Regional variability in changes in the incidence of hip fracture in the Spanish population (2000-2012)

Trends in hip fracture rates in spain from 2001 to 2018

The present study includes the longest period of analysis with the highest number of hip fracture episodes (756,308) described in the literature for Spain. We found that the age-adjusted rates progressively decreased from 2005 to 2018. We believe that this is significant because it may mean that measures such as prevention and treatment of osteoporosis, or programs promoting healthy lifestyles, have had a positive impact on hip fracture rates.

PURPOSE

To describe the evolution of cases and rates of hip fracture (HF) in patients 65 years or older in Spain from 2001 to 2018 and examine trends in adjusted rates.

METHODS

Retrospective, observational study including patients ≥65 years with acute HF. Data from 2001 to 2018 were obtained from the Spanish National Record of the Minimum Basic Data Set of the Ministry of Health. We analysed cases of HF, crude incidence and age-adjusted rates by sex, length of hospital stay (LOS) and in-hospital mortality, and used joinpoint regression analysis to explore temporal trends.

RESULTS

We identified 756,308 HF cases. Mean age increased 2.5 years, LOS decreased 4.5 days and in-hospital mortality was 5.5-6.5%. Cases of HF increased by 49%. Crude rate per 100,000 was 533.3 (95% confidence interval [CI], 532.1-534.5), increasing 14.0% (95%CI, 13.7-14.2). Age-adjusted HF incidence rate increased by 6.9% from 2001 (535.7; 95%CI, 529.9-541.5) to 2005 (572.4; 95%CI, 566.7-578.2), then decreased by 13.3% until 2017 (496.1, 95%CI, 491.7-500.6). Joinpoint regression analysis indicated a progressive increase in age-adjusted incidence rates of 1.9% per year from 2001 to 2005 and a progressive decrease of -1.1% per year from 2005 to 2018. A similar pattern was identified in both sexes.

CONCLUSIONS

Crude incidence rates of HF in Spain in persons ≥65 years from 2001 to 2018 have gradually increased. Age-adjusted rates show a significant increase from 2001 to 2005 and a progressive decrease from 2005 to 2018.

The incidence of musculoskeletal injuries: a systematic review and meta-analysis

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.

Results

The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures.

Conclusion

The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.

Development and external validation of a 1- and 5-year fracture prediction tool based on electronic medical records data: The EPIC risk algorithm

OBJECTIVES

We aimed to develop and validate a fracture risk algorithm for the automatic identification of subjects at high risk of imminent and long-term fracture risk.

RESEARCH, DESIGN, AND METHODS

A cohort of subjects aged 50-85, between 2007 and 2017, was extracted from the Catalan information system for the development of research in primary care database (SIDIAP). Participants were followed until the earliest of death, transfer out, fracture, or 12/31/2017. Potential risk factors were obtained based on the existing literature. Cox regression was used to model 1 and 5-year risk of hip and major fracture. The original cohort was randomly split in 80:20 for development and internal validation purposes respectively. External validation was explored in a cohort extracted from the Spanish database for pharmaco-epidemiological research in primary care.

RESULTS

A total of 1.76 million people were included from SIDIAP (50.7 % women with mean age of 65.4 years). Hip and major fracture incidence rates were 3.57 [95%CI 3.53 to 3.60] and 11.61 [95%CI 11.54 to 11.68] per 1000 person-years, respectively. The derived model included 19 risk factors. Internal validity showed good results on calibration and discrimination. The 1-year C-statistic for hip and major fracture were 0.851 (95%CI 0.853 to 0.864), and 0.717 (95%CI 0.742 to 0.749) respectively. The 5-year C-statistic for hip and major fracture were 0.849 (95%CI 0.847 to 0.852) and 0.724 (95%CI 0.721 to 0.727) respectively. External validation showed good performance for hip and major fracture risk prediction.

CONCLUSIONS

We have developed and validated a clinical prediction tool for 1- and 5-year hip and major osteoporotic fracture risks using electronic primary care data. The proposed algorithm can be automatically estimated at the population level using the available primary care records. Future work is needed on the cost-effectiveness of its use for population-based screening and targeted prevention of osteoporotic fractures.

