201
|
Leicht H, Gaertner T, Günster C, Halder AM, Hoffmann R, Jeschke E, Malzahn J, Tempka A, Zacher J. Time to Surgery and Outcome in the Treatment of Proximal Femoral Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:454-461. [PMID: 33734988 DOI: 10.3238/arztebl.m2021.0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/25/2020] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has not been conclusively established whether, or to what extent, the time to surgery affects mortality and the risk of complications after the surgical treatment of proximal femoral fractures. METHODS Data on 106 187 hospitalizations over the period 2015-2017 involving insurees of the German AOK health insurance company aged 20 and above were drawn from pseudonymized billing data and stratified in three subgroups: osteosynthesis for pertrochanteric fracture (PTF-OS: N = 52 358), osteosynthesis for femoral neck fracture (FNF-OS: N = 7970), and endoprosthesis for femoral neck fracture (FNF-EP: N = 45 859). Multivariate regression models were used to analyze the relation between preoperative in-hospital stay (time to surgery, TTS: 0 days [reference category], 1, 2, 3, 4-7 days) and mortality and general complications within 90 days, with risk adjustment for fracture site, operative method, age, sex, accompanying illnesses, and antithrombotic medication in the preceding year. RESULTS Mortality was significantly elevated only with PTF-OS, and only with a TTS of 2 days (odds ratio: 1.12 [95% confidence interval: (1.02; 1.23)]). General complications in relation to TTS were significantly elevated in the following situations: PTF-OS: 2 days: OR 1.24 [1.13; 1.37], 3 days: OR 1.33 [1.11; 1.60], 4-7 days: OR 1.47 [1.21; 1.78]; FNF-EP: 3 days: OR 1.21 [1.06; 1.37], 4-7 days: OR 1.42 [1.25; 1.62]; FNF-OS: 4-7 days: OR 1.86 [1.26; 2.73]. CONCLUSION A prolonged time to surgery is associated with an elevated general complication risk depending on the site of the fracture and the type of surgical procedure used.
Collapse
Affiliation(s)
- Hanna Leicht
- AOK Research Institute (WIdO), Berlin; Medical Service of German Statutory Health Insurance Providers (MDK) Hessen, Oberursel; Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld/Kremmen; BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt; AOK-Bundesverband, Berlin; Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin; HELIOS Health Kliniken GmbH, Berlin
| | | | | | | | | | | | | | | | | |
Collapse
|
202
|
Bourrion B, Souty C, Fournier L, Vilcu AM, Blanchon T, Böelle PY, Hanslik T, François M. Bisphosphonate Use and Hospitalization for Hip Fractures in Women: An Observational Population-Based Study in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168780. [PMID: 34444529 PMCID: PMC8392579 DOI: 10.3390/ijerph18168780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Bisphosphonates are widely used in the treatment of women at risk of osteoporotic hip fracture; however, the overall effectiveness of bisphosphonates in the prevention of osteoporotic fractures has not been studied in real life. To investigate whether the use of bisphosphonates in women aged 50 years and over is associated with a decrease in hospitalization for osteoporotic hip fractures, a historical prospective cohort study was conducted between 2009 and 2016 from a permanent representative sample consisting of 1/97 of the French health insurance beneficiaries. Bisphosphonate use was defined according to medication persistence and adherence regarding bisphosphonate dispensations. The primary outcome was the hospitalization rate for osteoporotic hip fracture. Among the 81,268 women included, 2005 were exposed to bisphosphonates. The median time of bisphosphonate exposure was 12 (IQR, 3–29) and 17 (IQR, 5–42) months for the persistence and adherence definitions, respectively. Exposure to bisphosphonates was not associated with a decrease in hospitalization for hip fracture: weighted HRadherence = 0.66 (95% CI, 0.33 to 1.33); HRpersistance = 0.77 (95% CI, 0.38 to 1.57). In real life, bisphosphonate use does not appear to reduce hospitalization for hip fractures, as to date, it is probably prescribed as primary prevention and for a duration too short to be effective.
Collapse
Affiliation(s)
- Bastien Bourrion
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
- Département de Médecine Générale, Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, 78180 Montigny le Bretonneux, France
- Correspondence:
| | - Cécile Souty
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
| | - Lucie Fournier
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
| | - Ana-Maria Vilcu
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
| | - Thierry Blanchon
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
| | - Pierre-Yves Böelle
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
- Service de Santé Publique, Hôpital Universitaire Saint-Antoine, AP-HP, 75012 Paris, France
| | - Thomas Hanslik
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
- Service de Médecine Interne, Hôpital Universitaire Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
- Faculté des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Mathilde François
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Université, 75012 Paris, France; (C.S.); (L.F.); (A.-M.V.); (T.B.); (P.-Y.B.); (T.H.); (M.F.)
- Département de Médecine Générale, Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, 78180 Montigny le Bretonneux, France
- CESP, Bâtiment 15/16 Inserm, Hôpital Paul Brousse, 16 Avenue Paul Vaillant Couturier, INSERM, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
| |
Collapse
|
203
|
Do VQ, Draper B, Harvey L, Driscoll T, Braithwaite J, Brodaty H, Mitchell R. Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community. Arch Osteoporos 2021; 16:120. [PMID: 34405278 DOI: 10.1007/s11657-021-00966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. OBJECTIVE To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. METHODS A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. RESULTS There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. CONCLUSION Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.
Collapse
Affiliation(s)
- Vu Quang Do
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia.
| | - Brian Draper
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Tim Driscoll
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| | - Henry Brodaty
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| |
Collapse
|
204
|
Koutalos AA, Chalatsis GI, Varsanis G, Malizos KN, Karachalios T. The effect of zoledronic acid and high-dose vitamin D on function after hip fractures. A prospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1145-1152. [PMID: 34387721 DOI: 10.1007/s00590-021-03092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Hip fractures are associated with functional decline and increased mortality. The aim of this study was to investigate the effect of zoledronic acid and high-dose vitamin D on function and mortality after hip fractures. PATIENTS AND METHODS Forty-five patients received zoledronic acid and high dose of vitamin D during hospitalization after fracture management. These patients were compared with a control group of 46 patients. Pre- and postoperative prospectively collected data including ASA score, Charlson comorbidity score, presence of dementia, Vitamin D, and the Barthel index were available. Final follow-up was performed after one year. Primary outcome was patients' function at final follow-up as measured with Barthel index score. Secondary outcomes included mortality, assessment of pain, and complications. RESULTS Barthel index score at final follow-up was decreased in both groups. There was no significant difference in Barthel index between the two groups (15.5 ± 5.0 vs 15.8 ± 5.8, p = 0.850). However, the Barthel index in the control group decreased beyond the smallest detectable change (3 points). Mortality was statistically different between groups (8.8% vs 28.2%, p = 0.047). Complications and pain at final follow-up were not different between groups. Multivariate analysis revealed that preoperative Barthel index and Charlson comorbidity score independently affected function at final follow-up. Logistic regression analysis disclosed that not receiving active treatment and complications were associated with increased mortality. CONCLUSIONS Medical treatment after surgical management of hip fractures results in reduced mortality and lessens the functional decline associated with these fractures.
Collapse
Affiliation(s)
- Antonios A Koutalos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece.
| | - George I Chalatsis
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Georgios Varsanis
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| |
Collapse
|
205
|
Hulsbæk S, Juhl C, Røpke A, Bandholm T, Kristensen MT. Exercise therapy is effective at improving short- and long-term mobility, ADL and balance in older patients following hip fracture: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2021; 77:861-871. [PMID: 34387664 DOI: 10.1093/gerona/glab236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. METHODS Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. RESULTS Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. CONCLUSION We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.
Collapse
Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Carsten Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Røpke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
206
|
Deng Y, Zheng Z, Cheng S, Lin Y, Wang D, Yin P, Mao Z, Tang P. The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity. INTERNATIONAL ORTHOPAEDICS 2021; 45:3201-3209. [PMID: 34350473 DOI: 10.1007/s00264-021-05104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This is a retrospective case-control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. METHODS A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. RESULTS A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. CONCLUSIONS Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.
Collapse
Affiliation(s)
- Yuan Deng
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhong Zheng
- Information Center of Logistics Support Department of Central Military Commission, Beijing, 100000, China
| | - Shi Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Yuan Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Duanyang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Pengbin Yin
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhi Mao
- Department of Critical Care Medicine, First Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
| | - Peifu Tang
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
| |
Collapse
|
207
|
Battalora L, Armon C, Palella F, Li J, Overton ET, Hammer J, Fuhrer J, Novak RM, Carlson K, Spear JR, Buchacz K. Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000-2017, USA. Arch Osteoporos 2021; 16:117. [PMID: 34337687 DOI: 10.1007/s11657-021-00949-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We evaluated the association of bone fracture with mortality among persons with HIV, controlling for sociodemographic, behavioral, and clinical factors. Incident fracture was associated with 48% greater risk of all-cause mortality, underscoring the need for bone mineral density screening and fracture prevention. PURPOSE/INTRODUCTION Low bone mineral density (BMD) and fracture are more common among persons with HIV (PWH) than those without HIV infection. We evaluated the association of bone fracture with mortality among PWH, controlling for sociodemographic, behavioral, and clinical factors. METHODS We analyzed data from HIV Outpatient Study (HOPS) participants seen at nine US HIV clinics during January 1, 2000, through September 30, 2017. Incident fracture rates and post-fracture mortality were compared across four calendar periods. Cox proportional hazards analyses determined factors associated with all-cause mortality among all participants and those with incident fracture. RESULTS Among 6763 HOPS participants, 504 (7.5%) had incident fracture (median age = 47 years) and 719 (10.6%) died. Of fractures, 135 (26.8%) were major osteoporotic (hip/pelvis, wrist, spine, arm/shoulder). During observation, 27 participants with major osteoporotic fractures died (crude mortality 2.97/100 person-years [PY]), and 48 with other site fractures died (crude mortality 2.51/100 PY). Post-fracture, age- and sex-adjusted all-cause mortality rates per 100 PY decreased from 8.5 during 2000-2004 to 1.9 during 2013-2017 (P<0.001 for trend). In multivariable analysis, incident fracture was significantly associated with all-cause mortality (Hazard Ratio 1.48, 95% confidence interval 1.15-1.91). Among 504 participants followed post-fracture, pulmonary, kidney, and cardiovascular disease, hepatitis C virus co-infection, and non-AIDS cancer, remained independently associated with all-cause mortality. CONCLUSIONS Incident fracture was associated with 48% greater risk of all-cause mortality among US PWH in care, underscoring the need for BMD screening and fracture prevention. Although fracture rates among PWH increased during follow-up, post-fracture death rates decreased, likely reflecting advances in HIV care.
