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Is It Possible to Predict the Length of Stay of Patients Undergoing Hip-Replacement Surgery? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106219. [PMID: 35627755 PMCID: PMC9141454 DOI: 10.3390/ijerph19106219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/17/2022]
Abstract
The proximal fracture of the femur and hip is the most common reason for hospitalization in orthopedic departments. In Italy, 115,989 hip-replacement surgeries were performed in 2019, showing the economic relevance of studying this type of procedure. This study analyzed the data relating to patients who underwent hip-replacement surgery in the years 2010-2020 at the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno. The multiple linear regression (MLR) model and regression and classification algorithms were implemented in order to predict the total length of stay (LOS). Lastly, using a statistical analysis, the impact of COVID-19 was evaluated. The results obtained from the regression analysis showed that the best model was MLR, with an R2 value of 0.616, compared with XGBoost, Gradient-Boosted Tree, and Random Forest, with R2 values of 0.552, 0.543, and 0.448, respectively. The t-test showed that the variables that most influenced the LOS, with the exception of pre-operative LOS, were gender, age, anemia, fracture/dislocation, and urinary disorders. Among the classification algorithms, the best result was obtained with Random Forest, with a sensitivity of the longest LOS of over 89%. In terms of the overall accuracy, Random Forest and Gradient-Boosted Tree achieved a value of 71.76% and an error of 28.24%, followed by Decision Tree, with an accuracy of 71.13% and an error of 28.87%, and, finally, Support Vector Machine, with an accuracy of 65.06% and an error of 34.94%. A significant difference in cardiovascular disease, fracture/dislocation, and post-operative LOS variables was shown by the chi-squared test and Mann-Whitney test in the comparison between 2019 (before COVID-19) and 2020 (in full pandemic emergency conditions).
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Piscitelli P, Neglia C, Feola M, Rizzo E, Argentiero A, Ascolese M, Rivezzi M, Rao C, Miani A, Distante A, Esposito S, Iolascon G, Tarantino U. Updated incidence and costs of hip fractures in elderly Italian population. Aging Clin Exp Res 2020; 32:2587-2593. [PMID: 32056151 DOI: 10.1007/s40520-020-01497-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/23/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed at updating our previous researches about the burden of hip fractures in elderly Italian population. METHODS We analyzed national hospitalizations records from 2000 to 2014 to compute age- and sex-specific standardized rates. RESULTS 1,335,375 hospitalizations were recorded in people ≥ 65 (1,031,816 women: 77.27% and 303,559 men: 22.73%) over 15 years, passing from 73,493 in year 2000 to 94,525 in 2014, with an overall increase of 28.62% over the 15-year period (females: + 25.1%; males: + 41.2%). About 84.9% of total hip fractures were suffered by patients aged ≥ 75 years old. Direct hospitalization costs and rehabilitation costs increased from 343 to 457 million Euros and from 392 to 504 million Euros from year 2000 to 2014, respectively. Overall costs of hip fractures raised from 735 to 961 million Euros (+ 30.74% from 2000 to 2014). CONCLUSION The number of hip fractures and related hospitalizations costs in Italian elderly population is still increasing due to the absolute number of fractures occurring in people ≥ 65 years old and particularly over 75 years old.
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Affiliation(s)
- Prisco Piscitelli
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy.
| | - Cosimo Neglia
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy
- University of Perugia, Perugia, Italy
| | - Maurizio Feola
- Division of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
| | - Emanuele Rizzo
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy
| | - Alberto Argentiero
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy
- University of Perugia, Perugia, Italy
| | - Mario Ascolese
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy
| | - Matteo Rivezzi
- Health Economics Laboratory, University of Foggia, Foggia, Italy
| | - Cecilia Rao
- Division of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
| | | | - Alessandro Distante
- Euro Mediterranean Scientific Biomedical Institute-ISBEM Research Centre, via Reali di Bulgaria, Mesagne, 72023, Brindisi, Italy
| | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Umberto Tarantino
- Division of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
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Aletto C, Aicale R, Pezzuti G, Bruno F, Maffulli N. Impact of an orthogeriatrician on length of stay of elderly patient with hip fracture. Osteoporos Int 2020; 31:2161-2166. [PMID: 32572520 DOI: 10.1007/s00198-020-05510-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022]
Abstract
UNLABELLED Hip fracture patients are complex, and orthopaedic management is limited to the surgery phase. To provide better evaluation pre-operatively and an optimal level of post-operative care, an orthogeriatrician was introduced in the orthopaedic team. This ensured that time to surgery from admission consistently was below 48 h, decreasing hospitalization time after surgery and total length of stay. INTRODUCTION Hip fractures are a major health issue in elderly and frail patient. The integration of orthogeriatric care within the orthopaedic team could be useful to optimize the clinical conditions of these patients in perioperative phases and stabilize them after surgery, reducing hospital length of stay. The present study evaluates the role of an orthogeriatrician in the management of patients with a hip fracture. MATERIALS AND METHODS Data about patients admitted and operated from February to September 2018 and from February to September 2019 were collected from the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno database. A total of 352 patients were identified and divided in two groups according to the year in which the orthogeriatrician was working in Orthopaedic Department. Records regarding age, sex, side and type of fracture, time of admission, day of surgery and discharge were collected and length of stay, days from the admission to surgery and days from surgery to discharge were calculated. RESULTS There were no statistically significant differences in the pre-surgery phases of both groups, and all patients were operated at a mean of 2.1 days ± 1.8 SD from admission (p > 0.05). No statistically significant difference between demographic data in both groups (p > 0.01) was observed. There was, however, statistically significant reduction of hospitalization time after surgery and total LOS from 2018 to 2019 (p < 0.01). CONCLUSION An Orthogeriatric doctor in an Orthopaedic and Traumatology Department may lead a multidisciplinary approach to manage elderly patients with hip fractures, ensuring that the time to surgery from admission is less than 48 h, and reducing hospitalization time after surgery and total length of stay.
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Affiliation(s)
- C Aletto
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - R Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - G Pezzuti
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - F Bruno
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - N Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy.
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
- Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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Iolascon G, Moretti A, Toro G, Gimigliano F, Liguori S, Paoletta M. Pharmacological Therapy of Osteoporosis: What's New? Clin Interv Aging 2020; 15:485-491. [PMID: 32273690 PMCID: PMC7105363 DOI: 10.2147/cia.s242038] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/07/2020] [Indexed: 02/05/2023] Open
Abstract
Osteoporosis and fragility fractures are relevant health issues because of their impact in terms of morbidity, mortality, and socioeconomic burden. Despite this alarming scenario, both underdiagnosis and undertreatment are common features of osteoporotic patients, particularly those who have already sustained a fragility fracture. Pharmacotherapy of osteoporosis is the main treatment option for these patients because of strong evidence about the efficacy of available drugs targeting bone metabolism. However, several issues can interfere with the effectiveness of anti-osteoporotic drugs in clinical practice, such as lack of awareness of both healthcare providers and patients, poor adherence to therapy, and safety in long-term treatment. Therefore, new therapeutic strategies have been proposed to overcome these problems, such as sequential therapy or emerging molecules mainly targeting the stimulation of bone formation. In particular, abaloparatide has been demonstrated to reduce major nonvertebral fracture risk compared with both placebo and teriparatide, although the European Medicines Agency (EMA) refused the marketing authorization because the benefits of this drug did not outweigh its risks. On the other side, EMA has recently approved romosozumab, a monoclonal antibody directed against sclerostin and the only available therapeutic option targeting Wnt signaling, as both bone-forming and antiresorptive intervention to treat osteoporosis and fragility fractures.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Correspondence: Antimo Moretti Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy Email
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Piscitelli P, Feola M, Rao C, Neglia C, Rizzo E, Vigilanza A, Rivezzi M, Faccilongo N, Contò F, Distante A, Tarantino U. Incidence and costs of hip fractures in elderly Italian population: first regional-based assessment. Arch Osteoporos 2019; 14:81. [PMID: 31342284 DOI: 10.1007/s11657-019-0619-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/11/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed for the first-time hospitalizations and costs for hip fractures in the elderly Italian population at the regional level from 2007 to 2014. The number of fractures and the overall costs increased, mainly due to people aged > 85 in all the Italian regions, although at different rates. OBJECTIVE We aimed at evaluating the burden of hip fractures in elderly Italian population at the regional level. METHODS We analyzed national hospitalizations records 2007-2014 to compute standardized hospitalizations rates (SHR) due to hip fractures per 10,000 inhabitants at the regional level and average annual percent change (AAPC), along with related costs. RESULTS Hip fractures occurred in people over 65 years increased from 89,601 to 94,525 over 8 years. The overall increase in the number of hospitalizations is attributable only to people aged ≥85. Actually, in the 65-74 and 74-84 age groups, total hospitalizations decreased from 13,396 to 12,268 and from 40,733 to 37,786 respectively, while they increased from 35,472 to 44,471 in people aged ≥85 (women = 28,605 and men = 6,867 in 2007; women = 34,636 and men = 9,835 in 2014). Almost 50% of hip fractures were found to have been experienced by patients aged 85 or older in 2014 (with women ≥ 85 representing 36.6% of total fractures), in accordance with the higher prevalence of osteoporosis in this age group. Fractures increase in people aged ≥ 85 was two-folds higher in males (AAPC: + 5.0%; P > 0.05) than in females (AAPC: + 2.6%; P > 0.05). Increases in the number of hospitalizations and related costs were observed for all the regions, with the only exception of Lazio (AAPC: - 4.6%; P < 0.05) and Friuli Venezia Giulia (hip fractures AAPC: - 1.9%; P < 0.05). The most significant increases in hip fractures and related costs were recorded in Calabria (+ 2.7%), Campania (+ 2.2%), and Lombardia (+ 2.0%). At the national level, SHR per 10,000 inhabitants due to hip fractures decreased in all three examined age groups (65-74, 75-84, and ≥ 85), both in males and females during the 8-year period (P < 0.05). This reduction was confirmed also when looking at the regional dataset, with few exceptions concerning female population (AAPC not statistically significant). When looking at the SHR per 10,000 inhabitants for the entire nation, we recorded a decreasing trend also in females aged 85 years old and over but not in males ≥ 85. Actually, men aged ≥ 85 showed increased HR per 10,000 in 10 regions out of 20. Direct hospitalization and rehabilitation costs increased in all the regions over the 8-year period (although at different rates), except for Friuli Venezia Giulia (where costs decreased from 21 to 19 million Euros) and Lazio (from 107 to 87 million Euros). Lombardia and Piemonte were the regions spending the highest amount of money to treat hip fractures in elderly people (151 and 95 million Euros in the year 2014, respectively). CONCLUSION Hip fractures in the elderly population remain a major public health issue in all Italian regions, especially in people aged 85 years old and over, although the problem is starting to become more controlled compared with the past. Women represent the majority of hip fractures, but the highest increasing rate has been observed in men. Pilot projects at regional level targeting elderly people at higher risk of fractures and treatment compliance are needed.