Predictive Performance of the FRAX Tool Calibrated for Spain vs. an Age and Sex Model: Prospective Cohort Study with 9082 Women and Men Followed for up to 8 Years

In Spain, the Fracture Risk Assessment Tool (FRAX) was adapted using studies with a small number of patients, and there are only a few external validation studies that present limitations. In this prospective cohort study, we compared the performance of FRAX and a simple age and sex model. We used data from the ESOSVAL cohort, a cohort composed of a Mediterranean population of 11,035 women and men aged 50 years and over, followed for up to 8 years, to compare the discrimination, calibration, and reclassification of FRAX calibrated for Spain and a logistic model including only age and sex as variables. We found virtually identical AUC, 83.55% for FRAX (CI 95%: 80.46, 86.63) and 84.10% for the age and sex model (CI 95%: 80.91, 87.29), and there were similar observed-to-predicted ratios. In the reclassification analyses, patients with a hip fracture that were reclassified correctly as high risk by FRAX, compared to the age and sex model, were −2.86%, using either the 3% threshold or the observed incidence, 1.54% (95%CI: −8.44, 2.72 for the 3% threshold; 95%CI: −7.68, 1.97 for the incidence threshold). Remarkably simple and inexpensive tools that are easily transferable into electronic medical record environments may offer a comparable predictive ability to that of FRAX.

Cognitive Impairment Level and Elderly Hip Fracture: Implications in Rehabilitation Nursing

PURPOSE

The aim of the study was to determine the cognitive impairment level influence in descriptive characteristics, comorbidities, complications, and pharmacological features of older adults with hip fracture.

DESIGN

Cross-sectional study.

METHOD

Five hundred fifty-seven older adults with hip fracture were recruited and divided into cognitive impairment levels (severe/moderate, mild, no impairment). Descriptive characteristics, comorbidities, complications, and pharmacological data were collected.

FINDINGS

Significant differences (p < .05, R = .012-.475) between cognitive impairment levels were shown. Shorter presurgery hospital length of stay and lower depression and Parkinson comorbidities; delirium complication; and antidepressants, antiparkinsonians, and neuroleptics use were shown for the no-impairment group. With regard to the cognitive impairment groups, lower presence of cardiopathy and hypertension; higher presence of dementia; antihypertensives, antiplatelets, and antidementia medication; infection/respiratory insufficiency complications; and lower constipation complications were shown.

CONCLUSION

Cognitive impairment levels may determine the characteristics, comorbidities, pharmacology, and complications of older adults with hip fracture.

CLINICAL RELEVANCE

Cognitive impairment level may impact rehabilitation nursing practice, education, and care coordination.

Stratified cost-utility analysis of total hip arthroplasty in displaced femoral neck fracture

OBJECTIVE

To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype.

METHOD

All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis.

RESULTS

The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465€ and 0.42 QALYs). Considering a willingness-to-pay threshold of €22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients.

CONCLUSIONS

Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients.

Effects of selective serotonin reuptake inhibitors and other antidepressant drugs on the risk of hip fracture: a case-control study in an elderly Mediterranean population

OBJECTIVES

To describe the association between exposure to different antidepressant drugs and hip fracture in an elderly Mediterranean population.

METHODS

Cases were all patients aged 50-95 years admitted to the emergency room of our hospital with hip fracture not related to a high intensity trauma during 2010. For each case, four controls were identified from primary care electronic medical records matched by age (±3 years), gender, date of consultation at the primary care centre (±1 month) and primary care centre. Pharmacological treatments received within the previous 5 years were retrieved from the prescription records. Crude and adjusted risks associated with exposures were calculated by conditional logistic regression. ORs were adjusted by matching variables and by significant risk factors identified in the bivariate analysis (prescription of ≥4 drugs, osteoporosis, diabetes mellitus and previous fracture).