Collapse
Affiliation(s)
- Linda Battalora
- Colorado School of Mines, 1301 19th St., Golden, CO, 80401, USA. .,Cerner Corporation, Kansas City, MO, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | - Frank Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edgar T Overton
- University of Alabama School of Medicine, Birmingham, AL, USA
| | | | - Jack Fuhrer
- Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Richard M Novak
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - John R Spear
- Colorado School of Mines, 1301 19th St., Golden, CO, 80401, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
208
|
Talevski J, Sanders KM, Vogrin S, Duque G, Beauchamp A, Seeman E, Iuliano S, Svedbom A, Borgström F, Kanis JA, Stuart AL, Brennan-Olsen SL. Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Arch Osteoporos 2021; 16:112. [PMID: 34264432 DOI: 10.1007/s11657-021-00981-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Little is known about factors that lead to excess mortality post-fracture. This study demonstrated that 5-year mortality is lower in older adults who recovered to their pre-fracture health-related quality of life (HRQoL) at 12-months compared to those who did not recover. Our results highlight the importance of post-fracture interventions known to improve HRQoL. INTRODUCTION Fragility fractures lead to increased mortality and decreased health-related quality of life (HRQoL) in older adults, although whether an association exists between these outcomes remains uncertain. The aim of this study was to determine whether recovery of HRQoL 12-month post-fracture is associated with lower 5-year mortality. METHODS This data linkage study included 524 adults (mean age: 70.2 years; 79.2% women) with fragility fracture (150 hip, 261 distal forearm, 61 vertebral, 52 humerus) from the Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS). HRQoL was measured using the EQ-5D-3L and all-cause mortality post-fracture was ascertained from the Australian National Death Index (NDI). Cox proportional hazards models were used to assess the association between HRQoL recovery (vs. non-recovery) and all-cause mortality within 5 years. RESULTS Overall, 279 participants (53.2%) recovered to their pre-fracture HRQoL at 12-month follow-up. There were 70 deaths (13.4%) during the 5-year post-fracture. Mortality rate was the highest in hip fracture participants (24.7%), followed by vertebral (16.4%), humeral (13.5%), and distal forearm fracture participants (6.1%). After adjustment for age, pre-fracture HRQoL, and fracture site, mortality risk was lower in participants who recovered to their pre-fracture HRQoL at 12-months compared to those who did not recover (HR = 0.56, 95% CI: 0.33-0.96, p = 0.034). CONCLUSION This study provides evidence that HRQoL recovery post-fracture is associated with improved 5-year survival in older adults. The extent to whether current interventions known to improve HRQoL post-fracture could prevent some of these deaths is unknown.
Collapse
Affiliation(s)
- Jason Talevski
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.
| | - Kerrie M Sanders
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Melbourne, VIC, Australia
| | - Ego Seeman
- Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia.,Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Sandra Iuliano
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia
| | | | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
209
|
Zupan J, Strazar K, Kocijan R, Nau T, Grillari J, Marolt Presen D. Age-related alterations and senescence of mesenchymal stromal cells: Implications for regenerative treatments of bones and joints. Mech Ageing Dev 2021; 198:111539. [PMID: 34242668 DOI: 10.1016/j.mad.2021.111539] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022]
Abstract
The most common clinical manifestations of age-related musculoskeletal degeneration are osteoarthritis and osteoporosis, and these represent an enormous burden on modern society. Mesenchymal stromal cells (MSCs) have pivotal roles in musculoskeletal tissue development. In adult organisms, MSCs retain their ability to regenerate tissues following bone fractures, articular cartilage injuries, and other traumatic injuries of connective tissue. However, their remarkable regenerative ability appears to be impaired through aging, and in particular in age-related diseases of bones and joints. Here, we review age-related alterations of MSCs in musculoskeletal tissues, and address the underlying mechanisms of aging and senescence of MSCs. Furthermore, we focus on the properties of MSCs in osteoarthritis and osteoporosis, and how their changes contribute to onset and progression of these disorders. Finally, we consider current treatments that exploit the enormous potential of MSCs for tissue regeneration, as well as for innovative cell-free extracellular-vesicle-based and anti-aging treatment approaches.
Collapse
Affiliation(s)
- Janja Zupan
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Klemen Strazar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria; Medical Faculty of Bone Diseases, Sigmund Freud University Vienna, 1020, Vienna, Austria
| | - Thomas Nau
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Centre, 1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria; Building 14, Mohamed Bin Rashid University of Medicine and Health Sciences Dubai, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Centre, 1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria; Department of Biotechnology, University of Natural Resources and Life Sciences Vienna, 1180, Vienna, Austria
| | - Darja Marolt Presen
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Centre, 1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.
| |
Collapse
|
210
|
Nguyen TV. Personalized fracture risk assessment: where are we at? Expert Rev Endocrinol Metab 2021; 16:191-200. [PMID: 33982611 DOI: 10.1080/17446651.2021.1924672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Osteoporotic fracture imposes a significant health care burden globally. Personalized assessment of fracture risk can potentially guide treatment decisions. Over the past decade, a number of risk prediction models, including the Garvan Fracture Risk Calculator (Garvan) and FRAX®, have been developed and implemented in clinical practice. Areas covered: This article reviews recent development and validation results concerning the prognostic performance of the two tools. The main areas of review are the need for personalized fracture risk prediction, purposes of risk prediction, predictive performance in terms of discrimination and calibration, concordance between the Garvan and FRAX tools, genetic profiling for improving predictive performance, and treatment thresholds. In some validation studies, FRAX tended to underestimate fracture by as high as 50%. Studies have shown that the predicted risk from the Garvan tool is highly concordant with clinical decision. Expert opinion: Although there are some discrepancy in fracture risk prediction between Garvan and FRAX, both tools are valid and can aid patients and doctors communicate about risk and make informed decision. The ideal of personalized risk assessment for osteoporosis patients will be realized through the incorporation of genetic profiling into existing fracture risk assessment tools.
Collapse
Affiliation(s)
- Tuan V Nguyen
- Healthy Ageing Theme, Garvan Institute of Medical Research Darlinghurst Australia
- St Vincent's Clinical School, UNSW Sydney, Sydney Australia
- School of Biomedical Engineering, University of Technology Sydney Sydney Australia
| |
Collapse
|
211
|
Impact of multiple nerves blocks anaesthesia on intraoperative hypotension and mortality in hip fracture surgery intermediate-risk elderly patients: A propensity score-matched comparison with spinal and general anaesthesia. Anaesth Crit Care Pain Med 2021; 40:100924. [PMID: 34217841 DOI: 10.1016/j.accpm.2021.100924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND A Hip fracture in the intermediate-risk elderly patient is common and associated with a high rate of postoperative morbidity and mortality. There is a lack of consensus on the optimal anaesthetic technique but there is a clear association between intraoperative hypotension and postoperative morbidity and mortality. We aimed to compare the haemodynamic stability of three anaesthesia techniques: general anaesthesia (GA), continuous spinal anaesthesia (CSA), and multiple nerve blocks (MNB). METHODS The primary outcome was the occurrence of intraoperative hypotension defined by a 30% decrease in mean arterial pressure (MAP) from baseline. Secondary outcomes included incidence of hypotension under 50 mmHg of MAP, time spent below MAP 50 mmHg, use of vasopressors, in-hospital and 30-day mortality. A propensity score-matched analysis was performed. RESULTS After screening and application of the exclusion criteria, 593 patients undergoing hip fracture surgery between the 1st of January 2015 and the 31st of December 2016 were included. The propensity score match analysis selected 43 patients in each group. The incidence of hypotension was significantly higher in the GA group than in the MNB and CSA groups: 39 (90%), 22 (51%), and 23 (53.5%), respectively; p < 0.0001. The incidence of MAP < 50 mmHg (59.5%, 23.3%, and 16.3%; p < 0.0001) and the use of vasopressors (93%, 39.5%, and 25.6%; p < 0.0001) were increased significantly in the GA group. With the GA group as a reference, odds ratios were reported in the MNB group at 0.08 [0.022-0.30] (p = 0.0002) for hypotension episodes; 0.17 [0.04-0.66] (p = 0.01) for hypotension < 50 mmHg for more than 3 min and 0.049 [0.013-0.018] (p < 0.0001) for use of vasopressors. The duration of hospital stay, postoperative complications, in-hospital and 30-day mortality rates did not differ significantly between the groups. CONCLUSION CSA and MNB provide better haemodynamic stability than GA. However, whatever the anaesthesia technique used, the mortality rates do not change even if MNB leads to less hypotension. IRB contact information: CERAR IRB 00010254-2016-118. Clinical Trial Number: ClinicalTrials.gov. ID: NCT03356704.