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Affiliation(s)
- Prisco Piscitelli
- Euro Mediterranean Scientific Biomedical Institute, ISBEM Research Centre, via Reali di Bulgaria, 72023, Mesagne, Brindisi, Italy.
| | - Maurizio Feola
- Department of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
| | - Cecilia Rao
- Department of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
| | - Cosimo Neglia
- Euro Mediterranean Scientific Biomedical Institute, ISBEM Research Centre, via Reali di Bulgaria, 72023, Mesagne, Brindisi, Italy
| | - Emanuele Rizzo
- Euro Mediterranean Scientific Biomedical Institute, ISBEM Research Centre, via Reali di Bulgaria, 72023, Mesagne, Brindisi, Italy
| | - Antonella Vigilanza
- Euro Mediterranean Scientific Biomedical Institute, ISBEM Research Centre, via Reali di Bulgaria, 72023, Mesagne, Brindisi, Italy
| | - Matteo Rivezzi
- Health Economics Laboratory (HERMES), Department of Economics, University of Foggia, Foggia, Italy
| | - Nicola Faccilongo
- Health Economics Laboratory (HERMES), Department of Economics, University of Foggia, Foggia, Italy
| | - Francesco Contò
- Health Economics Laboratory (HERMES), Department of Economics, University of Foggia, Foggia, Italy
| | - Alessandro Distante
- Euro Mediterranean Scientific Biomedical Institute, ISBEM Research Centre, via Reali di Bulgaria, 72023, Mesagne, Brindisi, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy
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Di Giovanni P, Di Martino G, Zecca IA, Porfilio I, Romano F, Staniscia T. Incidence of hip fracture and 30-day hospital readmissions in a region of central Italy from 2006 to 2015. Geriatr Gerontol Int 2019; 19:483-486. [PMID: 30868704 DOI: 10.1111/ggi.13645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/22/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
AIM Increased life expectancy causes a higher prevalence of chronic and degenerative diseases, and greater frailty among older people. Hip fracture is a common event for older people, and 1-year mortality after hip fracture is high. The present study was carried out in the Abruzzo region, Italy, over the years from 2006 to 2015, entailing as its main objectives the assessment of age and sex-specific trends in the incidence of hip fractures, with the subsequent hospital mortality. Causes of 30-day hospital readmissions were assessed. METHODS Data were collected from all hospital discharge records. Information on all 30-day readmissions was also retrieved. RESULTS Overall, 23 075 patients were admitted to hospital for hip fracture (mean age 81.0 ± 11.7 years,72.6% women). The overall hip fracture incidence remained constant over the study period, varying from 175.9 cases in 2006 to 179.3 cases per 100 000 in 2015. However, the incidence progressively increased from 40.0 to 51.0 among men, and from 61.6 to 80.9 among patients aged >85 years. The in-hospital mortality rate was 3.8%. Within 30 days from the hip fracture discharge, 10 526 patients (45.6%) had a second hospitalization, related to the condition of interest in >80% of the patients. Additionally, 414 (3.9%) patients died during the second hospitalization. CONCLUSIONS Although women aged >65 years remain the category of patients at highest risk of hip fracture, an increasing trend is observed among men and patients aged >85 years. Hip fracture is frequently associated with early hospital readmission and is responsible for elevated in-hospital mortality. Geriatr Gerontol Int 2019; 19: 483-486.
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Affiliation(s)
- Pamela Di Giovanni
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Di Martino
- Postgraduate School of Public Health and Preventive Medicine, Department of Medicine and Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Isaia Al Zecca
- Postgraduate School of Public Health and Preventive Medicine, Department of Medicine and Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Italo Porfilio
- Postgraduate School of Public Health and Preventive Medicine, Department of Medicine and Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, Rome, Italy
| | - Tommaso Staniscia
- Department of Medicine and Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Morandi A, Mazzone A, Bernardini B, Suardi T, Prina R, Pozzi C, Gentile S, Trabucchi M, Bellelli G. Association between delirium, adverse clinical events and functional outcomes in older patients admitted to rehabilitation settings after a hip fracture: A multicenter retrospective cohort study. Geriatr Gerontol Int 2019; 19:404-408. [DOI: 10.1111/ggi.13628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/24/2018] [Accepted: 01/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alessandro Morandi
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Andrea Mazzone
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Bruno Bernardini
- Department of Neurorehabilitation; IRCCS Humanitas Research Hospital; Milan Italy
| | - Teresa Suardi
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Roberto Prina
- Department of Rehabilitation, Redaelli Geriatric Institute; Vimodrone Italy
| | - Christian Pozzi
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI); Manno Switzerland
| | - Simona Gentile
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Marco Trabucchi
- Department of Rehabilitation, University of Tor Vergata; Rome Italy
| | - Giuseppe Bellelli
- Department of Rehabilitation, School of Medicine and Surgery; University of Milano-Bicocca, Acute Geriatric Unit, S. Gerardo Hospital; Monza Italy
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Decreasing trend of hip fractures incidence in Italy between 2007 and 2014: epidemiological changes due to population aging. Arch Osteoporos 2018. [PMID: 29523987 DOI: 10.1007/s11657-018-0423-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed hospitalization for hip fractures in elderly Italian people from 2007 to 2014. The number of fractures increased by 5.50% (women + 3.36; men + 12.9%) only due to people aged ≥ 85 years old. Incidence rates per 10,000 inhabitants decreased in all the age groups (65-74, 75-84, and also ≥ 85). PURPOSE To assess the burden of hip fractures in elderly Italian population moving from our previous researches documented a reduced incidence of hip fractures in Italian women aged 65-74 years old. METHODS We analyzed national hospitalization records from 2007 to 2014 to compute age- and sex-specific rates at national and regional level. RESULTS Seven hundred forty-one thousand six hundred thirty-three a total of 741,633 hospitalizations were observed in people ≥ 65 (women 568,203; men 173,430), with an overall increase of 5.50% over the 8-year period (females + 3.36; males + 12.9%). About 43.75% of total hip fractures were suffered by patients aged ≥ 85 years old. Women aged ≥ 85 accounted for 34.49% (n = 255,763) of total fractures. The incidence rate per 10,000 inhabitants in people aged 65-74 decreased from 28.65 to 25.31 in women (- 13.02%) and from 13.41 to 11.65 in men (- 13.12%). Incidence per 10,000 in people 75-84 decreased from 121.6 to 105.2 in women (- 13.49%) and from 55.8 to 47.5 in men (- 14.87%). Also, in people aged ≥ 85, the incidence per 10,000 declined from 300.99 to 268.72 in women (- 10.72%) and from 174.59 to 171.17 in men (- 1.96%). Standardized rates (SR) per 10,000 in the overall population aged 65 years old and over decreased between 2007 and 2014 from 22.9 to 20.1 and from 7.0 to 6.3 in women and men, respectively. Decreasing trends were documented in all Italian regions between 65 and 79 years old, with further reduction up to 84 years old in 16 regions out of 20. Region Lazio showed a decreasing trend also in people aged > 85 years old. CONCLUSION While the number of hospitalizations for hip fractures in Italy is still increasing due to the fractures occurring in people ≥ 85 years old, incidence rates are decreasing in all the age groups, including the oldest one, possibly because the number of subjects aged ≥ 85 is growing faster than the number of fractures.
