The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

Two-Year Mortality Predictors in Fragility Fractures-A Medical Records Review Study

PURPOSE

To evaluate two-year mortality predictors in all subtypes of fragility fractures.

METHODS

Medical records review, single-center study with Portuguese patients with fragility fractures; A univariate analysis, with chi-square for categorical variables and parametric t-student and non-parametric Wilcoxon tests for continuous variables, was performed. Posteriorly, a survival analysis, with subsequent Cox regression was conducted to establish independent risk factors/ predictors of two-year mortality in fragility fractures.

RESULTS

758 patients were enrolled in the study. We found a total of 151 deaths within the first two years post-fracture. On Cox regression, older age [OR1.10 CI (1.05-1.11)], male sex [OR1.85 CI(1.24-2.75)], anemia at baseline [OR2.44 CI(1.67-3.57)], malignancy [OR4.68 CI (2.13-10.27)], and multimorbidity [OR1.78 CI(1.11-2.87)] were found as independent predictors for two-year post-fracture mortality.

CONCLUSION

Our study suggests that male sex, older age, anemia, malignancy, and multimorbidity are mortality predictors in the first two years after fragility fractures, reinforcing the importance of comorbidity management in preventing or, at least, minimizing adverse outcomes following fragility fractures.

Assessment of rehabilitation nurses' knowledge and results of nurse educational programme (C2F) regarding osteoporosis and fragility fractures

BACKGROUND

Providing adequate care for the person with a fragility fracture is essential to prevent recurrences. A key strategy involves training by improving nursing care in the fields of osteoporosis and fragility fractures. However, in Portugal, there is no report on the level of knowledge of nurses, nor experimental studies on how to improve it.

OBJECTIVE

The study aimed to assess the knowledge of Rehabilitation Nurses in Portugal on osteoporosis and fragility fractures. Additionally, it sought to evaluate the impact of a specific educational programme on nurses' knowledge.

METHODS

In Phase I, a cross-sectional study involved 452 participants, utilizing a 26-question knowledge test. In Phase II, a quasi-experimental study included 42 nurses from 28 hospitals, subjected to a 30-h hybrid educational programme. The program comprised 9 online (2 h 30 min each) and 2 live sessions, covering assessment, pharmacological and non-pharmacological treatment, monitoring, project planning, consultations, and outcome indicators measurement. A before-and-after programme knowledge test was administered.

RESULTS

Phase I revealed an average knowledge score of 69.6%. In Phase II, there was a significant improvement with programme (70.4% vs. 85.8%, p < 0.01). Specialized nurses performed better than non-specialized nurses (80% vs. 75%, p = 0.011), and those from orthopaedic services showed the greatest improvement (92% vs. 83%, p = 0.014).

CONCLUSIONS

Rehabilitation Nurses in Portugal have room to improve their knowledge of osteoporosis and fragility fractures. The hybrid educational programme proved effective in improving nurses' knowledge, especially among specialist and orthopaedic service nurses. We hope that this knowledge can be translated into continuous improvement in healthcare provision.

Orem's Self-Care Model of Nursing Care: A Retrospective Study with Elders After Hip Arthroplasty

This retrospective study investigates the effectiveness of a nursing intervention based on Orem's self-care model of nursing with elderly patients with femoral head necrosis who underwent total hip arthroplasty. Postoperative outcomes in the intervention and control groups were assessed by the visual analog scale (VAS), Barthel index, and Harris Hip Score (HHS). Participants in the intervention group had significantly better outcomes in terms of VAS, Barthel index, and HHS. The occurrence of pneumonia was significantly different between the groups. Those who underwent Orem's self-care model of nursing intervention were highly satisfied with their status postoperatively compared with the control group.

Safety-promoting interventions for the older person with hip fracture on returning home: A systematic review

BACKGROUND

Older adults with a prior history of falls that results in hip fractures have difficulties in regaining pre-fracture functional capacity. Scientific evidence has shown benefits of the implementation of multidimensional rehabilitation programs, but this evidence is not systematized with regard to continuity of care after hospital discharge.

OBJECTIVE

To identify interventions that promote safety and functional recovery of older adults with hip fractures after hospital discharge.

METHOD

A systematic review was carried out according to Cochrane methodology. The research strategy was predefined for the MEDLINE and CINAHL databases. The identified articles were screened according to the eligibility criteria by two independent reviewers. The articles included in the bibliographic sample were evaluated for risk of bias.

RESULTS

Of the 10,036 articles found, 10 were included in this systematic review. The safety-promoting interventions identified were: exercise training, occupational therapy/activities of daily living training, transfer and gait training, strengthening exercises, education on assistive device use, fall prevention education, nutritional assessment, environmental modifications/adjustments at home, use of an app, medication, self-care education, and support and counseling.

CONCLUSIONS

In eight studies analyzed, exercise training emerged as the most effective intervention for promoting the safety of older adults after hip fractures on returning home. Three studies associated two or more interventions, which focused on exercise training, occupational therapy/training of activities of daily living, and conventional postoperative rehabilitation with transfer and gait training, strengthening exercises, education on assistive device use and discharge planning, aiming to achieve muscle strengthening and safe gait, associated with the performance of activities of daily living.