Collapse
|
212
|
Raichandani K, Agarwal S, Jain H, Bharwani N. Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery. J Clin Orthop Trauma 2021; 18:1-5. [PMID: 33936949 PMCID: PMC8079428 DOI: 10.1016/j.jcot.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In geriatric age group, hip fractures tend to become a major public health hazard. Due to this high occurrence, there is a need to develop standardized, effective, and multidisciplinary management for treatment. These elderly patients have excessive mortality that can extend ahead of the time of recovery. Early surgery after hip fractures has lead to a notable reduction in mortality rates. Still, it is considerably high as compared to other fractures. METHODS 266 patients of >65 years who were operated within 72 h hours in a tertiary level health care centre for hip fractures were included. They were evaluated with X-rays and grade of Singh's index was noted. Mortality rates and the factors associated with it such as age, sex, co morbidities (using Charlson's co morbidity Index/CCI) were evaluated after 2 year follow up. RESULTS The overall 2-year mortality reported in our study population was 11.2%. It was broadly lower as compared to most of the other studies. It was 6.3% in females as compared to 18.1% in males. While it was reported to be only 6% in 65-74 years of age, it was 25% in patients who were 85 years and above. 76.6% of the patients had Singh's index of ≤ grade 3 showing osteoporosis. The patients with Low Charlson's score showed only 4.2% mortality while those with high Charlson's score showed 25.5% mortality. CONCLUSION It was concluded that Mortality among elderly patients after early surgery after osteoporotic hip fractures is quite significant. The factors for improvement in long term survival post-hip fracture may include changing treatment patterns, increasing life expectancy and early surgery. Increase in age, female sex, and high CCI Scores were major risk factors of mortality after hip fractures in a 2-year follow-up period.
Collapse
Affiliation(s)
| | - Shubham Agarwal
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Hemant Jain
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| |
Collapse
|
213
|
Foo MXE, Wong GJY, Lew CCH. A systematic review of the malnutrition prevalence in hospitalized hip fracture patients and its associated outcomes. JPEN J Parenter Enteral Nutr 2021; 45:1141-1152. [PMID: 34169533 DOI: 10.1002/jpen.2211] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Malnutrition is associated with poorer outcomes in hospitalized patients. However, in hip fracture patients, the associations between malnutrition and poorer outcomes are unclear because of the use of nonestablished nutrition assessment tools in previous studies that may have some degree of misclassification bias. Therefore, this review aims to determine (1) the prevalence of malnutrition diagnosed in hospitalized hip fracture patients using established nutrition assessment tools and (2) the outcomes associated with malnutrition given some of the nonestablished nutrition assessment tools used in previous studies. METHODS Four electronic databases were used. Studies that used established nutrition assessment tools to diagnose malnutrition in hip fracture patients within 48 h of hospital admission were included. RESULTS Nine studies were included (n = 1665). Patients' mean age ranged from 79.9 to 86.1 years. Eight studies reported the frequencies of each sex, and for females, it ranged from 70% to 81.8%. The prevalence of malnutrition was 4.0% to 39.4%. Malnutrition was independently associated with (1) increased mortality and (2) functional dependence. There was also a trend towards more supported living arrangements and impaired mobility in the longer term. Malnutrition was not associated with (1) hospital length of stay, (2) hospital readmissions, and (3) incidence of complications. CONCLUSION The prevalence of malnutrition in hip fracture patients is highly variable and is associated with poorer outcomes. Therefore, identifying malnourished hip fracture patients using established nutrition assessment tools is important, and adequate resources can be allocated to prevent malnutrition through early screening and intervention.
Collapse
Affiliation(s)
- Melody Xuan En Foo
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Gabriel Jun Yung Wong
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Charles Chin Han Lew
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore
| |
Collapse
|
214
|
Kang YJ, Lee MT, Kim MS, You SH, Lee JE, Eom JH, Jung SY. Risk of Fractures in Older Adults with Chronic Non-cancer Pain Receiving Concurrent Benzodiazepines and Opioids: A Nested Case-Control Study. Drugs Aging 2021; 38:687-695. [PMID: 34159565 DOI: 10.1007/s40266-021-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between the concurrent use of benzodiazepines and opioids and the risk of fractures in older patients with chronic non-cancer pain. METHODS Patients with osteoarthritis or low back pain (≥ 65 years of age) included in the Korean National Health Insurance Service-National Sample Cohort database of Korea and with an incident diagnosis of hip, humeral, or forearm fracture between 2011 and 2015 were identified as cases. For each case, four controls were matched for age (within 5 years), sex, and year of cohort entry. We estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for fractures associated with concurrent use of benzodiazepines and opioids using a conditional logistic regression analysis, adjusting for comorbidities and comedications. RESULTS The aOR (95% CI) for the concurrent use of benzodiazepines and opioids was 1.45 (1.22-1.71), compared with those of non-use within 30 days before the index date. The aOR was 1.65 (1.22-2.23) in patients who were continuously receiving benzodiazepines and were newly initiated with concurrent opioids. The aORs for concurrent use were 1.95 (1.39-2.74) and 1.27 (1.03-1.56) in the case of hip fracture and forearm fracture, respectively. CONCLUSION The concurrent use of benzodiazepines and opioids was associated with an increased risk of fractures in older patients with chronic non-cancer pain. Therefore, patients continuously receiving benzodiazepines in whom opioids are newly initiated need careful monitoring, and such combined therapy should be limited to the shortest duration possible.
Collapse
Affiliation(s)
- Ye-Jin Kang
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Min-Taek Lee
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Myo-Song Kim
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Seung-Hun You
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jae-Eun Lee
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Joo-Hyeon Eom
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Sun-Young Jung
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, Republic of Korea.
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
| |
Collapse
|
215
|
Gani L, Anthony N, Dacay L, Tan P, Chong LR, King TF. Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore. JBMR Plus 2021; 5:e10515. [PMID: 34368607 PMCID: PMC8328799 DOI: 10.1002/jbm4.10515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
Bisphosphonates (BP) are the most commonly prescribed effective form of osteoporosis treatment with adverse effects associated with prolonged use such as atypical femoral fractures (AFF). Asians have an elevated risk of AFF at 5 to 6 times those of whites and Hispanics. In this study, we characterize factors associated with AFF and its mortality in a single center in Singapore. We conducted a cohort study of subjects older than 50 years admitted to Changi General Hospital (CGH), Singapore, with fragility subtrochanteric femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria, fractures are classified into atypical and typical subtrochanteric femoral fractures. CGH uses a nationalized electronic health record that allows review of information on patients' demographics, clinical history and previous investigations. Mortality was assessed as of December 31, 2019. Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. A total of 52.2% of AFF occurred with BP exposure of median duration 56.5 (28 to 66) months. Multivariate regression showed that BP exposure was associated with the highest risk of AFF (odds ratio [OR] = 6.65 [2.35–18.9]). AFF patients had higher 5‐year survival (0.85 versus 0.62, p = 0.001) compared with typical subtrochanteric fracture patients. However, after adjusting for variables, the type of subtrochanteric femoral fractures were no longer significantly associated with progression to death, whereas older age, higher mean Charlson comorbidity score, and Malay ethnicity were the strongest predictors of death. AFF constitutes a small proportion of hip and femoral fractures with prolonged BP use being the highest risk factor for its development. There is no evidence of increased mortality or morbidity in patients with AFF compared with the typical subtrochanteric fracture. The fear of AFF should not impede treatment of typical osteoporotic fractures in this population. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Linsey Gani
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Natasha Anthony
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Lily Dacay
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Pei Tan
- Centre of Trial Research Unit Changi General Hospital Singapore Singapore
| | - Le Roy Chong
- Department of Radiology Changi General Hospital Singapore Singapore
| | - Thomas Fj King
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| |
Collapse
|
216
|
Ховасова НО, Наумов АВ, Ткачева ОН, Дудинская ЕН. [Characteristics of geriatric and somatic status in patients with osteoporosis]. PROBLEMY ENDOKRINOLOGII 2021; 67:45-54. [PMID: 34297501 PMCID: PMC9112845 DOI: 10.14341/probl12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/17/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status. AIM To аssess comorbidity and geriatric status in elderly and senile patients with and without OP. MATERIALS AND METHODS The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 - patients with OP (n=178, 29.3%), group 2 - patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity -according to the Charlson index, and a comprehensive geriatric score. RESULTS OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age--related diseases such as Alzheimer's disease, Parkinson's disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent. CONCLUSION Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.
Collapse
Affiliation(s)
- Н. О. Ховасова
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - А. В. Наумов
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - О. Н. Ткачева
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - Е. Н. Дудинская
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| |
Collapse
|
217
|
Pincus D, Widdifield J, Palmer KS, Paterson JM, Li A, Huang A, Wasserstein D, Lapointe-Shaw L, Brown A, Taljaard M, Ivers NM. Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis. BMC Health Serv Res 2021; 21:576. [PMID: 34120597 PMCID: PMC8201723 DOI: 10.1186/s12913-021-06601-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Methods This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends. Results The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy. Conclusions We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06601-2.
Collapse
Affiliation(s)
- Daniel Pincus
- Department of Surgery, University of Toronto, 149 College Street, Room 508-A, ON, M5T 1P5, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Canada.
| | - Jessica Widdifield
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Karen S Palmer
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - J Michael Paterson
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Alvin Li
- ICES, Toronto, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - David Wasserstein
- Department of Surgery, University of Toronto, 149 College Street, Room 508-A, ON, M5T 1P5, Toronto, Canada.,Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adalsteinn Brown
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Noah M Ivers
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
218
|
Kaufman JM. Management of osteoporosis in older men. Aging Clin Exp Res 2021; 33:1439-1452. [PMID: 33821467 DOI: 10.1007/s40520-021-01845-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 02/08/2023]
Abstract
As many as one out of three fragility fractures occur in older men and the outcome of major osteoporotic fractures, in particular hip fractures, is worse in men than in women. Osteoporosis in older men is thus an important threat to the quality of life of individual patients and a considerable burden for society. However, only a small minority of older men with high or very high fracture risk are receiving therapy. This does not need to be so as tools for fracture risk assessment are available and several drugs have been approved for treatment. Nevertheless, the evidence base for the management of osteoporosis in older men remains limited. This narrative review summarises the evidence for older men on the burden of osteoporosis, the pathophysiology of fragility fractures, the clinical presentation, diagnosis and risk assessment, the patient evaluation, and the non-pharmacological and pharmacological management.
