incidence rates is higher than 1.0 in whites, while in blacks and Asians it has often been the reverse, with higher rates among men. In recent years in Hong Kong incidence rates in females have increased more rapidly than incidence rates in males, so that now the incidence rates in females are higher than those in males. In addition to the study in Hong Kong, most studies in Northern Europe and North America show an increase in age-adjusted hip fracture incidence rates over time over the past few decades. Methodological differences among the various studies (including differences in the definition of hip fracture, in case ascertainment, and in the selection and sample size of the study population) necessitate cautious interpretation of the findings of this report.
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Affiliation(s)
- S Maggi
- Office of Disease Prevention, Epidemiology and Clinical Applications, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland 20892
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23
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Abstract
The cost and time of hospitalization were analysed for 4161 hip fractures in 3898 patients aged 40 years or over treated in a Danish municipality from 1970 to 1985. The mean hospitalization time decreased from 32 to 21 days (P less than 0.0005). This tendency was most pronounced for patients who were treated with osteosynthesis. However, the annual number of fractures increased from 134 to 367. Consequently, the bed use rose 79 per cent. As the number of hip fractures is predicted to increase further, the total number of bed-days required by these patients will probably also continue to increase. In addition, the standard expense per day for a hospitalized orthopaedic patient increased from 372 to 2982 DKK. Thus, the mean expense per patient was 12,000 DKK in 1970 versus 63,000 in 1985, i.e. the total expense increased 1433 per cent. After adjustment for price indexes the increase was 362 per cent. The total cost of acute hospital care of hip fractures in Denmark was estimated to be greater than 0.5 billion DKK in 1985.
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Affiliation(s)
- H M Schrøder
- University Department of Orthopaedics, Aarhus County Hospital, Denmark
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24
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Borkan JM, Quirk M, Sullivan M. Finding meaning after the fall: injury narratives from elderly hip fracture patients. Soc Sci Med 1991; 33:947-57. [PMID: 1745919 DOI: 10.1016/0277-9536(91)90265-e] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hip fractures occur frequently among the elderly, often with severe medical, psychological and social repercussions. This research takes a new look at hip fracture rehabilitation, focusing on meanings and post-fracture prognostic indicators. An innovative methodological approach to narrative analysis is employed which combines ethnographic and epidemiologic techniques. Analyses of injury narratives from 80 elderly subjects interviewed soon after initial hospitalization are presented, focusing on three categories of meaning: explanatory models, sense of disability, and futurity. Insights from these narratives, as well as from questionnaires and observations, shed light on the experience of hip fracture for the elderly. In addition, aspects of the initial narratives are considered in relation to ambulation outcomes at 3 and 6 months. Those individuals who perceive their problem in a more external or mechanical fashion (caused by the environment) show greater improvement in ambulation at 3 and 6 months relative to those who show no evidence of this thinking or who perceive it as an internal or organic problem (in terms of disease or illness). Greater improvement in ambulation at 3 and 6 months is also noted for subjects whose perception of disability was consistent with more autonomy, independence, and a sense of connection with the world around them. The present study demonstrates the potential utility of narrative analysis as a data reduction approach. It also suggests the possibility of new psychosocial prognostic factors for hip fracture rehabilitation.
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Affiliation(s)
- J M Borkan
- Family and Community Medicine, University of Massachusetts Medical Center, Worcester 01655
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25
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Abstract
The incidence rates of femoral neck fractures, one of the most serious complications of senile osteoporosis, were 8.7-9.4 times greater in old people in long-stay institutions than among old people living at home. The relative proportion of fracture patients admitted from long-stay institutions was four times greater than expected. Operative intervention of femoral neck fracture patients seemed to be successful: 85.4%-88.5% of patients were discharged to the environments from which they had been admitted.
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Affiliation(s)
- O Simonen
- Finnish National Board of Health, Helsinki
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26
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Bengnér U, Ekbom T, Johnell O, Nilsson BE. Incidence of femoral and tibial shaft fractures. Epidemiology 1950-1983 in Malmö, Sweden. ACTA ORTHOPAEDICA SCANDINAVICA 1990; 61:251-4. [PMID: 2371821 DOI: 10.3109/17453679008993511] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied 362 fractures of the femur that had occurred during the years 1950-57 and 1973-83, and 849 fractures of the tibia that occurred during the the years 1950-55 and 1980-83. There was an increase in age-specific incidence over aged 60 years. The risk of low-energy femoral shaft fractures also had increased in elderly women. Both fracture types shifted their age- and sex-specific incidence in the direction of a fragility pattern. There was no increase in the incidence of tibial shaft fractures. Fracture type, site, and degree of displacement of the tibial fractures remained unchanged during the 30 years, i.e, they were predominantly distal, longitudinal fractures with moderate displacement.