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Carnevale V, Fontana A, Scillitani A, Sinisi R, Romagnoli E, Copetti M. Incidence and all-cause mortality for hip fracture in comparison to stroke, and myocardial infarction: a fifteen years population-based longitudinal study. Endocrine 2017; 58:320-331. [PMID: 28933053 DOI: 10.1007/s12020-017-1423-1] [Citation(s) in RCA: 7] [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: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE This population-based study investigated the incidence, in-hospital and long-term all-cause mortality, for hip fracture (HipFx), stroke (STR), and myocardial infarction (MI) in residents hospitalized between 2000 and 2014. METHODS Data about hospitalization were drawn from the administrative discharge database, whereas information about residents and all-cause mortality from the municipality of our town. Patients were followed-up from the first hospital admission until death or study end. For each cause, crude and age-adjusted all-cause mortality of men and women were compared by Mann-Whitney's test and Poisson models. Separate age-sex adjusted Cox models were estimated and the corresponding adjusted survival curves were drawn. RESULTS Among 1292 hospitalizations (of 1109 patients), 434 were for HipFx, 526 for STR, 332 for MI (183 with and 149 without coronary revascularization -MIwCR and MIwoCR, respectively). The incidence of HipFx and STR did not vary over time, MI slightly increasing in men. Age-adjusted in-hospital mortality for HipFx was lower than for STR and MIwoCR in the whole sample and in women (p < 0.001), but not in men. After discharge, men with HipFx had shorter survival and higher crude and age-adjusted mortality rate than women. The estimated HRs(95%CI) in respect to patients with MIwCR (having the lowest mortality) were: 6.11(3.12-11.97), p < 0.001 for HipFx; 5.78(2.93-11.32), p < 0.001 for STR; 2.68(1.27-5.66), p = 0.010 for MIwoCR in the whole sample [HR: 16.58(6.70-40.98) p < 0.001 for HipFx; 7.35(3.01-17.93) p < 0.001 for STR, in men]. CONCLUSIONS HipFx markedly impacts hospital care, and causes high in-hospital and long-term all-cause mortality, comparable to the two commonest non-tumor causes of death.
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Affiliation(s)
- Vincenzo Carnevale
- Units of Internal Medicine, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy.
| | - Andrea Fontana
- Units of Biostatistics, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
| | - Alfredo Scillitani
- Units of Endocrinology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
| | - Roberto Sinisi
- Health Statistics, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
| | | | - Massimiliano Copetti
- Units of Biostatistics, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, FG, Italy
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10
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Tarantino U, Iolascon G, Cianferotti L, Masi L, Marcucci G, Giusti F, Marini F, Parri S, Feola M, Rao C, Piccirilli E, Zanetti EB, Cittadini N, Alvaro R, Moretti A, Calafiore D, Toro G, Gimigliano F, Resmini G, Brandi ML. Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. J Orthop Traumatol 2017; 18:3-36. [PMID: 29058226 PMCID: PMC5688964 DOI: 10.1007/s10195-017-0474-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS Literature reviews by a multidisciplinary team. RESULTS The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided. CONCLUSIONS The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.
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Affiliation(s)
- Umberto Tarantino
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Gemma Marcucci
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Giusti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Marini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Simone Parri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Maurizio Feola
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Rao
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Basilici Zanetti
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Noemi Cittadini
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Dario Calafiore
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Francesca Gimigliano
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppina Resmini
- Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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11
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Neglia C, Argentiero A, Chitano G, Agnello N, Ciccarese R, Vigilanza A, Pantile V, Argentiero D, Quarta R, Rivezzi M, Di Tanna GL, Di Somma C, Migliore A, Iolascon G, Gimigliano F, Distante A, Piscitelli P. Diabetes and Obesity as Independent Risk Factors for Osteoporosis: Updated Results from the ROIS/EMEROS Registry in a Population of Five Thousand Post-Menopausal Women Living in a Region Characterized by Heavy Environmental Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111067. [PMID: 27809297 PMCID: PMC5129277 DOI: 10.3390/ijerph13111067] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Objectives: We aimed to analyze bone mineralization and the effect of different risk factors for osteoporosis in postmenopausal women. Methods: We found 4909 postmenopausal subjects within ≥10,000 records from the ROIS/EMEROS (Ionian and Salento Osteoporosis Registry/Euro Mediterranean Registry of Osteoporosis) registry, a population study carried out in an area characterized by heavy environmental pressure between Brindisi and Taranto from 2009 to 2016. All subjects were assessed via phalangeal quantitative ultrasound (QUS) to evaluate their bone mineralization (assessed via amplitude dependent speed of sound (AD-SoS)) and the association between demineralization and the presence of other conditions or risk factors. Results: Mean age was 64 ± 9.5 years and mean body mass index (BMI) was 28.7 ± 3.5 kg/m². Pearson correlation analyses revealed a negative association between bone mineralization (AD-SoS) and BMI (p < 0.001). By using multivariate logistic regression analysis, we observed significant values of odds ratios (ORs) of osteoporosis (adjusted for age, physical activity, and the use of drugs known to increase the risk of fractures) in subjects with diabetes and obesity: 1.39 (confidence interval (CI): 1.05-1.83) and 1.46 (CI: 1.20-1.78), respectively. A statistically significant linear trend of higher ORs of osteoporosis was found for increasing values of BMI. Conclusions: Our study confirmed the high impact of obesity and type 1 and type 2 diabetes on osteoporosis.
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Affiliation(s)
- Cosimo Neglia
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Alberto Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Giovanna Chitano
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Nadia Agnello
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Roberta Ciccarese
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Antonella Vigilanza
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Valerio Pantile
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Domenico Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Raffaele Quarta
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Matteo Rivezzi
- IOS, Southern Italy Hospital Institute, Medicina Futura Research, Naples 80100, Italy.
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public Health, Queen Mary University of London, London E1 4NS, UK.
| | - Carolina Di Somma
- IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples 80133, Italy.
| | | | - Giovanni Iolascon
- Department of Orthopaedic Surgery and Rehabilitation, Second University of Naples, Naples 81100, Italy.
| | - Francesca Gimigliano
- Department of Orthopaedic Surgery and Rehabilitation, Second University of Naples, Naples 81100, Italy.
| | - Alessandro Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Prisco Piscitelli
- IOS, Southern Italy Hospital Institute, Medicina Futura Research, Naples 80100, Italy.
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12
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Giannini S, Sella S, Rossini M, Braghin D, Gatti D, Vilei MT, Amabile A, Fusaro M, Frigo AC, Sergi G, Lovato R, Nobile M, Fabris F, Adami S. Declining trends in the incidence of hip fractures in people aged 65years or over in years 2000-2011. Eur J Intern Med 2016; 35:60-65. [PMID: 27363306 DOI: 10.1016/j.ejim.2016.06.007] [Citation(s) in RCA: 8] [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: 03/22/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to explore hip fracture (HFx) incidence in the Veneto Region of Italy, looking at potential differences with the national data. METHODS We analyzed HFx incidence for people aged 65years or over, in years 2000-2011, using data from the Regional Hospitalization Database. Patients were stratified by sex, calendar year and 5-year age class. Data for the single provinces of the Region were also obtained. Absolute number of HFx, crude incidence for 10,000 inhabitants and age-standardized fracture rates were calculated. RESULTS During the study period, there were 53,917 hospitalizations for HFx (77.7% in females). In the whole 11year period of observation, the absolute HFx number increased by 17.7% in males and 10.6% females, respectively. However, age-standardized incidence rates declined by 18% in the same period (IRR 0.82, 95% CI 0.78-0.87). This decreasing trend was almost identical through all the age-cohorts up to 84years. In the whole study period, HFx incidence was lower for Padova (IRR 0.63, 95% CI 0.60-0.66) and Verona (IRR 0.66, 95% CI 0.63-0.70) provinces as compared to the others. This regional profile was quite different with respect to the data published, for the same calendar years, for Italy as a whole, in spite of an almost identical demography of the population. CONCLUSIONS HFx incidence is declining in the Veneto Region of Italy. Further studies, aimed to investigate factors involved in this figure are needed.
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Affiliation(s)
- Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy.
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Daniela Braghin
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Maria Teresa Vilei
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Annalisa Amabile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maria Fusaro
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine, University of Padova, Italy
| | - Roberto Lovato
- Osteoporosis Center, Casa di Cura Villa Berica, Vicenza, Italy
| | - Martino Nobile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Fabrizio Fabris
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Silvano Adami
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
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13
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Azagra R, Zwart M, Encabo G, Aguyé A, Martin-Sánchez JC, Puchol-Ruiz N, Gabriel-Escoda P, Ortiz-Alinque S, Gené E, Iglesias M, Moriña D, Diaz-Herrera MA, Utzet M, Manresa JM. Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women. BMC Musculoskelet Disord 2016; 17:262. [PMID: 27317560 PMCID: PMC4912785 DOI: 10.1186/s12891-016-1096-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/24/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities. METHODS The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period. RESULTS One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively. CONCLUSIONS The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.