RESULTS

136 cases and 544 controls were analysed. Adjusted OR (95% CI) for hip fracture associated with exposure to any antidepressants was 2.42 (1.24 to 4.73); for selective serotonin reuptake inhibitors (SSRIs) it was 3.52 (1.67 to 7.41), for non-selective monoamine reuptake inhibitors 1.07 (0.18 to 6.46) and for other antidepressants 0.82 (0.27 to 2.48). Sertraline (OR 3.88 (1.15 to 13.09)) was the only active principle with significant adjusted risk. When only exposures >6 months were considered, significant risks persisted for SSRIs (OR 2.64 (1.10 to 6.37)).

CONCLUSIONS

The results of this study are coincident with other studies in which SSRIs, but not other types of antidepressants, are associated with an increased risk of hip fracture in our setting.

Oldest old hip fracture patients: centenarians as the lowest complexity patients

BACKGROUND

Hip fracture leads to an increase in mortality and deterioration in the quality of life. The increase in life expectancy results in an increase in the number of oldest old patients.

AIMS

To analyze the characteristics of centenarian hip fracture patients and compare them with younger hip fracture patients.

METHODS

Retrospective study, including 176 patients (48 centenarians, 65 nonagenarians and 63 octogenarians) undergoing surgery after hip from 2009 to 2018 and followed for 1-year survival. Qualitative variables were compared by Chi-square test and quantitative variables, by Kruskal-Wallis test. Survival analysis was performed by Kaplan-Meier test and statistical differences were assessed by log-rank test. p value < 0.05 was considered statistically significant.

RESULTS

Centenarians showed the lowest Charlson index (p = 0.001), cognitive impairment (p < 0.001), and daily drug intake (p = 0.034). The in-hospital, 30-day and 1-year mortality rates did not show statistical significant differences. The 1-year survival analysis showed that patients died in order of age (p = 0.045). No differences were found regarding readmissions.

DISCUSSION

Hip fracture incidence in centenarians is increasing. Our study states the lowest complexity for centenarians. Hip fracture mortality rates have been linked to patients' age. In-hospital mortality rate has been reduced, and for the 30-day and 1-year mortality rates, we noted that mortality follows a pattern clearly related to age.

CONCLUSIONS

Centenarians showed the lowest comorbidity and complexity. Readmissions before 1 year, mortality rates at discharge, 30-day and 1-year follow-up were not significantly different, but 1-year survival analysis showed that patients are dying as they are ageing.

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

OBJECTIVE

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

SETTING AND PARTICIPANTS

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

OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Validity of a computerised population registry of dementia based on clinical databases

INTRODUCTION

The handling of information through digital media allows innovative approaches for identifying cases of dementia through computerised searches within the clinical databases that include systems for coding diagnoses. The aim of this study was to analyse the validity of a dementia registry in Gipuzkoa based on the administrative and clinical databases existing in the Basque Health Service.

METHODS

This is a descriptive study based on the evaluation of available data sources. First, through review of medical records, the diagnostic validity was evaluated in two samples of cases identified and not identified as dementia. The sensitivity, specificity and positive and negative predictive value of the diagnosis of dementia were measured. Subsequently, the cases of living dementia in December 31, 2016 were searched in the entire Gipuzkoa population to collect sociodemographic and clinical variables.

RESULTS

The validation samples included 986 cases and 327 no cases. The calculated sensitivity was 80.2% and the specificity was 99.9%. The negative predictive value was 99.4% and positive value was 95.1%. The cases in Gipuzkoa were 10 551, representing 65% of the cases predicted according to the literature. Antipsychotic medication were taken by a 40% and a 25% of the cases were institutionalised.

CONCLUSIONS

A registry of dementias based on clinical and administrative databases is valid and feasible. Its main contribution is to show the dimension of dementia in the health system.

East-west gradient in hip fracture incidence in Spain: how much can we explain by following the pattern of risk factors?

Our objective was to analyze the incidence and trend of hip fracture in Spain and its distribution by Autonomous Community (AC). In Spain, the age-adjusted incidence rate of hip fracture is decreasing. There is great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, and climatic factors and cohort effect factors of the civil war explain 96% of this variability.