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Affiliation(s)
- U Bengnér
- Lund University Department of Orthopedics, Malmö General Hospital, Sweden
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27
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Heyse SP, Sartori L, Crepaldi G. Epidemiology of osteoporosis: a study of fracture mortality in Italy. Calcif Tissue Int 1990; 46:289-93. [PMID: 2110851 DOI: 10.1007/bf02563817] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S P Heyse
- Institute of Internal Medicine, University of Padova, Italy
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28
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Rehnberg L, Olerud C. Incidence of hip fractures in the elderly. Uppsala County 1980-1987. ACTA ORTHOPAEDICA SCANDINAVICA 1990; 61:148-51. [PMID: 2360433 DOI: 10.3109/17453679009006508] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The age-, sex-, and fracture-type-specific annual incidence of hip fracture in patients over 55 years of age in Uppsala County were computed for the years 1980 to 1987. The number of fractures increased by less than 2 percent annually. The increase was mainly due to age changes in the population. The overall increase in specific incidence rates was approximately 1 percent; and most age, sex, and fracture-type groups demonstrated an unaltered incidence. Cervical fractures in women 55 to 64 and 75 to 84 years of age decreased in specific incidence.
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Affiliation(s)
- L Rehnberg
- Department of Orthopedics, University Hospital, Uppsala, Sweden
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29
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Abstract
Sex-, race- and age-specific hip fracture rates were determined using Health Care Financing Administration data for Medicare-reimbursed hip fracture hospitalizations from 1980 to 1982. Rates were highest in White women, lowest in Black men, and intermediate in White men and Black women. Proportions of hip fracture patients dying during hospitalization and those discharged to nursing homes, respectively, were: White men (10.5%; 49%); Black men (9.3%; 32%); White women (5.0%; 54%); and Black women (8.2%; 30%).
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Affiliation(s)
- S E Kellie
- American Medical Association, Chicago, IL 60610
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30
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Mensforth RP, Latimer BM. Hamann-Todd Collection aging studies: osteoporosis fracture syndrome. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1989; 80:461-79. [PMID: 2603949 DOI: 10.1002/ajpa.1330800406] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The study presents a retrospective analysis of distal radius, proximal femur, vertebral, and sacral fractures that occurred in 938 Hamann-Todd Collection skeletons. Individuals included in the investigation were retrieved from dissecting room cadavers in Cleveland, Ohio, between the years 1910 and 1940. Demographic analysis showed that the mean ages at death for blacks and whites included in the study were 41.9 and 53.8 years, respectively. Evaluations of fracture repair status were made for all fractures that were identified. Observations that document side of involvement and unilateral/bilateral distribution were made for distal radius and hip fractures. It was found that the age-, sex-, and race-related fracture patterns which characterize the early 20th century Hamann-Todd sample strongly correspond in distribution and magnitude to those seen in modern American and European urban industrial communities. The distal radius, hip, vertebral, and sacral fractures which were identified in individuals over 60 years of age appear to be a primary result of skeletal fragility due to age progressive bone loss. However, it is suggested that the early onset and high frequency of distal radius fractures seen in climacteric Caucasian women may be more directly due to accidental falls initiated by a greater frequency, intensity, and duration of vasomotor disturbances which are known to accompanay estrogen withdrawal in perimenopausal white females.
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Affiliation(s)
- R P Mensforth
- Department of Anthropology, Cleveland State University, Ohio 44115
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31
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Larsson S, Eliasson P, Hansson LI. Hip fractures in northern Sweden 1973-1984. A comparison of rural and urban populations. ACTA ORTHOPAEDICA SCANDINAVICA 1989; 60:567-71. [PMID: 2603658 DOI: 10.3109/17453678909150124] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The hip-fracture incidence in persons aged 50 years and older in the two northernmost counties of Sweden was studied during three periods between 1973 and 1984. The mean age rose from 75 to 78 years, and the annual number of fractures increased from 511 to 754. Half of this increase could be attributed to demographic aging. For persons 80 years and older, the fracture incidence in 1983/84 was higher (P less than 0.01) than the fracture incidence in 1973/74. The women/men ratio was approximately 2:1 during the survey, while the ratio cervical/trochanteric fracture type changed from 1.7:1 to 1.8:1. The crude fracture incidence rate rose from 4.4 to 5.8 fractures per 1,000 women 50 years and older; the corresponding figures for men were 2.3 and 3.4. Comparison of a rural mountain population with an urban population revealed a lower age-adjusted hip-fracture incidence rate in the rural area during the final part of the study (P less than 0.001). In the rural population, there was no change in age-specific incidence during the survey, while in the urban area the age-specific incidence in person 75 years and older was higher in 1983/84 compared with 1973/74.