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Affiliation(s)
- Rafael Azagra
- Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain.,Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain.,QuironSalud-Hospital General de Catalunya, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
| | - Marta Zwart
- Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain. .,Health Center Can Gibert del Plà (ICS), Institut Català de la Salut, GROIMAP-USR Girona-IDIAP Jordi Gol, c/San Sebastian 9, 17005, Girona, Spain.
| | - Gloria Encabo
- Department of Nuclear Medicine, Valle de Hebron Hospital, Institut Català de la Salut, Ps/Valle de Hebron 119-129, 08035, Barcelona, Spain
| | - Amada Aguyé
- Health Center Granollers-Centre, Institut Català de la Salut, c/Museu 19, 08400, Granollers, Barcelona, Spain
| | - Juan Carlos Martin-Sánchez
- Department of Basic Sciences, Biostatistics Unit, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
| | - Nuria Puchol-Ruiz
- Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain
| | - Paula Gabriel-Escoda
- Health Center Barberà del Vallès, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Verge de l'Assumpció s/n, 08210, Barberà del Vallès, Barcelona, Spain
| | - Sergio Ortiz-Alinque
- Health Center Canaletes, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Ps d'Horta 17, 08290, Cerdanyola del Vallès, Barcelona, Spain
| | - Emilio Gené
- Department of Medicine, Universitat Autònoma de Barcelona, ps/Vall de Hebron 119, 08135, Barcelona, Spain.,Department of Medicine, Universitat Internacional de Catalunya, c/Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain.,Urgencies Service, Hospital of Sabadell, Corporació Sanitaria i Universitaria Parc Tauli, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain
| | - Milagros Iglesias
- Health Center Badia del Valles, Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Bética s/n, 08214, Badia del Vallés, Barcelona, Spain
| | - David Moriña
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, Av Gran Via, 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Departament d'Economia i Història Econòmica, Grups de Recerca d'Àfrica i Amèrica Llatines (GRAAL), Unitat de Fonaments de l'Anàlisi Econòmica, Universitat Autònoma de Barcelona, c/Emprius 2, 08202, Sabadell, Barcelona, Spain
| | - Miguel Angel Diaz-Herrera
- Health Center Cornellà 2 (Sant Ildefons), Institut Català de la Salut, GROIMAP-USR MN-IDIAP Jordi Gol, c/Republica Argentina s/n, 08940, Cornellá, Barcelona, Spain
| | - Mireia Utzet
- Biostatistics Unit, CUPESSE European Project, Universitat Pompeu Fabra, Ed Jaume I-Campus Ciutadella, 08003, Barcelona, Spain
| | - Josep Maria Manresa
- Unitat Supor Recerca Metropolitana Nord, IDIAP Jordi Gol, ctra de Barcelona 473, 08204, Sabadell, Barcelona, Spain.,Department of Nursing, Universitat Autònoma de Barcelona, avda Can Domenech s/n, 08193, Cerdanyola del Valles, Barcelona, Spain
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14
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Bianchi ML, Duca P, Vai S, Guglielmi G, Viti R, Battista C, Scillitani A, Muscarella S, Luisetto G, Camozzi V, Nuti R, Caffarelli C, Gonnelli S, Albanese C, De Tullio V, Isaia G, D'Amelio P, Broggi F, Croci M. Improving adherence to and persistence with oral therapy of osteoporosis. Osteoporos Int 2015; 26:1629-38. [PMID: 25619634 DOI: 10.1007/s00198-015-3038-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/12/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Osteoporosis treatment has low adherence and persistence. This study evaluated if greater patient involvement could improve them. At 12 months, only 114 out of 344 participants were "fully adherent and persistent" (all drug doses taken throughout the study). Only frequency of drug administration had a significant influence on adherence. INTRODUCTION Osteoporosis affects millions of individuals worldwide. There are now several effective drugs, but adherence to and persistence with treatment are low. This 12-month multicenter, prospective, randomized study evaluated the efficacy of two different methods aimed at improving adherence and persistence through greater patient involvement, compared with standard clinical practice. METHODS Three hundred thirty-four post-menopausal women, receiving an oral prescription for osteoporosis for the first time, were recruited and randomized into three groups: group 1 (controls, managed according to standard clinical practice) and groups 2 and 3 (managed with greater patient and caregiver involvement and special reinforcements: group 2, instructed to use several different "reminders"; group 3, same "reminders" as group 2, plus regular phone calls from and meetings at the referring Center). All enrolled women had two visits (baseline and 12 months). RESULTS Of 334 enrolled women, 247 (74%) started the prescribed therapy. Of those who started, 219 (88.7%) persisted in therapy for at least 10 months. At final evaluation, only 114 women were considered as "fully adherent and persistent" (all doses taken throughout the 12 months). There were no significant differences regarding "full adherence" among the three randomized groups. The frequency of drug administration had a significant influence: weekly administration had a >5-fold higher adherence and monthly administration an 8-fold higher adherence (p < 0.0001) than daily administration. CONCLUSIONS The special effort of devising and providing additional reminders did not prove effective. Additional interventions during the follow-up, including costly interventions such as phone calls and educational meetings, did not provide significant advantages.
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Affiliation(s)
- M L Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Via L. Ariosto 13, 20145, Milano, Italy,
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15
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Jou HJ, Siao RY, Tsai YS, Chen YT, Li CY, Chen CC. Postdischarge rehospitalization and in-hospital mortality among Taiwanese women with hip fracture. Taiwan J Obstet Gynecol 2015; 53:43-7. [PMID: 24767645 DOI: 10.1016/j.tjog.2012.04.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore the factors concerning postdischarge rehospitalization and in-hospital mortality among Taiwanese women older than 50 years with hip fracture. MATERIALS AND METHODS The National Health Insurance database from 2000 to 2006 was used to identity relevant cases. Women inpatients aged over 50 years with new-onset hip fracture in 2003 were identified. We analyzed the factors affecting postdischarge rehospitalization and in-hospital mortality. RESULTS In 2003, there were 9467 new-onset hip fracture inpatients claimed among Taiwanese women aged over 50 years. The 3-year cumulative rates of rehospitalization after discharge and in-hospital mortality rate were 11.01% (1043) and 7.10% (672), respectively. The factors determined to be related to rehospitalization were patient age, hospital level, length of stay of the initial hospitalization due to hip fracture, and Charlson comorbidity index (CCI) score. The factors determined to be related to in-hospital mortality were age, urbanization level of region where patients were insured, hospital level, length of stay of the initial hospitalization due to hip fracture, and CCI score. CONCLUSION Characteristics of women aged over 50 years with hip fracture remain an important issue based on high rehospitalization and in-hospital mortality rates. We have identified related risk factors that may be helpful in treating hip fracture among this population segment.
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Affiliation(s)
- Hei-Jen Jou
- Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Ruo-Yan Siao
- Department of Healthcare Development, Taiwan Adventist Hospital, Taipei, Taiwan
| | - You-Shih Tsai
- Department of Orthopedics, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yi-Tui Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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16
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The Economic Burden of Femoral Neck Fractures in Jamaica. W INDIAN MED J 2015; 63:454-9. [PMID: 25781282 DOI: 10.7727/wimj.2013.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 11/18/2022]
Abstract
Osteoporotic femoral neck fractures are increasing as the population ages. There is a significant cost to care for patients with such fractures. We prospectively analysed the in-hospital cost of managing 85 patients admitted to the University Hospital of the West Indies (UHWI) with such fractures. The majority of patients were females, 78.8%, and the mean age of the cohort was 83.7 years. There was a significant difference in the mean preoperative delay and length of stay between those patients treated publicly as compared to those treated privately, 9.6 vs 3.1 days and 18.9 vs 8.8 days, respectively. The mean acute cost of those treated publicly was 39% of the cost of those treated privately, J$110 878.80 vs J$284 287.61. The economic cost per year to the country for the acute management of femoral neck fractures was calculated at J$46 264 528.76 which is 0.30% of the 2005-2006 budgetary allocation for health. This cost was significantly associated with the length of hospital stay and the number of complications developed.
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17
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Rossini M, Viapiana O, Adami S, Idolazzi L, Buda S, Veronesi C, Degli Esposti L, Gatti D. Medication use before and after hip fracture: a population-based cohort and case-control study. Drugs Aging 2015; 31:547-53. [PMID: 24825617 DOI: 10.1007/s40266-014-0184-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Osteoporosis, together with age, is the main risk factor for hip fracture, the incidence of which has also been associated with an increased risk of falling or co-morbidities and related pharmacological treatments. OBJECTIVES The aim of this study was to investigate changes in concomitant pharmacological treatments prescribed before and after hip fracture in elderly patients compared with treatments prescribed to a matched cohort of subjects without hospitalisation for fractures. METHODS Data relating to the study population were extracted from a large population-based administrative database of the Italian National Health Authorities. A retrospective analysis was conducted involving female patients (6,431) aged ≥65 years and hospitalised for a hip fracture. The control group comprised age-matched subjects (38,586) not hospitalised for fracture. Changes in drug prescriptions 1 year before and 1 year after hip fracture and differences versus controls were compared. RESULTS Prior to the fracture, patients were taking more anti-Parkinson medications, antidepressants, medications for chronic obstructive pulmonary disease (COPD), bisphosphonates and calcium-vitamin D supplements, although the intake of the routinely monitored drug classes was significantly infrequent. Polypharmacy was less frequent in fractured women before fracture than in controls (22 vs. 25 %, respectively; P < 0.001), but it was more frequent (30 %, P < 0.001) post-fracture. The incidence of fracture was associated with a significant increase in the use of a number of drug classes: insulin, NSAIDs or analgesics, gastroprotectants, loop diuretics, β-blockers, antidepressants, antiparkinson drugs, antiepileptics and drugs for COPD. CONCLUSION Our study confirms a strong association between the use of some drugs (antidepressants, antiparkinson drugs, drugs for COPD) and the risk of hip fracture, but drug use is globally less common than in controls. Hip fracture is associated with a significant increase in drug use, suggesting a global deterioration of health conditions.