Collapse
|
219
|
Abdelnasser MK, Khalifa AA, Amir KG, Hassan MA, Eisa AA, El-Adly WY, Ibrahim AK, Farouk OA, Abubeih HA. Mortality incidence and its determinants after fragility hip fractures: a prospective cohort study from an Egyptian level one trauma center. Afr Health Sci 2021; 21:806-816. [PMID: 34795739 PMCID: PMC8568210 DOI: 10.4314/ahs.v21i2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Fragility hip fracture is a common condition with serious consequences. Most outcomes data come from Western and Asian populations. There are few data from African and Middle Eastern countries. Objective The primary objective was to describe mortality rates after fragility hip fracture in a Level-1 trauma centre in Egypt. The secondary objective was to study the causes of re-admissions, complications, and mortality. Methods A prospective cohort study of 301 patients, aged > 65 years, with fragility hip fractures. Data collected included sociodemographic, co-morbidities, timing of admission, and intraoperative,ostoperative, and post-discharge data as mortality, complications, hospital stay, reoperation, and re-admission. Cox regression analysis was conducted to investigate factors associated with 1-year mortality. Results In-hospital mortality was 8.3% (25 patients) which increased to 52.8% (159 patients) after one year; 58.5% of the deaths occurred in the first 3-months. One-year mortality was independently associated with increasing age, ASA 3–4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure. Conclusion Our in-hospital mortality rate resembles developed countries reports, reflecting good initial geriatric healthcare. However, our 3- and 12-months mortality rates are unexpectedly high. The implementation of orthogeriatric care after discharge is mandatory to decrease mortality rates.
Collapse
Affiliation(s)
| | - Ahmed A Khalifa
- Orthopedic Department, Qena faculty of medicine and its University Hospital, South valley university, Qena, Egypt
| | - Khaled G Amir
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Amr A Eisa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Wael Y El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed K Ibrahim
- Public Health and Community Medicine Department, faculty of medicine, Assiut University, Assiut, Egypt
| | - Osama A Farouk
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Hossam A Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
220
|
Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients-A Cross-Sectional Study. J Clin Med 2021; 10:jcm10112344. [PMID: 34071858 PMCID: PMC8198508 DOI: 10.3390/jcm10112344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.
Collapse
|
221
|
Effect of heart failure and malnutrition, alone and in combination, on rehabilitation effectiveness in patients with hip fracture. Clin Nutr ESPEN 2021; 44:356-366. [PMID: 34330490 DOI: 10.1016/j.clnesp.2021.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Heart failure and malnutrition are known to each negatively affect a patient's ability to improve their activities of daily living (ADL) through rehabilitation. Here, we investigated whether the negative effects of malnutrition and heart failure on ADL are additive in patients after hip fracture. METHODS This retrospective observational cohort study included 155 patients with hip fracture admitted to convalescent rehabilitation wards. Nutritional status was measured with the Geriatric Nutritional Risk Index (GNRI). Heart failure was assessed using plasma B-type natriuretic peptide (BNP) levels. Based on their GNRIs and BNP levels, patients were classified into four groups: a high GNRI (≥92)-low BNP (<100 pg/ml) group (n = 54); high GNRI-high BNP (≥100 pg/ml) group (n = 7); low GNRI (<92)-low BNP group (n = 67); and low GNRI-high BNP group (n = 27). The main outcome was rehabilitation effectiveness (REs). To confirm above hypothesis, heart failure was also assessed by American College of Cardiology/American Heart Association (ACC/AHA) stage classification, whereas nutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), either. RESULTS REs in the high GNRI-low BNP group, high GNRI-high BNP group, low GNRI-low BNP group, and low GNRI-high BNP group were 64.8 ± 22.6%, 36.0 ± 22.0%, 40.6 ± 23.6% and 28.5 ± 25.9%, respectively. REs was higher in the high GNRI-low BNP group than in other three groups, and REs in the low GNRI-low BNP group was higher than in the low GNRI-high BNP group. When we evaluated heart failure by ACC/AHA stage classification instead of BNP, or evaluated nutrition by MNA-SF instead of GNRI, the similar results were demonstrated. Multiple linear regression analyses revealed that age (p < 0.01), handgrip strength (p < 0.01), GNRI (p < 0.05), and BNP (p < 0.01) were significantly associated with REs. CONCLUSIONS These results suggest that malnutrition and heart failure are independently associated with REs and that they have an additive negative effect on improvement of ADL in elderly patients with hip fractures.
Collapse
|
222
|
Choi JV, Cheung RM, Mozel MR, Merchant RN, Lee SM. Perioperative outcomes following preoperative epidural analgesia in hip fracture patients undergoing surgical repair: A systematic review. PAIN MEDICINE 2021; 23:234-245. [PMID: 34022058 DOI: 10.1093/pm/pnab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair. DESIGN Systematic review. METHODS The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated. RESULTS Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies. CONCLUSIONS Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.
Collapse
Affiliation(s)
- Jonathan V Choi
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia. Orcid ID: 0000-0002-5341-2397
| | - Rachel M Cheung
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia
| | | | - Richard N Merchant
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0002-8526-2477
| | - Susan M Lee
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0001-9016-310X
| |
Collapse
|
223
|
Hulsbæk S, Bandholm T, Ban I, Foss NB, Jensen JEB, Kehlet H, Kristensen MT. Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial). BMC Geriatr 2021; 21:323. [PMID: 34016037 PMCID: PMC8136760 DOI: 10.1186/s12877-021-02273-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Anabolic steroid has been suggested as a supplement during hip fracture rehabilitation and a Cochrane Review recommended further trials. The aim was to determine feasibility and preliminary effect of a 12-week intervention consisting of anabolic steroid in addition to physiotherapy and nutritional supplement on knee-extension strength and function after hip fracture surgery. Methods Patients were randomized (1:1) during acute care to: 1. Anabolic steroid (Nandrolone Decanoate) or 2. Placebo (Saline). Both groups received identical physiotherapy (with strength training) and a nutritional supplement. Primary outcome was change in maximal isometric knee-extension strength from the week after surgery to 14weeks. Secondary outcomes were physical performance, patient reported outcomes and body composition. Results Seven hundred seventeen patients were screened, and 23 randomised (mean age 73.4years, 78% women). Target sample size was 48. Main limitations for inclusion were not home-dwelling (18%) and cognitive dysfunction (16%). Among eligible patients, the main reason for declining participation was Overwhelmed and stressed by situation (37%). Adherence to interventions was: Anabolic steroid 87%, exercise 91% and nutrition 61%. Addition of anabolic steroid showed a non-significant between-group difference in knee-extension strength in the fractured leg of 0.11 (95%CI -0.25;0.48) Nm/kg in favor of the anabolic group. Correspondingly, a non-significant between-group difference of 0.16 (95%CI -0.05;0.36) Nm/Kg was seen for the non-fractured leg. No significant between-group differences were identified for the secondary outcomes. Eighteen adverse reactions were identified (anabolic=10, control=8). Conclusions Early inclusion after hip fracture surgery to this trial seemed non-feasible, primarily due to slow recruitment. Although inconclusive, positive tendencies were seen for the addition of anabolic steroid. Trial registration Clinicaltrials.gov NCT03545347. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02273-z.
Collapse
Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bang Foss
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 7621, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
224
|
Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case-Control Study from a Single Center in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105205. [PMID: 34068405 PMCID: PMC8153577 DOI: 10.3390/ijerph18105205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case–control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case–control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients’ demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30–35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.
Collapse
|
225
|
Rostagno C, Cartei A, Polidori G, Civinini R, Ceccofiglio A, Rubbieri G, Curcio M, Boccaccini A, Peris A, Prisco D. Management of ongoing direct anticoagulant treatment in patients with hip fracture. Sci Rep 2021; 11:9467. [PMID: 33947928 PMCID: PMC8096972 DOI: 10.1038/s41598-021-89077-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Aim of the present study was to investigate the effects of ongoing treatment with DOACs on time from trauma to surgery and on in-hospital clinical outcomes (blood losses, need for transfusion, mortality) in patients with hip fracture. Moreover we evaluated the adherence to current guidelines regarding the time from last drug intake and surgery. In this observational retrospective study clinical records of patients admitted for hip fracture from January 2016 to January 2019 were reviewed. 74 patients were in treatment with DOACs at hospital admission. Demographic data, comorbidities and functional status before trauma were retrieved. As control group we evaluated 206 patients not on anticoagulants matched for age, gender, type of fracture and ASA score. Time to surgery was significantly longer in patients treated with DOACs (3.6 + 2.7 vs. 2.15 ± 1.07 days, p < 0.0001) and treatment within 48 h was 47% vs. 80% in control group (p < 0.0001). The adherence to guidelines’ suggested time from last drug intake to surgery was 46%. Neither anticipation nor delay in surgery did result in increased mortality, length of stay or complication rates with the exception of larger perioperative blood loss (Hb levels < 8 g/dl) in DOACs patients (34% vs 9% p < 0.0001). Present results suggest that time to surgery is significantly longer in DOAC patients in comparison to controls and adherence to guidelines still limited.