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Affiliation(s)
- S Larsson
- Umeå University Hospital Department of Orthopedics, Sweden
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32
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Rudman D, Rudman IW, Mattson DE, Nagraj HS, Caindec N, Jackson DL. Fractures in the men of a Veterans Administration Nursing Home: relation to 1,25-dihydroxyvitamin D. J Am Coll Nutr 1989; 8:324-34. [PMID: 2674259 DOI: 10.1080/07315724.1989.10720308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
One hundred fifty-three men, age 48-96, 86% white, had resided in this Nursing Home for an average of 6.3 years (range 1.3-36) as of August 1984. At that time, we reviewed their medical charts to record the numbers and sites of fractures which had been diagnosed during the preceding 1 to 5 years of Nursing Home residence, the duration of this period depending on the duration of institutionalization. In addition, a clinical database was compiled comprising 70 attributes, including diagnoses, drugs, plasma (serum) chemistries, and measures of hematologic, nutritional, and functional status. Fractures during the studied period of Nursing Home residence had occurred in 24 of 153 men; six residents had experienced two or more fractures. Fracture rates in hip, spine, and wrist were 2564, 366, and 549 per 100,000 patient years, respectively. The total fracture rate, hip fracture rate, and limb fracture rate were five to 11 times higher than in the age-matched general population of white men in the United States; in Rochester, MN; in Dundee, England; in Oxford, England; or in Finland. Univariate statistical analysis showed that the rates for hip fracture or for fracture at any site were significantly associated with 13 attributes: directly with age, plasma somatomedin C, blood urea N, serum creatinine, serum uric acid, serum 25-hydroxyvitamin D (25-OH-D), degree of functional impairment, and chronic urinary tract infection, and inversely with serum 1,25-dihydroxyvitamin D [1,25-(OH)2-D], serum albumin, hematocrit, and hemoglobin. There was not a significant correlation with the number of falls/month which occurred during the 7 months after August 1984. After the effect of age was partialed out, somatomedin C, 25-OH-D, 1,25-(OH)2-D, and the diagnosis of urinary tract infection were still significantly related to the occurrence of fractures. The fact that Nursing Home fracture cases had significantly higher blood urea nitrogen and 25-OH-D, and significantly lower 1,25-(OH)2-D, than their non-fracture counterparts suggests that impaired renal production of the latter vitamin D metabolite contributed to the excessive rate of fractures.
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Affiliation(s)
- D Rudman
- Veterans Administration Medical Center, North Chicago
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33
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Diez A, Puig J, Martinez MT, Diez JL, Aubia J, Vivancos J. Epidemiology of fractures of the proximal femur associated with osteoporosis in Barcelona, Spain. Calcif Tissue Int 1989; 44:382-6. [PMID: 2504450 DOI: 10.1007/bf02555965] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We studied the epidemiology of osteoporotic fractures of the proximal femur (cervical and trochanteric fractures) in residents of Barcelona, aged 45 years or over, for a 1-year period. Fractures resulting from metastases were not included. During the period of observation, a total of 1,358 patients with hip fractures were treated at acute-care hospitals in Barcelona. Of those, 1,163 were researched. For each case, age, sex, and home address were registered. The incidence of hip fractures per 100,000 inhabitants aged 45 years or over was 115.6 in men and 252.2 in women. Age was the most influencing factor in the occurrence of hip fractures. Women presented fractures of the proximal femur more frequently than men. The epidemiological curve was similar to that reported in other western countries, although the crude rate was lower than that found in northern countries. We conclude that osteoporotic fractures of the proximal femur are common processes in the Mediterranean area, and reflect the impact of osteoporosis in our environment; however, the lower incidence compared with northern geographical areas may probably reflect the influence of climatic, ethnic, or other factors.