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Affiliation(s)
- Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy,
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18
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Cirera E, Pérez K, Santamariña-Rubio E, Novoa AM, Olabarria M. Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010. Injury 2014; 45:2076-83. [PMID: 25294117 DOI: 10.1016/j.injury.2014.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. METHODS We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. RESULTS Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. CONCLUSIONS Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.
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Affiliation(s)
- Eva Cirera
- Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Elena Santamariña-Rubio
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Marta Olabarria
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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19
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Factors influencing surgical delay after hip fracture in hospitals of Emilia Romagna Region, Italy: a multilevel analysis. Hip Int 2014; 23:15-21. [PMID: 23397198 DOI: 10.5301/hip.2013.10717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 02/04/2023]
Abstract
Hip fracture is becoming a major public health concern, with associated mortality and morbidity particularly in the elderly. This study aims to investigate factors (i.e. patient factors and hospital variables) associated with increased risk for delaying surgery after hip fractures, and to assess whether and to what extent timing was associated with mortality risk. All patients aged 65 and over, resident in Emilia Romagna Region (Italy) and admitted to hospital for hip fracture (2009 - 2010) were selected. Data on surgical delay were adjusted using multilevel logistic regression model. A Cox proportional hazard model was fitted to a propensity score matched sample to assess mortality between delayed and early treated patients. Of the 10, 995 patients included (mean age: 83.3 years), 44.9% underwent surgery within 2 days. Significant risk factors for delayed surgery were: gender (OR: 1.16), comorbidity (OR: 1.29), anticoagulant (OR: 7.64) ,antiplatelet medication (OR: 2.43) , type of procedure (OR: 1.37) and day of admission (OR: Thu-Fri: 6.05; Sat-Sun: 1.17). Type of hospital and annual volume of hip fracture surgeries were not sufficient to explain hospital variability. A significant difference in mortality rate between early and delayed surgery emerged six months post surgery.
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20
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Piscitelli P, Brandi M, Cawston H, Gauthier A, Kanis JA, Compston J, Borgström F, Cooper C, McCloskey E. Epidemiological burden of postmenopausal osteoporosis in Italy from 2010 to 2020: estimations from a disease model. Calcif Tissue Int 2014; 95:419-27. [PMID: 25200337 DOI: 10.1007/s00223-014-9910-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/12/2014] [Indexed: 12/15/2022]
Abstract
The article describes the adaptation of a model to estimate the burden of postmenopausal osteoporosis in women aged 50 years and over in Italy between 2010 and 2020. For this purpose, a validated postmenopausal osteoporosis disease model developed for Sweden was adapted to Italy. For each year of the study, the 'incident cohort' (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and deaths. Fracture by site (hip, clinical vertebral, non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected fracture site-specific risk of death and subsequent fractures. Model inputs specific to Italy included population size and life tables from 1970 to 2020, incidence of hip fracture and BMD by age in the general population (mean and standard deviation). The model estimated that the number of postmenopausal osteoporotic women would increase from 3.3 million to 3.7 million between 2010 and 2020 (+14.3%). Assuming unchanged incidence rates by age group over time, the model predicted the overall number of osteoporotic fractures to increase from 285.0 to 335.8 thousand fractures between 2010 and 2020 (+17.8%). The estimated expected increases in hip, vertebral and non-hip non-vertebral fractures were 22.3, 17.2 and 16.3%, respectively. Due to demographic changes, the burden of fractures is expected to increase markedly by 2020.
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Affiliation(s)
- P Piscitelli
- I.O.S., Southern Italy Hospital Institute, Centro Direzionale, Isola E3, Palazzo Avalon, Naples, 80143, Italy,
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21
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Neglia C, Argentiero A, Chitano G, Agnello N, Giolli L, Di Tanna G, Paladini D, Amati A, Marsico A, Caiaffa V, Conte P, La Selva G, Crafa S, Colì G, Ciccarese R, Vigilanza A, Distante C, Argentiero D, Pantile V, Benvenuto M, Di Renzo T, Reale A, Coppola R, Distante A, Colao A, Di Somma C, Migliore A, Auriemma R, Piscitelli P. Diabetes and Obesity as Independent Risk Factors for Osteoporosis in Postmenopausal Women: A Population Study. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to analyze bone mineralization and the effect of different risk factors for osteoporosis in postmenopausal women. We studied 2,756 postmenopausal subjects out of ≥10,000 records from the ROIS registry in the frame of the PROF Project, a population study carried out in Salento (Taranto, Brindisi, Lecce) from 2009 to 2012. All subjects were assessed by phalangeal Quantitative Ultrasound (QUS) to evaluate their bone mineralization (assessed by Amplitude Dependent Speed of Sound, AD-SoS) and the association between demineralization and the presence of other conditions or risk factors. Mean age was 64±9.5 years and mean BMI was 28.7±3.5 Kg/m2. Pearson correlation analyses revealed a negative association between bone mineralization (AD-SoS) and BMI (P<0.001). By using multivariate logistic regression analysis, we observed significant values of Odds Ratios of osteoporosis (adjusted for age, physical activity and the use of drugs known to increase the risk of fractures) in subjects with diabetes and obesity: 1.39 (CI: 1,05–1,83) and 1.46 (CI: 1.20–1.78), respectively. A statistically significant linear trend of higher Odds Ratios of osteoporosis was found for increasing values of BMI. The percent change in the odds of vertebral fractures per single SD decrease of AD-SoS was 47% (P<0.001). Diabetes and obesity in postmenopausal women are likely to represent independent risk factors for osteoporosis. Phalangeal QUS showed a good power of predictivity in identifying subjects with vertebral fractures.
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Affiliation(s)
- C. Neglia
- Department of Biological and Environmental Science and Technology (Di.S.T.E.B.A), University of Salento, Lecce, Italy
| | - A. Argentiero
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G. Chitano
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - N. Agnello
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - L. Giolli
- E-Campus University, Novedrate, Italy
| | | | - D. Paladini
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Amati
- Local Health Authority, ASL Taranto Taranto, Italy
| | - A. Marsico
- Local Health Authority, ASL Taranto Taranto, Italy
| | - V. Caiaffa
- Local Health Authority, ASL Taranto Taranto, Italy
| | - P. Conte
- Local Health Authority, ASL Taranto Taranto, Italy
| | - G. La Selva
- Local Health Authority, ASL Brindisi, Brindisi, Italy
| | - S. Crafa
- Local Health Authority, ASL Taranto Taranto, Italy
| | - G. Colì
- Local Health Authority, ASL Lecce, Gallipoli Hospital, Gallipoli, Italy
| | - R. Ciccarese
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Vigilanza
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - C. Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - D. Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - V. Pantile
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - M. Benvenuto
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | | | | | | | - A. Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - A. Migliore
- Fatebenefratelli St. Peter's Hospital- Department of Rheumatology, Rome, Italy
| | - R. Auriemma
- IOS, Southern Italy Hospital Institute, Naples, Italy
- Coleman Ltd, Naples, Italy
| | - P. Piscitelli
- IOS, Southern Italy Hospital Institute, Naples, Italy
- Coleman Ltd, Naples, Italy
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Piscitelli P, Feola M, Rao C, Celi M, Gasbarra E, Neglia C, Quarta G, Liuni FM, Parri S, Iolascon G, Brandi ML, Distante A, Tarantino U. Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women. World J Orthop 2014; 5:386-391. [PMID: 25035844 PMCID: PMC4095034 DOI: 10.5312/wjo.v5.i3.386] [Citation(s) in RCA: 30] [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: 10/08/2013] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the hospitalization rate of femoral neck fractures in the elderly Italian population over ten years.
METHODS: We analyzed national hospitalizations records collected at central level by the Ministry of Health from 2000 to 2009. Age- and sex-specific rates of fractures occurred at femoral neck in people ≥ 65 years old. We performed a sub-analysis over a three-year period (2007-2009), presenting data per five-year age groups, in order to evaluate the incidence of the hip fracture in the oldest population.
RESULTS: We estimated a total of 839008 hospitalizations due to femoral neck fractures between 2000 and 2009 in people ≥ 65, with an overall increase of 29.8% over 10 years. The incidence per 10000 inhabitants remarkably increased in people ≥ 75, passing from 158.5 to 166.8 (+5.2%) and from 72.6 to 77.5 (+6.8%) over the ten-year period in women and men, respectively. The oldest age group (people > 85 years old) accounted for more than 42% of total hospital admissions in 2009 (n = 39000), despite representing only 2.5% of the Italian population. Particularly, women aged > 85 accounted for 30.8% of total fractures, although they represented just 1.8% of the general population. The results of this analysis indicate that the incidence of hip fractures progressively increased from 2000 to 2009, but a reduction can be observed for the first time in women ≤ 75 (-7.9% between 2004 and 2009).