Collapse
Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy. .,SOD medicina interna e post chirurgica AOU Careggi, Florence, Italy. .,Department of Experimental and Clinical Medicine, Chief of Medicina Interna e postchirurgica, University of Florence, AOU Careggi Firenze, Viale Morgagni 85, 50134, Florence, Italy.
| | | | | | - Roberto Civinini
- Dipartimento neuromuscoloscheletrico AOU Careggi, Florence, Italy
| | | | - Gaia Rubbieri
- SOD medicina interna e post chirurgica AOU Careggi, Florence, Italy
| | - Massimo Curcio
- SOD medicina interna e post chirurgica AOU Careggi, Florence, Italy
| | | | - Adriano Peris
- Dipartimento neuromuscoloscheletrico AOU Careggi, Florence, Italy
| | - Domenico Prisco
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy
| |
Collapse
|
226
|
Erivan R, Hacquart T, Villatte G, Mulliez A, Descamps S, Boisgard S. Place of residence before and place of discharge after femoral neck fracture surgery are associated with mortality: A study of 1238 patients with at least three years' follow-up. Orthop Traumatol Surg Res 2021; 107:102876. [PMID: 33652150 DOI: 10.1016/j.otsr.2021.102876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/30/2020] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoral neck fractures constitute a major public health challenge. The risk of death after surgery depends chiefly on the patient's general health and comorbidities. No studies assessing place of residence are available. The objectives of this study were to determine whether mortality differed according to the patient's previous place of residence and to the place of discharge, and to describe the complications occurring after femoral neck fracture surgery. HYPOTHESIS After femoral neck fracture surgery, the place of discharge is associated with the risk of death, and the complication rate is high. METHODS This single-centre retrospective study included 1241 adults who sustained a true femoral neck fracture between 2006 and 2016 and were followed up for at least 3 years. The following data were collected: age at the time of the fracture, sex, hospital stay length, place of residence before and after the fracture, characteristics of the fracture, type of treatment, time from the fracture to surgery, and whether anticoagulant therapy was given. We then recorded data on mortality and complications. RESULTS The 3-year mortality rate was 36.0±1.4% (95%CI, 33.3-38.7). Place of residence before the fracture was strongly associated with mortality: the risk of death was higher in patients who lived in care homes (hazard ratio [HR], 2.18) or were hospitalised (HR, 1.78) and lower in patients who lived at home (HR, 0.46). The risk of death was also higher in patients discharged to care homes (HR, 1.82) or to hospitals (HR, 1.90) and lower in patients discharged home (HR, 0.30). All these differences were statistically significant (p<0.0001). CONCLUSION Place of residence and likely place of discharge should be evaluated as soon as the patient is admitted to the emergency department, in order to provide the best information possible to the patient and family and to establish the most appropriate treatment strategy. Patient self-sufficiency is a major parameter that should be preserved to the extent possible. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Thomas Hacquart
- Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI) - CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| |
Collapse
|
227
|
Pedro JC, Nicolau RB, Offenbacher RW, Credidio MV, Reis FBD, Cocco LF. EVALUATION OF POST-SURGICAL MANAGEMENT OF FRAGILITY FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2021; 29:137-142. [PMID: 34290560 PMCID: PMC8266284 DOI: 10.1590/1413-785220212903242944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the conduct of Brazilian orthopedists regarding preventive treatment after fragility fracture surgery. METHODS A questionnaire was applied to Brazilian orthopedists. Statistical analyses were performed using the SPSS 16.0 program. RESULTS 257 participants were analyzed. Most participants, 90.7% (n = 233), reported that they cared for patients with fractures and 62.3% (n = 160) treated them. The most indicated treatments were vitamin D (22.6%; n = 134) and calcium supplementation (21.4%; n = 127). According to the experience of the physicians - experienced (n = 184) and residents (n = 73) - fragility fractures were more common in the routine of residents (98.6%; n = 72) than experienced physicians (87.5%; n = 161), p = 0.0115. While treatment conduction was more reported by experienced physicians (63.6%; n = 117) than residents (58.9%; n = 43), p = 0.004. More experienced orthopedists (21.4%; n = 97) indicated treatment with bisphosphates than residents (14.2%; n = 20), p = 0.0266. CONCLUSION Although most professionals prescribe treatment after fragility fracture surgery, about 40% of professionals still do not treat it, with differences in relation to experience. In this sense, we reinforce the importance of secondary prevention in the management of fragility fractures. Level of Evidence II, Prospective comparative study.
Collapse
Affiliation(s)
- João Carlos Pedro
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - Roberto Bezerra Nicolau
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - Renato Watoniki Offenbacher
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - Marcos Vinicius Credidio
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - Fernando Baldy Dos Reis
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - Luiz Fernando Cocco
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| |
Collapse
|
228
|
Ingstad F, Solberg LB, Nordsletten L, Thorsby PM, Hestnes I, Frihagen F. Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporos Int 2021; 32:873-881. [PMID: 33201249 DOI: 10.1007/s00198-020-05739-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
UNLABELLED Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. INTRODUCTION We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. METHODS Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. RESULTS A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. CONCLUSION Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.
Collapse
Affiliation(s)
- F Ingstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
- University of Copenhagen, Copenhagen, Denmark.
| | - L B Solberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - L Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - I Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - F Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| |
Collapse
|
229
|
Lin TC, Wang PW, Lin CT, Chang YJ, Lin YJ, Liang WM, Lin JCF. Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation. BMC Musculoskelet Disord 2021; 22:403. [PMID: 33941152 PMCID: PMC8091504 DOI: 10.1186/s12891-021-04277-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation. Methods We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation. Results The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death. Conclusions The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04277-7.
Collapse
Affiliation(s)
- Tzu-Chieh Lin
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Wen Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Teng Lin
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan
| | - Yu-Jun Chang
- Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Ju Lin
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan.
| | - Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, No.67, Sec. 3, Ming-Shen E. Rd, Taipei, 10478, Taipei, Taiwan. .,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
230
|
Soukkio PK, Suikkanen SA, Aartolahti EM, Kautiainen H, Kääriä SM, Hupli MT, Pitkälä KH, Sipilä S, Kukkonen-Harjula KT. Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1692-1699. [PMID: 33939973 DOI: 10.1016/j.apmr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. DESIGN Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. SETTING Home-based intervention. PARTICIPANTS Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. INTERVENTIONS Supervised physical exercise twice a week. MAIN OUTCOME MEASURES The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. RESULTS Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. CONCLUSIONS Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.
Collapse
Affiliation(s)
- Paula K Soukkio
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä.
| | - Sara A Suikkanen
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä
| | - Eeva M Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki
| | | | - Markku T Hupli
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki; Helsinki University Hospital, Unit of Primary Health Care, Helsinki
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä; Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | |
Collapse
|
231
|
Bhandari SK, Adams AL, Li BH, Rhee CM, Sundar S, Krasa H, Danforth KN, Kanter MH, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ. Sub-acute hyponatraemia more than chronic hyponatraemia is associated with serious falls and hip fractures. Intern Med J 2021; 50:1100-1108. [PMID: 31707754 DOI: 10.1111/imj.14684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Falls and hip fractures among older people are associated with high morbidity and mortality. Hyponatraemia may be a risk for falls/hip fractures, but the effect of hyponatraemia duration is not well understood. AIMS To evaluate individuals with periods of sub-acute and chronic hyponatraemia on subsequent risk for serious falls and/or hip fractures. METHODS Retrospective cohort study in the period 1 January 1998 to 14 June 2016 within an integrated health system of individuals aged ≥55 years with ≥2 outpatient serum sodium measurements. Hyponatraemia was defined as sodium <135 mEq/L with sub-acute (<30 days) and chronic (≥30 days) analysed as a time-dependent exposure. Multivariable Cox proportional-hazards modelling was used to estimate hazard ratios (HR) for serious falls/hip fractures based on sodium category. RESULTS Among 1 062 647 individuals totalling 9 762 305 sodium measurements, 96 096 serious falls/hip fracture events occurred. Incidence (per-1000-person-years) of serious falls/hip fractures were 11.5, 27.9 and 19.8 for normonatraemia, sub-acute and chronic hyponatraemia. Any hyponatraemia duration compared to normonatraemia had a serious falls/hip fractures HR (95%CI) of 1.18 (1.15, 1.22), with sub-acute and chronic hyponatraemia having HR of 1.38 (1.33, 1.42) and 0.91 (0.87, 0.95), respectively. Examined separately, the serious falls HR was 1.37 (1.32, 1.42) and 0.92 (0.88, 0.96) in sub-acute and chronic hyponatraemia, respectively. Hip fracture HR were 1.52 (1.42, 1.62) and 1.00 (0.92, 1.08) for sub-acute and chronic hyponatraemia, respectively, compared to normonatraemia. CONCLUSIONS Our findings suggest that early/sub-acute hyponatraemia appears more vulnerable and associated with serious falls/hip fractures. Whether hyponatraemia is a marker of frailty or a modifiable risk factor for falls remains to be determined.
Collapse
Affiliation(s)
- Simran K Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Annette L Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bonnie H Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Connie M Rhee
- Otsuka Pharmaceuticals Development & Commercialization, Inc., San Francisco, California, USA
| | - Shirin Sundar
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, California, USA
| | - Holly Krasa
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, California, USA
| | - Kim N Danforth
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Kamyar Kalantar-Zadeh
- Otsuka Pharmaceuticals Development & Commercialization, Inc., San Francisco, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| |
Collapse
|
232
|
Dobre R, Niculescu DA, Petca RC, Popescu RI, Petca A, Poiană C. Adherence to Anti-Osteoporotic Treatment and Clinical Implications after Hip Fracture: A Systematic Review. J Pers Med 2021; 11:jpm11050341. [PMID: 33923261 PMCID: PMC8146075 DOI: 10.3390/jpm11050341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
The role of anti-osteoporotic treatment as part of the secondary prevention after hip fracture in terms of mortality and re-fracture risk has been studied, and the results are promising. Decreased treatment adherence and compliance is a problem that needs to be addressed by healthcare professionals. A systematic review of the literature was performed using the PubMed database with terms that included hip fracture, mortality, second fracture, and specific anti-osteoporotic treatment. We included 28 articles, 21 regarding mortality and 20 re-fracture rates in hip fracture patients. All studies showed lower mortality after hip fracture associated with anti-osteoporotic treatment, mostly bisphosphonate agents. The re-fracture risk is still debatable, since conflicting data were found. Although most of the studies showed notable effects on mortality and re-fracture rates associated with anti-osteoporotic treatment, we still need more data to validate the actual results.