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Affiliation(s)
- A Diez
- Department of Internal Medicine, Hospital G.M.D. Esperança, Barcelona, Spain
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34
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Jarnlo GB, Jakobsson B, Ceder L, Thorngren KG. Hip fracture incidence in Lund, Sweden, 1966-1986. ACTA ORTHOPAEDICA SCANDINAVICA 1989; 60:278-82. [PMID: 2787575 DOI: 10.3109/17453678909149277] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The hip fracture incidence in the city of Lund and its rural surroundings was studied for the years 1966, 1972, 1981, and 1986. The total incidence increased from 3.3 to 5.1 per 1,000 inhabitants above 50 years of age. For persons more than 80 years old, the incidence almost doubled from 13.2 to 25.5, i.e., this group represented the entire increase in incidence. In the urban population, men with cervical fractures had an increased incidence. A smaller increase in incidence for both men and women was found in the rural area. Compared with larger cities, the incidence increase in the urban population in Lund was lower over time, but in 1986 the figures were comparable to those in Gothenburg in 1981. The total incidence in the mixed urban and rural population was as of 1981 higher than in Denmark and Finland, but lower than in Norway. If the incidence in the elderly continues to increase to 1995, there will be three times as many hip fractures as there were in 1966.
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Affiliation(s)
- G B Jarnlo
- Department of Orthopedics, Lund University Hospital, Sweden
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35
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Obrant KJ, Bengnér U, Johnell O, Nilsson BE, Sernbo I. Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif Tissue Int 1989; 44:157-67. [PMID: 2493320 DOI: 10.1007/bf02556558] [Citation(s) in RCA: 166] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- K J Obrant
- Department of Orthopedic Surgery, Malmö Allmänna Sjukhus, University of Lund, Sweden
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36
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Gärdsell P, Johnell O, Obrant KJ, Sernbo I. Fracture of the upper end of the femur is not associated with familial fracture disposition. Arch Orthop Trauma Surg 1989; 108:265-7. [PMID: 2640095 DOI: 10.1007/bf00932310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Based on the population of the city of Malmö, Sweden, we performed a retrospective cohort study. By choosing patients who had fractures of the upper end of the femur in the 1950s as an indication of senile osteoporosis, and by studying the roentgenographic records of their children from the 1950s and on we concluded that this type of osteoporosis is not a condition that is aggravated in certain families. Offspring of parents who had a hip fracture in the 1950s are not more prone to have fractures than a control group.
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Affiliation(s)
- P Gärdsell
- Department of Orthopedics, Malmö General Hospital, University of Lund, Sweden
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37
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Holmberg S, Thorngren KG. Consumption of hospital resources for femoral neck fracture. ACTA ORTHOPAEDICA SCANDINAVICA 1988; 59:377-81. [PMID: 3421072 DOI: 10.3109/17453678809149385] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 1,673 patients with femoral neck fracture, the utilization of hospital and rehabilitation resources following primary operations and necessary reoperations was assessed in relation to type of treatment center and outcome of the fracture. All the patients were admitted from their homes to either orthopedic or general surgery departments, urban or rural. The fractures were treated by one of four osteosynthesis methods and followed for 6 years postoperatively. About 30 per cent of the fractures developed healing complications. Patients treated in surgical departments utilized more acute and rehabilitation bed days than those treated in orthopedic departments. The patients stayed longer in city surgical departments than in rural surgical departments. The Thornton osteosynthesis used by general surgical specialists resulted in 29 percent, mainly early complications, whereas the Rydell osteosynthesis used by orthopedic specialists had 24 percent, mainly late complications. This difference resulted in more than 40 percent higher consumption of bed days by the Thornton-nailed patient. In sum, a fracture without complications consumed, on an average, 31 cost standardized bed days compared with 101 bed days for fracture with complications. Thus, every fracture with complications was SEK 112,000 more expensive than the complication-free one.
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Affiliation(s)
- S Holmberg
- Department of Orthopedics, University Hospital, Danderyd, Sweden
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38
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Finsen V. Improvements in general health among the elderly: a factor in the rising incidence of hip fractures? J Epidemiol Community Health 1988; 42:200-3. [PMID: 3065438 PMCID: PMC1052717 DOI: 10.1136/jech.42.2.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Both hip fracture incidence and life expectancy are known to have increased during the last decades. Seventeen studies of hip fracture incidence from Great Britain and Scandinavia were collected from the literature. It was found that there was a good correlation for both men and women between the incidence of cervical but not trochanteric fractures in the 75-79 year age group and the mean life expectancy at 70 years of age at the time in the country concerned. The increased incidence is probably accounted for partly by the increased lifespan of the infirm. It is, however, suggested that increases in life expectancy among a majority of the elderly also entail better general health at any particular age, and that this may lead to a higher level of physical mobility which raises the risk of falls and fractures.