CONCLUSION: Incidence of hip fractures in Italy are continuously increasing, although women aged 65-74 years old started showing a decreasing trend.
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23
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Ghirardi A, Di Bari M, Zambon A, Scotti L, Della Vedova G, Lapi F, Cipriani F, Caputi AP, Vaccheri A, Gregori D, Gesuita R, Vestri A, Staniscia T, Mazzaglia G, Corrao G. Effectiveness of oral bisphosphonates for primary prevention of osteoporotic fractures. Eur J Clin Pharmacol 2014; 70:1129-37. [DOI: 10.1007/s00228-014-1708-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
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Legnani C, Dondi A, Pietrogrande L. Conservative treatment of a femoral neck fracture following nail removal. J Midlife Health 2014; 4:191-4. [PMID: 24672194 PMCID: PMC3952413 DOI: 10.4103/0976-7800.118995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrochanteric fracture that had occurred 20 months earlier. This was indicated due to continuous discomfort related to the protruding apex of the implant over the great trochanter. Due to pain persistence two days after surgery, a computed tomography (CT) scan was performed, documenting a minimally displaced impacted subcapital femoral neck fracture. Conservative management with close radiographic follow-up was conducted. After six months, the patient had returned to previous daily activities and a satisfactory range of motion was achieved without pain on walking. The purpose of our paper is to discuss the decision of removing hardware in the elderly osteoporotic patient and to analyze the possibility to conservatively treat an impacted minimally displaced subcapital fracture occurring after the removal of an IMN inserted previously for the treatment of a trochanteric fracture. In the elderly population with decreased bone quality, the removal of intramedullary implants of the proximal femur should be carefully evaluated, and osteoporotic patients undergoing reduction and fixation of femoral fractures should be encouraged to start antiosteoporotic therapy (bisphosphonate, teriparatide) to reduce the risk of further bone loss. Conservative treatment should be considered for the management of lesser symptomatic minimally displaced impacted fractures, where the inherent stability of the fracture allows rapid healing without further surgical attempts.
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Affiliation(s)
- Claudio Legnani
- Orthopaedics and Traumatology Residency, University of Milan, Milan, Italy
| | - Alessandra Dondi
- Orthopaedics and Traumatology Residency, University of Milan, Milan, Italy
| | - Luca Pietrogrande
- Department of Health Science - DISS, University of Milan, Milan, Italy
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Scotti L, Arfè A, Zambon A, Merlino L, Corrao G. Cost-effectiveness of enhancing adherence with oral bisphosphonates treatment in osteoporotic women: an empirical approach based on healthcare utilisation databases. BMJ Open 2014; 4:e003758. [PMID: 24662445 PMCID: PMC3975742 DOI: 10.1136/bmjopen-2013-003758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Adherence with bisphosphonates therapy is generally low. Enhancing adherence with bisphosphonates would be effective in achieving the full benefits of therapy albeit a growth in the expenditure for supporting incremented drug use is expected. The cost-effectiveness of enhancing adherence with oral bisphosphonates in a large population of osteoporotic women has been assessed in the current study. DESIGN Retrospective cohort study. SETTING Healthcare utilisation databases of Lombardy Region, Italy. PARTICIPANTS A cohort of 28 558 women aged 45 years or more, resident in the Italian Region of Lombardy, who were newly treated with oral bisphosphonates during 2003-2004, was followed for 6 years after index prescription. OUTCOME MEASURES Fracture-free survival time, healthcare cost and incremental cost-effectiveness ratio (ICER) of enhancing adherence, that is, the additional cost that would be spent every year for gaining one fracture-free year as a consequence of enhancing adherence at a certain level. RESULTS Enhanced adherence from 33% (baseline) to 80%, increased both fracture-free survivals from 970 to 973 years and healthcare costs from €118 000 to €265 000 every 1000 woman-years, with ICER value of €53 000 (95% CI €49 000 to €58 000). ICER values were lower for older women (€50 000; 95% CI €42 000 to €58 000) and for those suffering from at least a chronic comorbidity (€25000; 95% CI 95% CI €7000 to €47 000). CONCLUSIONS Enhancing adherence with oral bisphosphonates offers important benefits in reducing the risk of fracture, although at a substantial cost.
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Affiliation(s)
- Lorenza Scotti
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Andrea Arfè
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Lombardia Regional Council, Milan, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
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de Waure C, Specchia ML, Cadeddu C, Capizzi S, Capri S, Di Pietro ML, Veneziano MA, Gualano MR, Kheiraoui F, La Torre G, Nicolotti N, Sferrazza A, Ricciardi W. The prevention of postmenopausal osteoporotic fractures: results of the Health Technology Assessment of a new antiosteoporotic drug. BIOMED RESEARCH INTERNATIONAL 2014; 2014:975927. [PMID: 24689066 PMCID: PMC3932293 DOI: 10.1155/2014/975927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 10/29/2013] [Accepted: 11/08/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. METHOD Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. RESULTS In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. CONCLUSION Denosumab could add value in the prevention of osteoporotic fractures.
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Affiliation(s)
- Chiara de Waure
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Maria Lucia Specchia
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Chiara Cadeddu
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Silvio Capizzi
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Stefano Capri
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Maria Luisa Di Pietro
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Maria Assunta Veneziano
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Maria Rosaria Gualano
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Flavia Kheiraoui
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Giuseppe La Torre
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Nicola Nicolotti
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Antonella Sferrazza
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Walter Ricciardi
- Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Universitá Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
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Eekman DA, ter Wee MM, Coupé VMH, Erisek-Demirtas S, Kramer MH, Lems WF. Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation. Osteoporos Int 2014; 25:195-204. [PMID: 24072405 DOI: 10.1007/s00198-013-2505-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/05/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81% of these costs in employed patients. INTRODUCTION The aim of this prospective study was to gain insight into the current total costs of clinical fractures in osteoporotic patients aged 50 years and older. METHODS In a study in the Netherlands, patients prospectively filled out cost diaries every 3 months, during 1 year after a clinical fracture. Primary analyses were performed on those patients with all four cost diaries returned. In-depth analyses of indirect costs were performed, dividing results for employed and unemployed patients. Sensitivity analyses using imputation techniques were performed on patients who returned two or three diaries RESULTS Of the 116 included patients, 69 completed all four diaries, 24 only two or three, and 23 patient completed one or no diaries. For all fractures, approximately 50% of the total costs were due to indirect costs; employed patients contributed for at least 81% of the indirect cost. Humerus fractures were most expensive with a total 1-year cost of €16.841 per patient. Indirect costs in the group with clinical spine fractures were highest (<euro>12.522), accounting for 89.1% of the total costs for this fracture. CONCLUSION Indirect costs account for roughly half of the total costs of clinical fractures, which are largely related to sick leave. When performing cost analyses in fracture patients, we advise a societal perspective in which indirect costs are also considered, and to apply a patient derived prospective data collection method to get a 'true' and complete image of the total costs due to clinical fractures.
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Affiliation(s)
- D A Eekman
- Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands,
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Polesie S, Sigurdsen U, Bjørgul K. Unchanging incidence of hip fracture in southeastern norway. Geriatr Orthop Surg Rehabil 2013; 4:58-63. [PMID: 24093078 DOI: 10.1177/2151458513501321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to ascertain trends in the incidence of hip fracture in southeastern Norway by comparing the hip fracture incidence for the years 2008 to 2010 to that of a study from 1998 to 2003 in the same area. METHODS We determined the number of hip fractures for the geographical area of Ostfold county, and the age- and gender-specific incidence per 100 000, with 95% confidence intervals, was calculated. Use of bisphosphonates was determined by extracting data from public databases. RESULTS The hip fracture incidence for men aged 50 to 74 and older than 75 years was 120 (100-141) and 1305 (1237-1372) in the latest time period, 1998-2003, whereas the incidence for the previous period, 2008-2010, was 124 (103-146) for men aged 50 to 75 and 1333 (1189-1476) for men older than 75 years. For women of 50 to 74 years, the incidence was 184 (158-209), and for women older than 75 years, it was 2523 (2428-2618). In the first time period, the corresponding incidence was 228 (200-257) for women aged 50 to 74 and 2330 (2189-2471) for women older than 75 years. As the 95% confidence intervals overlap in all the comparisons, it indicates the the incidence did not significantly differ between the time periods. Bisphosphonate use did not exceed 2% in any age group for men. For women, the highest rate of bisphosphonate use was 12.6% in the 85- to 89-year groups. CONCLUSION We cannot confirm reports of decreasing incidence of hip fracture.