INTRODUCTION

In Spain, there is great variability between the different Autonomous Communities (ACs) in the incidence of hip fracture. The objectives of our study are (1) to estimate the incidence rate and trend of hospital admissions for hip fracture in Spain and by ACs and (2) to analyze risk factors/markers that could explain the variability in the incidence and trend between different ACs.

METHOD

This work includes 2 studies (TREND-HIP and VAR-HIP). TREND-HIP: retrospective, national, observational study based on the administrative database of the National Health System that includes a Minimum Basic Data Set (MBDS) of hospital admissions. VAR-HIP: ecological study based on the analysis of the results obtained in TREND-HIP study, with different risk factors/markers obtained from different sources.

RESULTS

In the 17 years included in the analysis, there were 744,848 patients diagnosed with hip fracture. The global age-adjusted rate of hip fracture at the national level was 315.38/100,000 person*year (95% CI 312.36-317.45); by AC, the rate varied from 213.97 in the Canary Islands to 363.13 in the Valencia and Cataluña communities. We observe an east-west gradient in Spain. The trend for both sexes was - 0.67% (95% CI 0.9990-0.9957) (p < 0.001). In the analysis of risk factors/markers that explain this distribution, we found significant correlations with genetic factors, demographics, climatic factors and the time a region was on the Republican side of the civil war. The linear regression model that includes the factors that show significant correlation explains 96% of the variability observed.

CONCLUSION

In Spain, the age-adjusted incidence rate for hip fracture is decreasing. There is a great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, climatic factors and the cohort effect of the civil war explain 96% of this variability.

Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population

The prevalence of hip fracture and associated risk factors in China were evaluated in a Health and Retirement Longitudinal Study. There is an apparent geographic variation in the prevalence of hip fracture in China. Advanced age, West region, lower education, under-weight, having self-reported history of chronic lung diseases, heart diseases, stroke, and arthritis appear to be associated with risk of hip fracture.

INTRODUCTION

The aim of this study is to estimate the prevalence of hip fracture and to identify its risk factors in China.

METHODS

Using the national survey data collected from the China Health and Retirement Longitudinal Study (CHARLS), we estimated the prevalence of hip fracture, considering the complex survey design and response rate. We applied the weighted logistic regression analysis to identify risk factors associated with hip fracture employing cross-sectional study designs.

RESULTS

Among 20,110 respondents included in the analysis, there were 431 hip fractures. The overall prevalence of hip fracture among middle-aged and older Chinese adults was 2.36%. From those aged<50 years to 60-69 years, the prevalence of hip fracture did not increase with age, but significantly increased after the age of 70; 1.62% for those aged <50 years and 5.42% for those aged ≥70 years. East, South-Central, South-West, and North-West region had a higher prevalence of hip fracture than North and North-East region. Compared with underweight, obesity (OR 0.37 [95% CI 0.20-0.69]) was associated with a lower likelihood of hip fracture. A self-reported history of chronic lung diseases (OR 2.11 [95% CI 1.51-2.96]), heart diseases (OR 1.36 [95% CI 1.00-1.85]), stroke (OR 2.30 [95% CI 1.08-4.92]), and arthritis (OR 2.30 [95% CI 1.08-4.92]) were significantly correlated with hip fracture.

CONCLUSIONS

There is an apparent geographic variation in the prevalence of hip fracture in China. Advanced age, West region, lower education, under-weight, having self-reported history of chronic lung diseases, heart diseases, stroke, and arthritis appear to be associated with risk of hip fracture. Understanding the geographic variations in hip fracture prevalence is important for allocation of healthcare resources. Knowing the reasons for hip fracture is necessary to implement a comprehensive policy for hip fracture prevention in China.

Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium

Despite an increase in absolute numbers, the age-standardized incidence of hip fractures in Singapore declined in the period 2000 to 2017. Among the three major ethnic groups, Chinese women had the highest fracture rates but were the only group to show a temporal decline.