Collapse
Affiliation(s)
- Ramona Dobre
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
- Correspondence: ; Tel.: +40-770-597590
| | - Dan Alexandru Niculescu
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Răzvan-Ionuț Popescu
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Aida Petca
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 011461 Bucharest, Romania
| | - Cătălina Poiană
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
| |
Collapse
|
233
|
Wu H, Li Y, Tong L, Wang Y, Sun Z. Worldwide research tendency and hotspots on hip fracture: a 20-year bibliometric analysis. Arch Osteoporos 2021; 16:73. [PMID: 33866438 DOI: 10.1007/s11657-021-00929-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/05/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed the overall knowledge structure, development trends, and research hotspots of 7684 publications related to hip fracture through the bibliometric method. Our results indicate this area has received more and more attention from researchers. Prevention of complications will be the focus of future studies. INTRODUCTION Hip fracture is an international public health problem, with high morbidity, mortality, and associated health care costs. Research on hip fracture has been developed rapidly in recent years, but no bibliometric studies have been performed. We aimed to identify the publication changes in scientific output relating to hip fracture over the past two decades. METHODS The scientific output relating to hip fracture from 2000 to 2019 was identified and selected from the Web of Science Core Collection. Excel 2019 was used to summarize the quantitative indicators including publication number, citations, H-index, journal's impact factors, and journal citation reports. VOS viewer and CiteSpace software tools were used for co-authorship, citation, co-citation, and co-occurrence analyses between countries, institutions, journals, authors, references, and keywords. Data were analyzed on November 13, 2020. RESULTS A total of 7684 publications were extracted. The USA was the leading contributor in this field with the largest publications (1876, 24.41%), the most citations (75,423 times), and the highest H-index (124). The number of publications in the Western European region is 1.82 times higher than that of North America region, and 3.59 times that of Eastern Asia region. The most productive institutions on hip fracture were University of Maryland (160). Injury (506) had the highest number of publications, while Osteoporosis International (20,483 times) was the most co-cited journal. Magaziner J and Parker MJ were the key researchers. The keywords were stratified into five clusters: cluster 1 ("operative approaches study"), cluster 2 ("rehabilitation study"), cluster 3 ("osteoporosis study"), cluster 4 ("outcomes and complications study"), and cluster 5 ("epidemiology study"). For hotspots, "tranexamic acid" showed a relatively latest average appearing years of 2017.52, followed by "30-day-mortality," "readmission," and "length of stay." CONCLUSIONS There will be an increasing number of publications on the hip fracture research based on the current global trends, and the USA stays ahead in this field. In terms of region, Western Europe had the greater impact than North America. It is recommended to pay attention to the promising hotspots, such as tranexamic acid, 30-day-mortality, readmission, and length of stay.
Collapse
Affiliation(s)
- Haiyang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Yuqiao Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Linjian Tong
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Yulin Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Zhiming Sun
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China.
- Department of Orthopaedic Surgery, Tianjin Huanhu Hospital, No. 6, Jizhao Road, Jinnan District, Tianjin, 300350, China.
| |
Collapse
|
234
|
Yuan Y, Tian W, Deng X, Yue R, Ge X, Wu X, Zhang P. Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods. J Orthop Surg Res 2021; 16:246. [PMID: 33849586 PMCID: PMC8042877 DOI: 10.1186/s13018-021-02399-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. The current study was to investigate the etiology and bacterial drug resistance patterns of elderly patients with hip fractures and lower respiratory tract infections on prolonged bedridden time and to determine their prognosis. METHODS Patients diagnosed with hip fractures admitted from May 2015 to April 2017 were included. The basic characteristics including the patients' gender, age, fracture type, operation mode, bedridden duration, length of hospital stay, prognosis, past medical history, routine bloodwork, C-reactive protein (CRP), procalcitonin (PCT), blood biochemistry, blood gas analysis, glycosylated hemoglobin (HbA1C%), sputum smear, sputum culture, and anti-infection and related therapy were recorded. All patients were classified into three groups based on bed rest duration, including short-term (<1 month), mid-term (1-12 months), and long-term (> 12 months). The correlation between the bedridden time and the patients' basic characteristics, disease history, laboratory examination results, pathogen, anti-infection, and related therapy were evaluated. The risk factors related to the prognosis of the disease were investigated. RESULTS Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels (P < 0.05). Sputum bacteriological culture results showed that, with bed rest prolongation, the proportion of Pseudomonas aeruginosa and fungal infections increased. Binomial logistic regression of pulmonary infection prognosis, glucocorticoid use during the anti-infective period, prolonged bedridden time, and serum albumin level showed that intravenous use of glucocorticoid during anti-infective treatment, bed rest > 1 year, and low serum albumin level were related to poor prognosis. CONCLUSION Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. Glucocorticoids should be used cautiously.
Collapse
Affiliation(s)
- Yuan Yuan
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Wei Tian
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xiaohui Deng
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Rui Yue
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xiaozhu Ge
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xinbao Wu
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Ping Zhang
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| |
Collapse
|
235
|
Dobre R, Niculescu DA, Cirstoiu C, Popescu G, Poiana C. Mortality rates and risk factors after low-trauma hip fracture in the largest university center in Romania. Arch Osteoporos 2021; 16:64. [PMID: 33834297 DOI: 10.1007/s11657-021-00934-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We calculated in-hospital, 30-day, and 1-year mortality rates and analyzed potential mortality risk factors in 2742 patients with low-trauma hip fractures. We found a high mortality rate at 30 days and 1 year after hip fracture. The high mortality can be explained by a very high number of conservatively treated fractures. PURPOSE Data on mortality after low-trauma hip fracture in Romania is scarce and comes from a single-hospital study. Our aim was to calculate mortality rates and risk factors in all patients admitted for low-trauma hip fracture in the largest university medical center of Romania. METHODS We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest, Romania, and surrounding Ilfov County and calculated the crude in-hospital, 30-day, and 1-year mortality rates after low-trauma hip fractures. A number of potential clinical risk factors for mortality were evaluated. RESULTS We analyzed 2742 low-trauma hip fractures. The in-hospital, 30-day, and 1-year all-cause mortality rates were 4.26% (n=117), 9.59% (n=263), and 29.72% (n=815) respectively. Four hundred and fifty (16.41%) fractures were managed conservatively with a 1-year mortality HR of 3.05 (p<0.001) compared to surgically treated fractures. The 1-year mortality rate in conservatively treated fractures was 56.44% compared to 24.47% in surgically treated fractures. Age, male sex, length of stay in hospital, day of surgery, post-surgical complications, and late surgery were significantly associated (p<0.001) with mortality after hip fracture. The lowest 1-year mortality rate was in surgically treated patients with a length of stay in hospital between 6 and 10 days. CONCLUSION We found a high mortality rate at 30 days and 1 year after low-trauma hip fracture. The high mortality rates can be attributable, in part, to the high number of conservatively treated fractures.
Collapse
Affiliation(s)
- Ramona Dobre
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania. .,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.
| | - Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania
| | - Catalin Cirstoiu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 169 Splaiul Independenței, 050098, Bucharest, Romania.,Bucharest Emergency University Hospital, 169 Splaiul Independenței, 050098, Bucharest, Romania
| | - Gheorghe Popescu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 8 Calea Floreasca, 014461, Bucharest, Romania.,Bucharest Clinical Emergency Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania
| |
Collapse
|
236
|
Predictors of 1-year Mortality After Hip Fracture Surgery in Patients with Age 50 years and Above: An Indian Experience. Indian J Orthop 2021; 55:395-401. [PMID: 34306553 PMCID: PMC8275729 DOI: 10.1007/s43465-021-00396-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hip fractures are considered as a major cause of mortality worldwide. Even after being the second most populous country in world and facing huge burden of hip fractures, there is scarcity of data from India. For the first time in Indian context, we analysed the predictors of mortality after hip fracture surgery in patients with age 50 years and above. MATERIALS AND METHODS In this prospective cohort study, patients with age ≥ 50 years and having hip fractures presented to our institute from January 2018 through October 2018 were enrolled after meeting including and excluding criteria. Patients were followed-up for minimum 1 year after surgery. Association between 1-year mortality and different affecting variables were analysed. Significant variables were further analysed using logistic regression to find independent predictors. RESULTS Out of 87 patients followed-up for 1 year, 25 patients died within 1 year of surgery. Age > 75 years, road traffic accident as mode of injury, delay in surgery > 48 h, > 2 co-morbidities, haemoglobin level ≤ 10 at the time of admission and osteoporosis are significantly associated with high mortality. When these significant variables were further analysed using logistic regression, age > 75 years and > 2 co-morbidities were only factors associated independently with high mortality. CONCLUSION In patients with age 50 years and above, following hip fracture surgery, age > 75 years and > 2 co-morbidities are the predictors of 1-year mortality when adjusted for other variable. A better designed multi-centric study can be more helpful in understanding the things in Indian context.
Collapse
|
237
|
Abstract
PURPOSE OF REVIEW To critically assess recent evidence concerning osteoporosis fracture risk. RECENT FINDINGS Robust instruments exist for predicting factures incorporating well-documented risk factors especially prior fracture whose magnitude varies with site, occurrence time, and age. Stratifying time-since-prior fracture has resulted in the concept of imminent fracture risk and increased focus on secondary fracture prevention. Secondary fracture prevention recommendations include fracture liaison service, pharmacologic and non-pharmacologic multidisciplinary intervention, and communicating that fractures in older adults are the predictable consequence of underlying osteoporosis rather than unfortunate accidents. Quality improvement in osteoporosis care includes diagnosing osteoporosis on the basis of clinical fractures rather than exclusively relying on bone density testing; applying diagnostic rather than screening approaches to patients with prior fractures; regularly updating fall and fracture histories; performing a physical exam focused on spinal curvature, posture, and musculoskeletal function; reviewing images to identify prevalent fractures that may have been missed; and general use of fracture risk algorithms at all stages of osteoporosis management. Communicating effectively with patients about osteoporosis and fractures, their consequences, and pharmacological and non-pharmacological management is the cornerstone of high-value care.