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Affiliation(s)
- Sam Polesie
- Department of Orthopedic Surgery, Ostfold Hospital Trust, Fredrikstad, Norway
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Iolascon G, Gravina P, Luciano F, Palladino C, Gimigliano F. Characteristics and circumstances of falls in hip fractures. Aging Clin Exp Res 2013; 25 Suppl 1:S133-5. [PMID: 24046036 DOI: 10.1007/s40520-013-0115-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/25/2013] [Indexed: 12/01/2022]
Abstract
Osteoporosis is a chronic disease characterized by a loss of bone mass and deterioration of bone microstructure that lead to a greater risk of fragility fractures. Fall is generally the main cause of fractures. Hip fractures are the most common ones and are usually correlated to a greater morbidity and mortality. The aim of our observational study was to evaluate, among patients with hip fragility fracture, characteristics and circumstances of falls. We conducted a national epidemiological survey, involving 80 physiatrists. They were asked to collect data on patients over 55 years of age who underwent a fragility fracture in the 12 months prior to recruitment. For each patient they had to fill a form including questions on different aspects of patients' medical history: age, gender, reason for the visit, type of fracture, number of falls in the last year and the year before the fall. Among 419 patients who sustained hip fracture, 70 had experienced a fall, while 119 were incurred in more falls in the 12 months before the fracture. In most people of our cohort, hip fracture was caused by a fall that occurred on the side during the morning.
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Affiliation(s)
- G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy,
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Guglielmi G, Rossini M, Nicolosi MG, Ragno A, Lentini G, de Terlizzi F. Three-year prospective study on fracture risk in postmenopausal women by quantitative ultrasound at the phalanges. J Clin Densitom 2013; 16:341-346. [PMID: 22901551 DOI: 10.1016/j.jocd.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022]
Abstract
The purpose of this study was the calculation of fracture risk in a prospective study on postmenopausal women by quantitative ultrasound (QUS) at the phalanges. A total of 2341 postmenopausal women were recruited in 5 centers in Italy during 2006 and 2007 for QUS measurement during a screening program for osteoporosis. Two ultrasound parameters were collected: amplitude-dependent speed of sound (AD-SoS) and ultrasound bone profile index (UBPI). Women were then recontacted in 2010 and were asked about fracture occurrence during the period since previous QUS measurement. Data about new fracture occurred in this period, site and cause of fracture were requested. Two thousand two hundred eleven women were successfully recontacted. Mean age of the recruited women was 60.9 ± 10.0 yr, mean age at menopause was 49.3 ± 4.4 yr, mean body mass index (BMI) was 26.5 ± 4.6 kg/m². A total number of 108 new major osteoporotic fractures occurred during the 3-yr period, of which 23 are hip fractures, 51 are vertebral fractures. Relative risk (RR) per standard deviation (SD) decrease for major fractures was 1.77 (confidence interval [CI]: 1.59-1.97) for AD-SoS and 2.06 (CI: 1.78-2.37) for UBPI. When corrected for age, BMI, age at menopause, the RRs are still significant and equal to 1.44 (CI: 1.26-1.65) for AD-SoS and 1.67 (CI: 1.39-2.00) for UBPI. RR for vertebral fractures was 1.63 (CI: 1.41-1.88) for AD-SoS and 1.73 (CI: 1.44-2.08) for UBPI. RR for hip fractures was 1.92 (CI: 1.55-2.37) for AD-SoS and 2.68 (CI: 1.86-3.86) for UBPI. Ultrasound parameters AD-SoS and UBPI are able to significantly predict future major fractures in a prospective cohort of more than 2000 postmenopausal women.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy.
| | - Maurizio Rossini
- Department of Rheumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mario Guido Nicolosi
- Department of Gynecology and Obstetrics, Divisione Ospedaliera B, S. Anna Hospital, Torino, Italy
| | - Alessandro Ragno
- Department of Internal Medicine, Ospedale "Regina Apostolorum," Albano Laziale, Italy
| | - Giovanni Lentini
- Department of Gynecology and Obstetrics, Buccheri La Ferla FBF Hospital, Palermo, Italy
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Lapi F, Cipriani F, Caputi AP, Corrao G, Vaccheri A, Sturkenboom MC, Di Bari M, Gregori D, Carle F, Staniscia T, Vestri A, Brandi M, Fusco V, Campisi G, Mazzaglia G. Assessing the risk of osteonecrosis of the jaw due to bisphosphonate therapy in the secondary prevention of osteoporotic fractures. Osteoporos Int 2013; 24:697-705. [PMID: 22618266 DOI: 10.1007/s00198-012-2013-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
SUMMARY There is evidence that the use oral bisphosphonates can lead to osteronecrosis of the jaws (ONJ). Although the occurrence of ONJ appears rare among oral bisphosphonates (BPs) users, it is important to know that it exists and can be opportunely minimized. INTRODUCTION The purpose of this study is to evaluate the association between BPs prescribed for the secondary prevention of osteoporotic fractures and the occurrence of ONJ. METHODS An Italian record linkage claims database with a target population of around 18 million individuals (6 million over 55 years of age) constituted the data source. We conducted a nested case-control study within a cohort of individuals aged 55+ years old, who were discharged from hospitals with a primary diagnosis of incident osteoporotic fracture. The date related to the discharge diagnosis of ONJ was the index date. Conditional logistic regression for matched data was fitted to estimate the odds ratio (OR) along with 95 % confidence intervals (95 % CI) for the likely association between use of BPs and the risk of ONJ. RESULTS Any one of the 61 ascertained cases of ONJ (incidence rate, 36.6 per 100,000 person-years) was matched to 20 controls for a total of 1120 controls. When the exposure to BPs was modeled according to recency (i.e., exposure time window prior to the index date) of use, the adjusted OR (95 % CI) for current users was 2.8 (1.3-5.9) against never users. The cumulative use of BPs has shown to increase the incidence of ONJ among patients with primary osteoporotic fractures, although not statistically significant risk has been observed. CONCLUSIONS Although the risk of BP-related ONJ appears low in non-oncological indications, it is important to be aware that it exists and to know how it may be predicted and possibly minimized.
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Affiliation(s)
- F Lapi
- Regional Agency for Healthcare Services of Tuscany, Florence, Italy.
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Cassell E, Clapperton A. A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporos Int 2013; 24:99-109. [PMID: 22349962 DOI: 10.1007/s00198-012-1937-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/31/2012] [Indexed: 01/06/2023]
Abstract
UNLABELLED In Victoria, Australia, the age-standardised incidence of fall-related hip fracture hospitalisations decreased significantly by 25% over the period 1998/1999-2008/2009. Significant decreases in fall-related hip fractures were observed in males and females, across all 5-year age groups, in Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people. INTRODUCTION The study aim was to investigate trends in the incidence of fall-related and hip fracture hospitalisations among Victorians aged 65 years and older overall and by age, gender, country of birth, socio-economic status (SES) and location of the event (home, residential care institution, etc.) over the 11-year period 1998/1999 to 2008/2009. METHODS Annual counts and age-standardised rates for fall-related hospitalisations among people aged 65 years and older were estimated using Victorian hospital admissions data. The statistical significance of changes in trends over time were analysed using a log-linear regression model of the rate data assuming a Poisson distribution of cases. RESULTS Although the age-standardised incidence of fall-related hospitalisations increased significantly by 13% (95% confidence interval [CI], 9% to 18%) in Victoria, the age-standardised incidence of fall-related hip fracture hospitalisations decreased from 600/100,000 in 1998/1999 to 467/100,000 in 2008/2009 - an estimated overall reduction of 25% (95% CI, -29% to -22%). By contrast, the age-standardised incidence of fall-related hospitalisations for fractures at other body sites either increased significantly or showed no significant change. Significant decreases in fall-related hip fractures were observed in both males and females, across all 5-year age groups, in both Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people but not in people living in residential care facilities. CONCLUSION Despite the downward trend in the age-standardised incidence of fall-related hip fractures in Victoria, the burden of fall-related and hip fracture hospitalisations on health care systems and the community is set to escalate due to the ageing of the Victorian population.
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Affiliation(s)
- E Cassell
- Victorian Injury Surveillance Unit, Monash Injury Research Institute, Clayton, Victoria, Australia.
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Piscitelli P, Iolascon G, Argentiero A, Chitano G, Neglia C, Marcucci G, Pulimeno M, Benvenuto M, Mundi S, Marzo V, Donati D, Baggiani A, Migliore A, Granata M, Gimigliano F, Di Blasio R, Gimigliano A, Renzulli L, Brandi ML, Distante A, Gimigliano R. Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging 2012; 7:575-83. [PMID: 23269863 PMCID: PMC3529634 DOI: 10.2147/cia.s36828] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population. METHODS We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820-821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433-434), and TIA (code 435) between 2001-2005. Cost analyses were based on diagnosis-related groups. RESULTS The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005). CONCLUSION The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.