INTRODUCTION

A study published in 2001 predicted a 30-50% increase in Singapore hip fracture incidence rates over the ensuing 30 years. To test that prediction, we examined the incidence of hip fracture in Singapore from 2000 to 2017.

METHODS

We carried out a population-based study of hip fractures among Singapore residents aged ≥ 50 years. National medical insurance claims data were used to identify admissions with a primary discharge diagnosis of hip fracture. Age-adjusted rates, based on the age distribution of the Singapore population of 2000, were analyzed separately by sex and ethnicity (Chinese, Malay, or Indian).

RESULTS

Over the 18-year study period, 36,082 first hip fractures were recorded. Total hip fracture admissions increased from 1487 to 2729 fractures/year in the years 2000 to 2017. Despite this absolute increase, age-adjusted fracture rates declined, with an average annual change of - 4.3 (95% CI - 5.0, - 3.5) and - 1.1 (95% CI - 1.7, - 0.5) fractures/100,000/year for women and men respectively. Chinese women had 1.4- and 1.9-fold higher age-adjusted rates than Malay and Indian women: 264 (95% CI 260, 267) versus 185 (95% CI 176, 193) and 141 (95% CI 132, 150) fractures/100,000/year, respectively. Despite their higher fracture rates, Chinese women were the only ethnic group exhibiting a decline, most evident in those ≥ 85 years, in age-adjusted fracture rate of - 5.3 (95% CI - 6.0, - 4.5) fractures/100,000/year.

CONCLUSION

Although the absolute number of fractures increased, steep drops in elderly Chinese women drove a reduction in overall age-adjusted hip fracture rates. Increases in the older population will lead to a rise in total number of hip fractures, requiring budgetary planning and new preventive strategies.

Seasonality in incidence and mortality of hip fracture

OBJECTIVES

To determine whether there is a seasonal relationship in the incidence and in-hospital mortality of patients with hip fracture.

PATIENTS AND METHODS

Longitudinal descriptive study of cases that included 1104 patients older than 64years admitted for fracture of the proximal extremity of the femur in the Hospital HCU Virgen de la Victoria during a period of 30months The epidemiological characteristics of the patients were recorded and the monthly incidence of fractures was related with the month of the year in which it occurred, as well as with the meteorological conditions, temperature and rainfall.

RESULTS

The study population comprised a total of 1104 patients, with a greater proportion of women (75.1%). The average age was 82.3years. A tendency towards an increased incidence of these fractures was found. The in-hospital annual mortality rate was 2.97%, higher for men and in the age group over 84years. Seasonality was found in terms of the incidence of fractures above the average in the month of October and below this in the month of February. On the other hand, mortality was lower than the average in the month of March and higher in August. In both, a low correlation with temperature and rainfall was found.

CONCLUSIONS

The seasonal distribution of hip fractures presented an increase over the average in the month of October and a decrease in February. Mortality increased over the average in the month of August and decreased in March.

Influence of demographic and clinical characteristics of elderly patients with a hip fracture on mortality: A retrospective, total cohort study in North-East Spain

IMPORTANCE

The increased mortality after hip fracture (HF) is caused by multiple factors, and large samples are needed to assess the weight of each factor. To date, few studies have investigated these factors through a total cohort approach, and the complexity of underlying medical conditions has not been considered.

OBJECTIVE

To investigate the influence of demographic and clinical characteristics on increased mortality risk in elderly patients with hip fracture (HF).

DESIGN

Retrospective, total cohort study collecting 4-year data.

SETTING

All hospitals and primary care units owned by, or associated with, Catalonia's local health department (CatSalut) (north-east Spain).

PARTICIPANTS

All patients aged ≥65 years, admitted to Catalan hospitals from CatSalut because of a HF between 1st January 2012 and 31st December 2015.

EXPOSURE

Hip fracture.

MAIN OUTCOME MEASURES

The main outcome was survival. Measures regarding demographic and clinical characteristics at the moment of hospital admission included age, sex, osteoporosis treatment, previous fractures, type of intervention, nutritional status, and comorbidities. Patients were stratified using the Adjusted Morbidity Groups (GMA) risk assessment tool.