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Affiliation(s)
- V Finsen
- Department of Orthopaedic Surgery, Trondheim University Hospital, Norway
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39
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Abstract
Changes with age in cross-sectional geometry of the lower limb bones were investigated in a large sample of cadaveric skeletal material from U.S. white adults. Section properties (areas and second moments of area) were determined at 11 locations by sectioning and direct measurement of 103 femora and 99 tibiae. All properties were standardized for body size differences by dividing by powers of bone length, and age trends were determined through linear regression analysis. Results indicate that while both men and women undergo endosteal resorption of bone and medullary expansion with aging, only men exhibit concurrent subperiosteal bone apposition and expansion. As a consequence, men show little change in cortical area and some increase in second moments of area with age, while women show decreases in both cortical area and second moments of area. Thus, only men appear to remodel bone in a way that would tend to compensate for loss of bone material strength with aging. In a previous study of a preindustrial sample with high activity levels, both men and women exhibited bone subperiosteal expansion and increase in second moments of area with aging. Together with observed differences in fracture incidence among living populations, these findings suggest that relatively low activity levels may not stimulate optimal bone remodeling throughout life and thus may contribute to higher risk of fracture in old age.
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Affiliation(s)
- C B Ruff
- Department of Cell Biology and Anatomy, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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40
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Abstract
To explore possible changes in proximal femur (hip) fracture incidence over time, an earlier study among Rochester, Minnesota residents for 1928-1977 was updated through 1982. Reanalysis of data demonstrated rising age-adjusted rates for men over this time. Crude rates rose for women as well, but age adjusted rates leveled off in the mid-1950s, as did overall rates, since the majority of hip fractures were in women. Secular trends were primarily due to changes in the incidence of initial hip fractures associated with moderate trauma, the sort usually attributed to osteoporosis. No differences were noted in trends for cervical vs. intertrochanteric femur fractures; and, excluding the low values for 1928-1942, no significant trends were noted for women within various age groups. Our results for women conflict with estimates from a number of other studies, but these differences may provide a basis for hypothesis development.
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Affiliation(s)
- L J Melton
- Department of Medical Statistics and Epidemiology, Mayo Clinic, Rochester, Minnesota 55905
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41
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Mannius S, Mellström D, Odén A, Rundgren A, Zetterberg C. Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations. ACTA ORTHOPAEDICA SCANDINAVICA 1987; 58:38-42. [PMID: 3577739 DOI: 10.3109/17453678709146340] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of Göteborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in Göteborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.
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42
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Finsen V, Benum P. Past fractures indicate increased risk of hip fracture. ACTA ORTHOPAEDICA SCANDINAVICA 1986; 57:337-9. [PMID: 3788499 DOI: 10.3109/17453678608994406] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We compared the prevalence of previous fractures among 428 women and 147 men who had hip fractures with the fracture prevalence of the general population. An increased prevalence of previous fractures was found in patients with a hip fracture up to the age of 70 for women and 80 for men. Below these age limits, the probability of a later hip fracture increased with the number of previously sustained fractures.
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43
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Bengnér U, Johnell O, Redlund-Johnell I. Increasing incidence of tibia condyle and patella fractures. ACTA ORTHOPAEDICA SCANDINAVICA 1986; 57:334-6. [PMID: 3788498 DOI: 10.3109/17453678608994405] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The age and sex specific incidence of tibial condyle fractures and patellar fractures were compared between 1950-55 and 1980-83 in the urban population of Malmö. In elderly women there was an increased incidence over these 30 years for both fracture types.
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44
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Bengnér U, Johnell O, Redlund-Johnell I. Epidemiology of ankle fracture 1950 and 1980. Increasing incidence in elderly women. ACTA ORTHOPAEDICA SCANDINAVICA 1986; 57:35-7. [PMID: 3083643 DOI: 10.3109/17453678608993211] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
During 1980-82, 739 ankle fractures occurred in Malmö. These were compared with 383 ankle fractures occurring in 1950-52. In men there was an increase in the age-specific incidence up to the age of 60, especially in fractures of the lateral malleolus. In women there was an increase in the age-specific incidence above the age of 50, both in lateral malleolar fractures and, even more pronounced, in bi- and tri- malleolar fractures.