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Lippuner K, Grifone S, Schwenkglenks M, Schwab P, Popp AW, Senn C, Perrelet R. Comparative trends in hospitalizations for osteoporotic fractures and other frequent diseases between 2000 and 2008. Osteoporos Int 2012; 23:829-39. [PMID: 21625882 DOI: 10.1007/s00198-011-1660-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/02/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED In Switzerland, the number, incidence, and cost of acute hospitalizations for major osteoporotic fractures (MOF) and major cardiovascular events (MCE) increased in both women and men between 2000 and 2008, although the mean length of stay (LOS) was significantly reduced. Similar trend patterns were observed for hip fractures and strokes (decrease) and nonhip fractures and acute myocardial infarctions (increase). INTRODUCTION The purpose of this study was to compare the trends and epidemiological characteristics of hospitalizations for MOF and other frequent diseases between years 2000 and 2008 in Switzerland. METHODS Trends in the number, age-standardized incidence, mean LOS, and cost of hospitalized MOF and MCE (acute myocardial infarction, stroke, and heart failure) were compared in women and men aged ≥ 45 years, based on data from the Swiss Federal Statistical Office. RESULTS Between 2000 and 2008, the incidence of acute hospitalizations for MOF increased by 3.4% in women and 0.3% in men. In both sexes, a significant decrease in hip fractures (-15.0% and -11.0%) was compensated by a concomitant, significant increase in nonhip fractures (+24.8% and +13.8%). Similarly, the incidence of acute hospitalizations for MCE increased by 4.4% in women and 8.2% in men, as an aggregated result from significantly increasing acute myocardial infarctions and significantly decreasing strokes. While the mean LOS in the acute inpatient setting decreased almost linearly between years 2000 and 2008 in all indications, the inpatient costs increased significantly (p < 0.001) for MOF (+30.1% and +42.7%) and MCE (+22.6% and +47.1%) in women and men, respectively. CONCLUSIONS Between years 2000 and 2008, the burden of hospitalized osteoporotic fractures to the Swiss healthcare system has continued to increase in both sexes. In women, this burden was significantly higher than that of MCE and the gap widened over time.
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Affiliation(s)
- K Lippuner
- Osteoporosis Policlinic, Inselspital, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland.
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Budhia S, Mikyas Y, Tang M, Badamgarav E. Osteoporotic fractures: a systematic review of U.S. healthcare costs and resource utilization. PHARMACOECONOMICS 2012; 30:147-70. [PMID: 22187933 DOI: 10.2165/11596880-000000000-00000] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Osteoporotic fractures are costly in terms of both the dollar amount and healthcare utilization. The objective of this review was to systematically synthesize published evidence regarding direct costs associated with the treatment of osteoporosis-related fractures in the U.S. We conducted a systematic literature review of published studies that used claims databases and economic studies reporting costs associated with osteoporosis-related fractures in the U.S. Studies published between 1990 and 2011 were systematically searched in PubMed (primary source), Ovid HealthSTAR, EMBASE and the websites of large agencies. Data concerning study design, patient population and cost components assessed were extracted with qualitative assessment of study methods, limitations and conclusions. Cost assessment included direct medical and hospitalization (inpatient) costs. The cost differences by age and gender were examined. Of the 33 included studies, 26 reported an estimated total medical cost and hospital resource use associated with osteoporotic fractures. These studies indicated that, in the year following a fracture, medical and hospitalization costs were 1.6-6.2 higher than pre-fracture costs and 2.2-3.5 times higher than those for matched controls. Analysis of the hospitalization costs by osteoporotic fracture type resulted in hip fractures identified as the most expensive fracture type (unit cost range $US 8358-32195), while wrist and forearm fractures were the least expensive (unit cost range $US 1885-12136). Although incremental fracture costs were generally lower in the elderly than in the younger population, total costs were highest for the older (≥65 years of age) population. Total healthcare costs for fractures were highest for the older female population, but unit fracture costs in women were not consistently found to be higher than for men. The qualitative assessment of the included studies demonstrated that the design and reporting of individual studies were of good quality. However, the findings of this review and comparisons across studies were limited by differences in methodologies used by the different studies to derive costs, the populations included in the studies used and the fracture assessment. Despite the variability in estimates, the literature indicates that osteoporosis-related fractures are associated with high total medical and hospitalization costs in the U.S. The variability in the cost estimates highlights the importance of comparing the methodologies and the types of costs used when choosing an appropriate unit cost for economic modelling.
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Lapi F, Simonetti M, Michieli R, Pasqua A, Brandi ML, Frediani B, Cricelli C, Mazzaglia G. Assessing 5-year incidence rates and determinants of osteoporotic fractures in primary care. Bone 2012; 50:85-90. [PMID: 21985999 DOI: 10.1016/j.bone.2011.09.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 07/11/2011] [Accepted: 09/22/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the gender and age-related 5-year incidence rates of osteoporotic fractures, and their related predictors, in a primary care setting. METHODS We obtained information from the Health Search-CSD Longitudinal Patients Database (HSD). This is an Italian General Practice data repository which comprises information given by computer-based patient records of a selected group of over 900 Primary Care Physicians (PCPs). We selected all patients aged 50 to 85 years, who were actively included into the PCP's list at the beginning of the enrolment period (1st January 2002-31st December 2003). We excluded individuals who were registered in the PCPs' list for less than 1 year before the entry date (Index date) into the cohort, as well as those who were diagnosed with Paget disease or malignant neoplasm. Participants were followed up until the occurrence of osteoporotic fracture, one of the exclusion criteria, or the end of the study period. RESULTS The 5-year rates (per 1000 person-years) of any osteoporotic fracture were 11.56 (95% C.I. 11.33 to 11.77) among females, and 4.91 (95% C.I. 4.75 to 5.07) among males. For hip fractures, the overall incidence rates were 3.23 (95% C.I. 3.11 to 3.34) among females and 1.21 (95% C.I. 1.12 to 1.28) among males, respectively. Advanced age, history of fracture, use of corticosteroids, rheumatoid arthritis, BMI<=20, presence of osteoporosis, gastrointestinal and chronic hepatic disease, depression, chronic obstructive pulmonary disease, use of anticonvulsants and a higher number of co-medications, increased the risk of any osteoporotic fractures. CONCLUSIONS The use of primary care data confirms a higher incidence of osteoporotic fractures among females vs. males as well as in older individuals. Predictors of osteoporotic fractures were consistent with FRAX® algorithm. Given the clinical utility of a simple score for the assessment of absolute fracture risk among osteoporotic patients, its assessment and validation in the Italian HSD could potentially provide an applicable prediction tool.
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Affiliation(s)
- F Lapi
- Department of Preclinical and Clinical Pharmacology, University of Florence, Italy.
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Gnudi S, Sitta E, Pignotti E. Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinal study in post-menopausal females. Br J Radiol 2011; 85:e467-73. [PMID: 22096224 DOI: 10.1259/bjr/57130600] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. METHODS In a 5 year follow-up study, the hip fracture incidence in 729 post-menopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. RESULTS The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). CONCLUSION Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture.
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Affiliation(s)
- S Gnudi
- Struttura Semplice Dipartimentale di Medicina Generale, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Isaia GC, Braga V, Minisola S, Bianchi G, Del Puente A, Di Matteo L, Pagano Mariano G, Latte VM, D'Amico F, Bonali C, D'Amelio P. Clinical characteristics and incidence of first fracture in a consecutive sample of post-menopausal women attending osteoporosis centers: The PROTEO-1 study. J Endocrinol Invest 2011; 34:534-40. [PMID: 21897107 DOI: 10.1007/bf03345393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Osteoporosis is a highly prevalent disease and fractures are a major cause of disability and morbidity. AIM The purpose of this study was to characterize post-menopausal women attending osteoporosis centers in Italy, to evaluate physician management, and to determine the incidence of first osteoporotic fracture. SUBJECTS AND METHODS PROTEO-1 was an observational longitudinal study with a 12-month follow-up. Data were collected from women attending osteoporosis centers. Women without prevalent fracture were eligible to enter the 1-yr follow-up phase: the clinical approach to patients according to their fracture risk profile and the incidence of fracture were recorded. RESULTS 4269 patients were enrolled in 80 centers in the cross-sectional phase; 34.2% had an osteoporotic fracture at baseline. Patients with prevalent fractures were older and more likely to be treated compared with non-fractured patients. The incidence of vertebral or hip fracture after 1 yr was 3.84%, regardless of the calculated risk factor profile, and was significantly higher in patients with back pain at baseline (4.2%) compared with those without back pain (2.2%; p=0.023). Generally, physicians prescribed more blood exams and drugs to patients at higher risk of fracture. Among fractured patients only 24% were properly treated; the rate of non-responders to treatment was about 4%. CONCLUSIONS In a large, unselected sample of post-menopausal women attending osteoporosis centers, those without previous fracture were at substantial risk of future fracture, regardless of their theoretical low 10-yr fracture risk. The presence of back pain in women without previous fracture warrants close attention.
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Affiliation(s)
- G C Isaia
- Gerontology Section, Department of Surgical and Medical Disciplines, University of Turin, Turin, Italy.
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Tarantino U, Capone A, Planta M, D'Arienzo M, Letizia Mauro G, Impagliazzo A, Formica A, Pallotta F, Patella V, Spinarelli A, Pazzaglia U, Zarattini G, Roselli M, Montanari G, Sessa G, Privitera M, Verdoia C, Corradini C, Feola M, Padolino A, Saturnino L, Scialdoni A, Rao C, Iolascon G, Brandi ML, Piscitelli P. The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study. Arthritis Res Ther 2010; 12:R226. [PMID: 21190571 PMCID: PMC3046539 DOI: 10.1186/ar3213] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 12/10/2010] [Accepted: 12/29/2010] [Indexed: 12/12/2022] Open
Abstract
Introduction We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. Methods We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. Results We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. Conclusions The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies.
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Affiliation(s)
- Umberto Tarantino
- Division of Orthopaedics and Traumatology, Tor Vergata Foundation University Hospital, University of Rome, Tor Vergata, Viale Oxford 81, Rome, 00133, Italy.
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