RESULTS

Of the 30,552 patients included in the study sample, 10,439 (34%) died during follow-up, 6821 (22%) within the first year after hospital admission. Mean (SD) age was 84 (7) years; 75% were female. Baseline factors with greater influence on survival were age (HRs 1.44 [95% CI 1.22-1.70], 2.38 [2.03-2.79], and 4.38 [3.73-5.15] for age groups 70-79, 80-89, and >89, respectively), underweight (HR 1.65 [1.36-2.01]), lack of surgical intervention (HR 2.64 [2.47-2.83]), and very high risk stratum of GMA risk (HR 1.58 [1.45-1.73]). Vitamin D/calcium supplementation and osteoporosis treatment showed a significant but moderate influence on mortality (HRs 0.84 (0.79-0.88) and 0.92 [0.85-0.99], respectively).

CONCLUSIONS AND RELEVANCE

In elderly patients with HF, age and health status factors at hospital admission have the greatest impact on mortality risk after hospital admission. Our findings encourage a comprehensive intervention aimed at improving underlying medical conditions of HF patients.

[Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]

OBJECTIVE

To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid.

MATERIAL AND METHOD

This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables).

RESULTS

The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%.

DISCUSSION

Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.

Validity of a computerized population registry of dementia based on clinical databases

INTRODUCTION

The handling of information through digital media allows innovative approaches for identifying cases of dementia through computerized searches within the clinical databases that include systems for coding diagnoses. The aim of this study was to analyze the validity of a dementia registry in Gipuzkoa based on the administrative and clinical databases existing in the Basque Health Service.

METHODS

This is a descriptive study based on the evaluation of available data sources. First, through review of medical records, the diagnostic validity was evaluated in 2 samples of cases identified and not identified as dementia. The sensitivity, specificity and positive and negative predictive value of the diagnosis of dementia were measured. Subsequently, the cases of living dementia in December 31, 2016 were searched in the entire Gipuzkoa population to collect sociodemographic and clinical variables.

RESULTS

The validation samples included 986 cases and 327 no cases. The calculated sensitivity was 80.2% and the specificity was 99.9%. The negative predictive value was 99.4% and positive value was 95.1%. The cases in Gipuzkoa were 10,551, representing 65% of the cases predicted according to the literature. Antipsychotic medication were taken by a 40% and a 25% of the cases were institutionalized.

CONCLUSIONS

A registry of dementias based on clinical and administrative databases is valid and feasible. Its main contribution is to show the dimension of dementia in the health system.

Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010

BACKGROUND AND OBJECTIVE

The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend.

METHODS

Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010.

RESULTS

There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895).

CONCLUSIONS

In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia.

The 13-year observation of hip fracture in Poland-worrying trend and prognosis for the future

INTRODUCTION

Hip fractures are often considered to be one of the most common osteoporotic fractures. In our previous study, we noted the increasing trend in the total number of hip fractures as well as crude and standardized rates, for both women and men. This observation enabled us to delve deeper into the study of osteoporotic fractures.

METHODS

Hospital records between 1.01.2002 and 31.12.2014 with ICD-10 codes S72.0. S72.1 and S72.2 (femoral neck. intertrochanteric, subtrochanteric, and inter and subtrochanteric fracture) were analysed. All fractures occurred in citizens who lived in the district Tarnowskie Góry and the city of Piekary Śląskie aged 50 years and more.

RESULTS

1507 fragility hip fractures (400 in men, and 1107 in women) were registered. The rates increase in both sexes was still observed. The tendency to sustain fractures was lower in female (29.3%) than in the male population (63.6%). We observed a lower increase in urban (35.8%) population when compared to rural (40.8%) population. Incidence rate ratios for female gender were 1.89 (95% CI 1.65-2.18). The rates in 2014 were as follows: crude rate of 216.2 (men 140.9; women 276.5) and standardized 183.9 (131.6 and 219.4, respectively). This observation allowed as to project a total crude rate of 467.2 (men 329.6; women 584.7) for the year 2050.