Collapse
Affiliation(s)
- Sanford Baim
- Division of Endocrinology and Metabolism, Rush University Medical Center and Cook County Health and Hospital System, Professional Building, 1725 W. Harrison St., Suite 250, Chicago, IL, 606012, USA.
| | - Robert Blank
- Bone Biology and Healthy Aging Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| |
Collapse
|
238
|
Peng G, Guan Z, Hou Y, Gao J, Rao W, Yuan X, Guo J, Huang X, Zhong Z, Lin J. Depicting developing trend and core knowledge of hip fracture research: a bibliometric and visualised analysis. J Orthop Surg Res 2021; 16:174. [PMID: 33663568 PMCID: PMC7931604 DOI: 10.1186/s13018-021-02292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hip fracture is common and carries high morbidity and mortality; thus, it has become a vital concern. We aim to analyse the present status, worldwide trends in hip fracture and state of clinical research. Methods Publications from 2000 to 2019 were retrieved from the Web of Science database and analysed using a bibliometric methodology. VOSviewer software was utilised for analysis. Results In total, 6139 publications were included, and publications increased annually from 152 in 2000 to 592 in 2019. U.S. researchers have produced the most publications, the highest H-index and the greatest number of citations. Osteoporosis International has published the most papers on the topic. Leading researchers, contributing institutions, their cooperative relationships and scientific masterpieces have been identified. The publications can be divided into five clusters: ‘mortality’, ‘surgical management’, ‘rehabilitation’, ‘osteoporosis’ and ‘epidemiology’. A clear developing trend was described, which began with fracture epidemiology and prevention, transitioned to perioperative management, orthogeriatric care and patient safety and then to functional recovery, disease burden and national audits in recent times. Conclusions Hip fractures result in conditions that extend far beyond orthopaedics concerning epidemiology and preventive medicine, internal medicine and endocrinology, as well as critical care and gerontology. Interest, research and publications are on the rise.
Collapse
Affiliation(s)
- Guanrong Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong Province, China.,Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Zhenhua Guan
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Yunfei Hou
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Jiaxiang Gao
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Wenqun Rao
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Xianyun Yuan
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Jiusheng Guo
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Xiaohua Huang
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Zhangrong Zhong
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China.
| | - Jianhao Lin
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China.
| |
Collapse
|
239
|
Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, Søgaard AJ, Omsland TK. Increased Mortality in Hip Fracture Patients Living Alone: A NOREPOS Study. J Bone Miner Res 2021; 36:480-488. [PMID: 33403722 DOI: 10.1002/jbmr.4212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29-1.44; HR women = 1.23, 95% CI 1.18-1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25-6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population. © 2021 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Cecilie Dahl
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri M Solbakken
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Schei
- Institute of Community Medicine and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway
| | - Anne-Johanne Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | |
Collapse
|
240
|
Senay A, Fernandes JC, Delisle J, Morin SN, Dragomir A, Nazha S, Perreault S. Patient Healthcare Trajectory and its Impact on the Cost-Effectiveness of Fracture Liaison Services. J Bone Miner Res 2021; 36:459-468. [PMID: 33484586 DOI: 10.1002/jbmr.4216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
This study aimed to assess the cost-utility of a Fracture Liaison Service (FLS) with a systematic follow-up according to patients' follow-up compliance trajectories. The Lucky Bone™ FLS is a prospective cohort study conducted on women and men (≥40 years) with fragility fractures. Dedicated personnel of the program identified fractures, investigated, treated, and followed patients systematically over 2 years. Groups of follow-up compliance trajectories were identified, and Markov decision models were used to assess the cost-utility of each follow-up trajectory group compared to usual care. A lifetime horizon from the perspective of the healthcare payer was modeled. Costs were converted to 2018 Canadian dollars and incremental cost-utility ratios (ICURs) were measured. Costs and benefits were discounted at 1.5%. A total of 532 participants were followed in the FLS (86% women, mean age of 63 years). Three trajectories were predicted and interpreted; the high followers (HFs, 48.4%), intermediate followers (IFs, 28.1%), and low followers (LFs, 23.5%). The costs of the interventions per patient varied between $300 and $446 for 2 years, according to the follow-up trajectory. The FLS had higher investigation, treatment, and persistence rates compared to usual care. Compared to usual care, the ICURs for the HF, IF, and LF trajectory groups were $4250, $21,900, and $72,800 per quality-adjusted life year (QALY) gained, respectively ($9000 per QALY gained for the overall FLS). Sensitivity analyses showed that the HF and IF trajectory groups, as well as the entire FLS, were cost-effective in >67% of simulations with respect to usual care. In summary, these results suggest that a high-intensity FLS with a systematic 2-year follow-up can be cost-effective, especially when patients attend follow-up visits. They also highlight the importance of understanding the behaviors and factors that surround follow-up compliance over time as secondary prevention means that they are at high risk of re-fracture. © 2020 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Andréa Senay
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Julio C Fernandes
- CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Josée Delisle
- CIUSSS Nord de l'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,CIUSSS Nord de l'Ile de Montréal, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Suzanne N Morin
- Center for Outcomes and Evaluation, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Sara Nazha
- Department of Surgery, Division of Urology, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada.,Sanofi Aventis endowment Research Chair in Optimal Drug Use, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
241
|
Schoeneberg C, Aigner R, Pass B, Volland R, Eschbach D, Peiris SE, Ruchholtz S, Lendemans S. Effect of time-to-surgery on in-house mortality during orthogeriatric treatment following hip fracture: A retrospective analysis of prospectively collected data from 16,236 patients of the AltersTraumaRegister DGU®. Injury 2021; 52:554-561. [PMID: 32951920 DOI: 10.1016/j.injury.2020.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Time-to-surgery in geriatric hip fractures remains of interest. The majority of the literature reports a significantly decreased mortality rate after early surgery. Nevertheless, there are some studies presenting no effect of time-to-surgery on mortality. The body of literature addressing the effect of an orthogeriatric co-management is growing. Here we investigate the effect of time-to-surgery on in-house mortality in a group of patients treated under the best possible conditions in certified orthogeriatric treatment units. METHODS We conducted a retrospective cohort registry analysis from prospectively collected data of the AltersTraumaRegister DGU®. Data were analyzed univariably, and the association of early surgery with in-house mortality was assessed with multivariable logistic regression while controlling for specified patient characteristics. Additionally, propensity score matching for time-to-surgery was applied to examine its effect on the in-house mortality rate. FINDINGS A total of 15,099 patients met the inclusion criteria. The median age was 85 years (IQR 80-89), and 72.1% were female. The overall in-house mortality rate was 5.5%. Most (71.2%) of the patients were treated within 24 h, and 91.6% within 48 h. Neither the multivariable logistic regression model nor the propensity score matching indicated that early surgery was associated with a decreased mortality rate. The most important indicators for mortality were ASA ≥ 3 [Odds ratio (OR) 3.4, 95% confidence interval (CI) 2.35-5.11], fracture event during inpatient stay (OR 2.6, 95% CI 1.48-4.3), ISAR ≥ 2 (OR 1.88, 95% CI 1.33-2.76), and male gender (OR 1.71, 95% CI 1.39-2.09). INTERPRETATION Our results suggest that for those patients, who were treated in an orthogeriatric co-management under the best possible conditions, there are no significant differences regarding in-house mortality rate between the time-to-surgery intervals of 24 and 48 h or slightly above. This and the comparatively small number of patients who underwent surgery after 24 h show that an extension of the pre-surgery interval, justified by an orthogeriatric treatment team, will not be detrimental to the affected patients.
Collapse
Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - Ruth Volland
- AUC, Akademie der Unfallchirurgie GmbH, Munich, Germany.
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | | | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | -
- Working Committee on Geriatric Trauma Registry (AK ATR) of the German Trauma Society (DGU), Berlin, Germany
| |
Collapse
|
242
|
Genest F, Schneider M, Zehnder A, Lieberoth-Leden D, Seefried L. Differential impact of osteoporosis, sarcopenia and obesity on physical performance in aging men. Endocr Connect 2021; 10:256-264. [PMID: 33475529 PMCID: PMC8052579 DOI: 10.1530/ec-20-0580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Aging and concurrent constitutional changes as sarcopenia, osteoporosis and obesity are associated with progressive functional decline. Coincidence and mutual interference of this risk factors require further evaluation. METHODS Cross-sectional evaluation of musculoskeletal health in a community-dwelling cohort of men aged 65-90 years. Objectives included descriptive analysis of age-related decline in physical performance, prevalence of osteoporosis (FRAX-Score), sarcopenia (EWGSOP criteria) and obesity (BMI > 30 kg/m2) and their coincidence/interference. RESULTS Based on 507 participants assessed, aging was associated with progressive functional deterioration, regarding power (chair rise test -1.54% per year), performance (usual gait speed -1.38% per year) and muscle force (grip strength -1.52% per year) while muscle mass declined only marginally (skeletal muscle index -0.29% per year). Prevalence of osteoporosis was 41.8% (n = 212) while only 22.9% (n = 116) of the participants met the criteria for sarcopenia and 23.7% (n = 120) were obese. Osteosarcopenia was found in n = 79 (15.6%), sarcopenic obesity was present in 14 men (2.8%). A combination of all three conditions could be confirmed in n = 8 (1.6%). There was an inverse correlation of BMI with physical performance whereas osteoporosis and sarcopenia did not interfere with functional outcomes. CONCLUSION Based on current definitions, there is considerable overlap in the prevalence of osteoporosis and sarcopenia, while obesity appears to be a distinct problem. Functional decline appears to be associated with obesity rather than osteoporosis or sarcopenia. It remains to be determined to what extend obesity itself causes performance deficits or if obesity is merely an indicator of insufficient activity eventually predisposing to functional decline.