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45
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Engesaeter LB, Søreide O. Consumption of hospital resources for hip fracture. Discharge rates for fracture in Norway. ACTA ORTHOPAEDICA SCANDINAVICA 1985; 56:17-20. [PMID: 3984698 DOI: 10.3109/17453678508992971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The hospital discharge rate for the period 1977-1981 in a population of 1.08 million was 1.91 per 1000 inhabitants for hip fractures and 3.89 for other fractures (skull fractures excluded). Discharges for fractures constituted 4.3 per cent of the discharges from the somatic hospitals. Hip fracture consumed one fourth of all somatic hospital bed-days for the oldest patients.
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Zetterberg C, Elmersson S, Andersson GB. Reoperations of hip fractures. ACTA ORTHOPAEDICA SCANDINAVICA 1985; 56:8-11. [PMID: 3984709 DOI: 10.3109/17453678508992969] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence and type of reoperations after osteosynthesis of cervical and trochanteric femoral fractures in the city of Göteborg, Sweden was studied from 1965 through 1981. The yearly incidence of reoperations decreased for both types of fractures over the years. Reoperations after cervical fractures were frequent, occurring in about 30 per cent. There were few reoperations after trochanteric fractures on the other hand, 3.6 per cent in 1981. Arthroplasties comprised the greatest number of reoperations, with a fairly constant relative frequency of about 18 per cent during the study period.
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Abstract
The paper reviews the advantages to be gained from a joint approach to fractured neck of femur by departments of orthopaedic surgery and geriatric medicine.
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48
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Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Two-year follow-up of femoral neck fractures. Comparison of osteosynthesis methods. ACTA ORTHOPAEDICA SCANDINAVICA 1984; 55:521-5. [PMID: 6507073 DOI: 10.3109/17453678408992951] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
For 14 consecutive months, all 152 femoral neck fracture patients greater than or equal to 50 years of age admitted to the Lund University Hospital were operated on with two hook-pins if born on an uneven date and a four-flanged nail if born on an even date. A clinical 2-year follow-up revealed a 35 per cent mortality. Among survivors, radiographic healing complications were seen in undisplaced fractures in 1/13 pinned and 5/14 nailed (p greater than 0.05) and in displaced fractures in 12/36 pinned and 23/32 nailed (p less than 0.01). This outcome correlated well with the early postoperative scintimetry. Reoperation within 2 years had been performed for seven pinned and 19 nailed fractures. In hook-pinning, thus, less than one patient out of 12 needed a reoperation with THR within 2 years. This figure is interpreted as strongly favouring hook-pinning before arthroplasty as the primary procedure in femoral neck fracture.
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Jarnlo GB, Ceder L, Thorngren KG. Early rehabilitation at home of elderly patients with hip fractures and consumption of resources in primary care. Scand J Prim Health Care 1984; 2:105-12. [PMID: 6443532 DOI: 10.3109/02813438409018083] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
From 1976 onwards an active rehabilitation programme has been applied to elderly patients with fresh hip fractures at the Department of Orthopaedics in Lund in Southern Sweden. This involves early mobilisation in the hospital (internal fixation and immediate weight-bearing) and at home, rehabilitation in cooperation with primary health care personnel from the time of the patient's admission. The purposes of this investigation were to evaluate the effect of this programme in primary care and to assess the consumption of resources for rehabilitation at home of patients with cervical or trochanteric hip fractures. One hundred of 161 consecutive patients returned home directly on discharge from the hospital and were followed up until four months after the fracture by the home care unit (a primary health care centre). Most patients regained their previous functions within four months of their fractures. Patients with cervical fractures consumed less resources for rehabilitation than patients with trochanteric fractures. The total cost per patient was ten times higher for care at a convalescent-home than for rehabilitation at home through primary care. Early at home rehabilitation of elderly patients with hip fractures gives good results at a minimal cost and is thus of advantage both to the patient and to the community.
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Johnell O, Nilsson B, Obrant K, Sernbo I. Age and sex patterns of hip fracture--changes in 30 years. ACTA ORTHOPAEDICA SCANDINAVICA 1984; 55:290-2. [PMID: 6741476 DOI: 10.3109/17453678408992358] [Citation(s) in RCA: 104] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The age- and sex-specific incidence of hip fractures was studied over a period of 30 years. There was a continuous increase in incidence over the years. The trend was most obvious in the oldest age groups and in men.
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