CONCLUSIONS

The number of osteoporotic hip fractures in Polish men and women is still relatively low, but the epidemiological situation is getting worse. The over 13 years of follow-up demonstrated that the trend to increase in total number of hip fractures for men and women is still observed. This prognosis is of a major concern.

Trends in osteoporotic hip fracture epidemiology over a 17-year period in a Spanish population: Alcorcón 1999-2015

Our aim was to analyze trends in osteoporotic hip fracture rates in a suburban health area over a long time period. We detected a steady decrease, especially in women, that could be explained by historical, administrative, lifestyle changes as well as by medical behavior.

PURPOSE

The purpose of this study was to analyze trends in osteoporotic hip fracture rates in a suburban health area over a long time period.

METHODS

This is an ecological retrospective study of all discharges occurring in the Alcorcón health area and registered in the minimum basic data set (MBDS). The incidence of osteoporotic hip fracture was calculated by age and sex strata over the last 17 years. General lineal models were used to analyze trends.

RESULTS

Between 1999 and 2015, 4271 osteoporotic hip fractures occurred in people over 45 (78% women; mean age 83). The annual osteoporotic hip fracture rate was 290/100,000 persons over 45 (women 428; men 134), or 767/100,000 persons over 65 (women 1087, men 364). The incidence of fractures decreased yearly by 3.6% (95% CI 2.8 to 4.5) in the 1999-2015 period (p < 0.001) and was more pronounced in women [3.9% (95% CI 3.0 to 4.8)] than in men [2.4% (95% CI 0.9 to 3.8)]. In people over 65 years, fracture incidence decreased yearly by 3.7% (95% CI 2.8 to 4.6; p < 0.001). Again, this was more pronounced in women [4% (95% CI 3.05 to 4.9)] than in men [2.4 (95% CI 0.8 to 3.9)] while the female/male ratio decreased from 4.45 in 1999 to 2.4 in 2015. These differences were similar for extracapsular and intracapsular fractures.

CONCLUSIONS

These findings suggest a downward trend in the incidence of hip fracture in Alcorcón, both in men and in women. Possible explanations are discussed, including the effectiveness of osteoporosis diagnosis and treatment campaigns over the last 20 years, and the so-called "cohort effect."

Primary and secondary non-adherence to osteoporotic medications after hip fracture in Spain. The PREV2FO population-based retrospective cohort study

Osteoporotic medication after hip fracture is widely recommended by clinical practice guidelines, and medication adherence is essential to meet clinical trial risk reduction figures in the real world. We assessed primary and secondary non-adherence to osteoporosis medications in patients discharged following a hip fracture and identified factors associated with secondary non-adherence. From a population-based retrospective cohort of 19,405 patients aged 65 years and over discharged from a hip fracture in the region of Valencia (Spain) from January 1, 2008 and June 30, 2012, we followed, over a minimum of 365 days, 4,856 patients with at least one osteoporotic medication prescribed within the first six months after discharge. Less than one third of the patients discharged alive after a hip fracture received osteoporotic treatment. Primary non-adherence among naïve patients was low. However, long-term secondary adherence measured by Proportion of Days Covered with medication (PDC) and persistence was largely suboptimal, with naïve users having worse results than experienced patients. Secondary non-adherence was associated with primary non-adherence and age, dementia or sedative treatments for naïve users and with being male, being older than 85 and having dementia for experienced users. Three quarters of naïve users and two thirds of experienced users had interrupted treatment at 48 months.

National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals

BACKGROUND

Traumatic fractures place a substantial burden on health-care systems worldwide. Although detailed information about incidence, distribution, and risk factors for traumatic fractures is vital for planning and prevention, in China, national data are unavailable. We aimed to do an up-to-date national survey on the population-weighted incidence of traumatic fractures in China.