Collapse
Affiliation(s)
- Franca Genest
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | - Michael Schneider
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | - Andreas Zehnder
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | | | - Lothar Seefried
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
- Correspondence should be addressed to L Seefried:
| |
Collapse
|
243
|
Baidoo PK, Odei JB, Ansu V, Segbefia M, Holdbrook-Smith H. Predictors of hip fracture mortality in Ghana: a single-center prospective study. Arch Osteoporos 2021; 16:35. [PMID: 33609199 DOI: 10.1007/s11657-021-00883-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a 4-year period. METHODS Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December 2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios (HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors. RESULTS Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%) transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and 27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03). Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p = 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR = 5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more likely to experience death than those with an ASA score of I or II (95% CI: 0.93-8.89, p = 0.08). Additionally, a higher risk of death was associated with patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis (HR = 8.75, p = 0.006). CONCLUSION Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with proximal femur fractures to improve the outcome.
Collapse
Affiliation(s)
- Paa Kwesi Baidoo
- Directorate of Orthopedics and Trauma, Komfo Anokye Teaching Hospital, Kumasi, Ghana. .,Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana.
| | - James B Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Velarie Ansu
- School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Michael Segbefia
- Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
| | - Henry Holdbrook-Smith
- Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
| |
Collapse
|
244
|
Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
Collapse
Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| |
Collapse
|
245
|
Blanco JF, da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enríquez JM, Díaz-Álvarez A. 30-day mortality after hip fracture surgery: Influence of postoperative factors. PLoS One 2021; 16:e0246963. [PMID: 33592047 PMCID: PMC7886122 DOI: 10.1371/journal.pone.0246963] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.
Collapse
Affiliation(s)
- Juan F. Blanco
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- * E-mail:
| | - Carmen Pablos-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - José Miguel Julián-Enríquez
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Agustín Díaz-Álvarez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Anaesthesiology Department, University Hospital of Salamanca, Salamanca, Spain
| |
Collapse
|
246
|
Vigni GE, Bosco F, Cioffi A, Camarda L. Mortality Risk Assessment at the Admission in Patient With Proximal Femur Fractures: Electrolytes and Renal Function. Geriatr Orthop Surg Rehabil 2021; 12:2151459321991503. [PMID: 33623723 PMCID: PMC7876745 DOI: 10.1177/2151459321991503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
In patients over 65y.o. who were surgically treated for a hip fracture,
electrolytes have not been specifically studied as predictors of mortality. The
main purpose of this study was to assess whether electrolytes and chronic kidney
disease (CKD) stages, evaluated at admission, could represent a pre-operative
prognostic factor in this population. Moreover, the role of epidemiological and
clinical parameters was analyzed with and without a surgical timing
stratification. This retrospective study included 746 patients. For each
patient, their age, gender, fracture classification, Hb value, comorbidities,
ASA class, chronic kidney disease, creatinine levels, electrolytes and surgical
timing were collected. CKD-epi, MDRD, modified MDRD and BIS1 were used to obtain
eGFR and CKD stages. All parameters were analyzed individually and in relation
to the different surgical timing. Descriptive statistics, Chi-square test and
survivability analysis with Kaplan Meier curve were used. In patients with a hip
fracture non-significant association with increased mortality was shown for the
following variables: Hb value, sodium values, calcium values, CKD stages and
creatinine values. Otherwise altered kalemia was associated with a statistically
significant increase in mortality as well as male gender, two or more comorbid
medical conditions, advanced age (>75 years), higher ASA class. Surgery
performed within 72h resulted in a statistically significant reduction in
mortality at 6 months and, when performed in 24h-48h, a further reduction at 4
years. Age and ASA class statistically significant increased mortality
regardless the surgical timing. Male patients operated after 48h from
hospitalization were associated with a statistically significant increase in
mortality rate. Two or more comorbidities were related to a statistically
significant increased number of deaths when patients were treated after 96h.
Altered kalemia values at hospitalization are associated with a statistically
significant increase in mortality in patients operated after 72h from
admission.
Collapse
Affiliation(s)
- Giulio Edoardo Vigni
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Alessio Cioffi
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| |
Collapse
|
247
|
Ponzano M, Rodrigues IB, Hosseini Z, Ashe MC, Butt DA, Chilibeck PD, Stapleton J, Thabane L, Wark JD, Giangregorio LM. Progressive Resistance Training for Improving Health-Related Outcomes in People at Risk of Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther 2021; 101:6048920. [PMID: 33367736 DOI: 10.1093/ptj/pzaa221] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Osteoporosis clinical practice guidelines recommend exercise to prevent fractures, but the efficacy of exercise depends on the exercise types, population studied, or outcomes of interest. The purpose of this systematic review was to assess the effects of progressive resistance training (PRT) on health-related outcomes in people at risk of fracture. METHODS Multiple databases were searched in October 2019. Eligible articles were randomized controlled trials of PRT interventions in men and women ≥50 years with low bone mineral density (BMD) or fracture history. Descriptive information and mean difference (MD) and SD were directly extracted for included trials. A total of 53 studies were included. RESULTS The effects of PRT on the total number of falls (incidence rate ratio [IRR] = 1.05; 95% CI = 0.91 - 1.21; 7 studies) and on the risk of falling (risk ratio [RR] = 1.23; 95% CI = 1.00 - 1.51; 5 studies) are uncertain. PRT improved performance on the Timed "Up and Go" test (MD = -0.89 seconds; 95% CI = -1.01 to -0.78; 13 studies) and health-related quality of life (standardized MD = 0.32; 95% CI = 0.22-0.42; 20 studies). PRT may increase femoral neck (MD = 0.02 g/cm2; 95% CI = 0.01-0.03; 521 participants, 5 studies) but not lumbar spine BMD (MD = 0.02 g/cm2; 95% CI = -0.01-0.05; 4 studies), whereas the effects on total hip BMD are uncertain (MD = 0.00 g/cm2; 95% CI = 0.00-0.01; 435 participants, 4 studies). PRT reduced pain (standardized MD = -0.26; 95% CI = -0.37 to -0.16; 17 studies). Sensitivity analyses, including PRT-only studies, confirmed these findings. CONCLUSION Individuals at risk of fractures should be encouraged to perform PRT, as it may improve femoral neck BMD, health-related quality of life, and physical functioning. PRT also reduced pain; however, whether PRT increases or decreases the risk of falls, the number of people experiencing a fall, or the risk of fall-related injuries is uncertain. IMPACT Individuals at risk of fractures should be encouraged to perform PRT, as it may have positive effects on femoral neck BMD, health-related quality of life, physical functioning, and pain, and adverse events are rare. LAY SUMMARY Exercise is recommended for people at risk of osteoporotic fractures. Our study showed that progressive resistance training improves physical functioning, quality of life, and reduces pain. The effects of progressive resistance training on the risk of falling are unclear. Adverse events are rare, and often minor (eg, soreness, pain, musculoskeletal injury). Considering the benefits and safety, people at risk of fractures should engage in progressive resistance training interventions.
Collapse
Affiliation(s)
| | | | | | - Maureen C Ashe
- The University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Debra A Butt
- University of Toronto, Toronto, Canada.,Scarborough Health Network, Scarborough, Canada
| | | | | | - Lehana Thabane
- McMaster University, Hamilton, Canada.,St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - John D Wark
- University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Parkville, Australia
| | - Lora M Giangregorio
- University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Canada
| |
Collapse
|
248
|
Cary MP, Zhuang F, Draelos RL, Pan W, Amarasekara S, Douthit BJ, Kang Y, Colón-Emeric CS. Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture. J Am Med Dir Assoc 2021; 22:291-296. [PMID: 33132014 PMCID: PMC7867606 DOI: 10.1016/j.jamda.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs). DESIGN Retrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument data. SETTING AND PARTICIPANTS A total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture. MEASURES Patient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models. RESULTS For 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95). CONCLUSION AND IMPLICATIONS A scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.
Collapse
Affiliation(s)
- Michael P Cary
- School of Nursing, Duke University, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.
| | - Farica Zhuang
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Rachel Lea Draelos
- Department of Computer Science, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, USA
| | | | | | - Yunah Kang
- School of Nursing, Duke University, Durham, NC, USA
| | - Cathleen S Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA; Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| |
Collapse
|
249
|
Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
Collapse
|
250
|
Pasquale MK, Sheer RL, Yehoshua A, McFadden A, Chines A, Caloyeras J. Evaluation of an Osteoporosis Outreach Program for Men With a Fragility Fracture and Their Physicians. Med Care 2021; 59:148-154. [PMID: 33273290 PMCID: PMC7899217 DOI: 10.1097/mlr.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many health plans have outreach programs aimed at appropriately screening, evaluating, and treating women experiencing fragility fractures; however, few programs exist for men. OBJECTIVE The objective of this study was to develop, implement, and evaluate an osteoporosis outreach program for men with a recent fragility fracture and their physicians. RESEARCH DESIGN AND SUBJECTS A total of 10,934 male patients enrolled in a Medicare Advantage with Prescription Drug Plan with a recent fragility fracture were randomized to a program or control group. Patients and their physicians received letters followed by phone calls on osteoporosis and the importance of screening and treatment. The evaluation compared bone mineral density (BMD) test utilization and osteoporosis medication treatment (OPT) among patients who received the outreach versus no outreach at 12 months. The effect of the program was estimated through univariate and multivariable logistic regressions. RESULTS The program had a significant impact on BMD evaluation and OPT initiation. At 12 months, 10.7% of participants and 4.9% of nonparticipants received a BMD evaluation. The odds ratio (OR) (95% confidence interval) was 2.31 (1.94, 2.76), and the number needed to outreach to receive a BMD test was 18. OPT was initiated in 4.0% of participants and 2.5% of nonparticipants. The OR (95% confidence interval) of receiving OPT was 1.60 (1.24, 2.07), and the number needed to outreach was 69. Adjusted ORs were similar in magnitude and significance. CONCLUSION The program was highly effective by more than doubling the rate of BMD evaluation; however, more intensive interventions may yield an even higher screening rate.
Collapse
|