METHODS

The China National Fracture Study (CNFS) was a retrospective epidemiological study that recruited a nationally representative sample from eight provinces, 24 urban cities, and 24 rural counties in China using stratified random sampling and the probability proportional to size method. All eligible household members who had lived in their current residence for 6 months or longer were personally interviewed by trained research teams about traumatic fractures of the trunk, arms, or legs (not including the skull, sternum, and ribs) that had occurred in 2014. Telephone surveys were used for participants who were non-contactable after repeated visits. Fracture cases were verified by clinical records, medical history, and radiographs by orthopaedic surgeons and radiologists. We estimated incidence rates for traumatic fractures for the overall population and for subgroups by age and sex, as well as by demographic factors such as ethnic origin, occupation, geographical region, and residency category. We also studied potential associations between fractures and various factors of interest, such as age, ethnic origin, education, smoking, alcohol drinking, sleep time per day, and history of previous fracture. Data were weighted during statistical analysis to ascertain the national incidence rate. This study is registered with the Chinese Clinical Trial Registry, number ChiCTR-EPR-15005878.

FINDINGS

Between Jan 19, 2015, and May 16, 2015, 535 836 individuals were selected and invited to participate in the study. Questionnaires from 23 649 (4%) individuals were excluded due to missing items, insufficient responses, or logical errors. Following exclusions, 512 187 (96%) individuals participated in the CNFS, consisting of 259 649 (51%) boys and men and 252 538 (49%) girls and women. Of these individuals, 1763 individuals had experienced traumatic fractures during 2014 (n=1833). The population-weighted incidence rate of traumatic fractures of the trunk, arms, or legs was 3·21 (95% CI 2·83-3·59) per 1000 population in 2014 (3·65, 3·12-4·18 in men and 2·75, 2·46-3·04 in women). For all ages, sleeping less than 7 h per day was identified as a risk factor for traumatic fractures. We identified previous fracture history as a risk factor for adults aged 15 years and older. Alcohol consumption incurred a risk effect for men aged 15 years and older and women aged 15-64 years.

INTERPRETATION

Our results provide detailed information about fracture incidence, distribution, and risk factors, which can now be used as an up-to-date clinical evidence base for national health-care planning and preventive efforts in China and elsewhere. Specific public health policies that focus on decreasing alcohol consumption, prohibiting drunk driving, promoting smoking cessation, and encouraging individuals to obtain sufficient sleep and maintain a healthy bodyweight should be urgently implemented to help reduce the risk of traumatic fractures.

FUNDING

The Hebei Province Medical Science Special Major Projects Research Fund.

Secular trend in the incidence of hip fracture in Catalonia, Spain, 2003-2014

Objectives

to describe the secular trend and seasonal variation in the incidence of hip fracture (HF) over 12 years (2003-2014) in Catalonia, the community with the highest incidence of HF in Spain.

Methods

data about age, gender, type of fracture and month of hospitalisation among patients aged 65 years and older discharged with a diagnosis of HF were collected. Crude and age-standardised annual incidence rate were reckoned. To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR) was calculated.

Results

we identified 100,110 HF in the period, with an increase of 16.9% (women 13.4%; men 28.4%). Trochanteric fractures were the most frequent (55.8%). The crude incidence rate (per 100,000 population) decreased from 677.2 (95% confidence interval (95% CI) 662.0-692.7) to 657.6 (95% CI 644.0-671.5). The standardised incidence rate decreased from 754.0 (95% CI 738.6-769.3) to 641.5 (95% CI 627.7-655.3), with a sharp decrease in women (-16.8%) while it was stable in men. The incidence by type of fracture was stable. The trend throughout the period showed a slight decrease with IRR 0.99 (95% CI 0.98-0.99; P = 0.025). The incidence was stable in the oldest group (+85 years), while there was a downward trend in the younger groups. A significant seasonal pattern was observed, with more cases in winter and less in summer (spring as reference).

Conclusions

the secular trend reveals a decreasing incidence of HF although the absolute number has increased in the last 12 years in Catalonia. Trochanteric fractures were the most prevalent and a seasonal pattern was observed, with more cases in winter.

Declining trends in the incidence of hip fractures in people aged 65years or over in years 2000-2011

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.