Rapid decline of kidney function increases fracture risk in the general population: Insights from TLGS

BACKGROUND

Although the association between Chronic Kidney Disease (CKD) and all-cause fractures was addressed in previous studies, the association between estimated glomerular filtration rate (eGFR) decline and fractures was poorly addressed. For the first time we examined the association between rapid kidney function decline (RKFD) and fracture incidence among Iranian general population.

METHODS

In a Tehranian community-based cohort, RKFD was defined as a 30 % decline in eGFR over 2-3 years. Cox proportional hazards models, adjusted for age, sex, current eGFR, diabetes mellitus, hypertension, dyslipidemia, current smoking, obesity status, waist circumference, prevalent cardiovascular diseases, aspirin, steroid use, education level, and marital status, were used to examine the association of RKFD with different fracture outcomes.

RESULTS

Among 5305 (3031 women) individuals aged ≥30 years, during the median follow-up of 9.62 years, 226 fracture events were observed. The multivariable hazard ratio of RKFD for any-fracture events, lower-extremity, and major osteoporotic fractures were 2.18 (95 % CI, 1.24-3.85), 2.32 (1.15-4.71), and 2.91 (1.29-6.58), respectively. These associations remained significant after accounting for the competing risk of death. The impact of RKFD on the development of incident all-cause fractures was not modified by gender [men: 2.64 (1.11-6.25) vs. women: 2.11 (1.00-4.47)] and according to current CKD status [without CKD: 2.34 (1.00-5.52) vs. with CKD: 2.59 (1.04-6.44)] (all P for interaction >0.5).

CONCLUSIONS

RKFD can increase the incidence of fractures among general population, the issue that was equally important among non-CKD individuals, emphasizing the need for early identification and management in those with rapidly declining eGFR.

Costs of Hip Fractures in Postmenopausal Women in Portugal: A Study from the Payer's Perspective

N/a.

Costs of incident non-hip osteoporosis-related fractures in postmenopausal women from a payer perspective

Osteoporosis-related fractures lead to high morbidity, mortality, and healthcare costs among post-menopausal women. This study showed that incident non-hip osteoporosis-related fractures are frequent among women aged 50 + in Portugal, leading to excessive healthcare costs of €74 million per year, in a conservative scenario.

PURPOSE

This study aimed to estimate the costs of incident non-hip osteoporosis-related fractures among postmenopausal women living in Portugal from a payer perspective.

METHODS

The study includes women ≥ 50 years old who participated in the baseline assessment (2011-2013) and the first follow-up wave (2013-2015) of the Epidemiology of Chronic Diseases cohort, a Portuguese community-based longitudinal prospective study (n = 2,762). Incident non-hip osteoporosis-related fractures were defined as any self-reported low impact non-hip fractures since baseline. Healthcare resource utilization during the year following fracture was obtained from an informal panel of experts. The amounts of resources used were multiplied by the national tariffs practiced in the National Health Service (NHS) to obtain the cost per patient in the year following a wrist, vertebral, or other site fracture, which was subsequently multiplied by the estimated annual number of incident fractures to obtain the total annual cost of incident non-hip osteoporosis-related fractures among postmenopausal women.

RESULTS

Each year approximately 5,000 wrist, 3,500 vertebral, and 39,000 other-site osteoporosis-related fractures occur in women aged 50 + in Portugal. Healthcare costs per patient in the year following fracture vary from €2,709.52 for vertebral fractures to €3,096.35 for other fractures. Non-hip incident osteoporosis-related fractures among 50 + women cost approximately €74 million per year. Among all healthcare services, physiotherapy represents the bulk of costs.

CONCLUSIONS

This study pinpoints the relevance of preventing non-hip osteoporosis-related fractures, as these cost about €74 million per year in direct healthcare costs, a substantial impact on the budget of the Portuguese NHS.

An enhanced version of FREM (Fracture Risk Evaluation Model) using national administrative health data: analysis protocol for development and validation of a multivariable prediction model

BACKGROUND

Osteoporosis poses a growing healthcare challenge owing to its rising prevalence and a significant treatment gap, as patients are widely underdiagnosed and consequently undertreated, leaving them at high risk of osteoporotic fracture. Several tools aim to improve case-finding in osteoporosis. One such tool is the Fracture Risk Evaluation Model (FREM), which in contrast to other tools focuses on imminent fracture risk and holds potential for automation as it relies solely on data that is routinely collected via the Danish healthcare registers. The present article is an analysis protocol for a prediction model that is to be used as a modified version of FREM, with the intention of improving the identification of subjects at high imminent risk of fracture by including pharmacological exposures and using more advanced statistical methods compared to the original FREM. Its main purposes are to document and motivate various aspects and choices of data management and statistical analyses.

METHODS

The model will be developed by employing logistic regression with grouped LASSO regularization as the primary statistical approach and gradient-boosted classification trees as a secondary statistical modality. Hyperparameter choices as well as computational considerations on these two approaches are investigated by an unsupervised data review (i.e., blinded to the outcome), which also investigates and handles multicollinarity among the included exposures. Further, we present an unsupervised review of the data and testing of analysis code with respect to speed and robustness on a remote analysis environment. The data review and code tests are used to adjust the analysis plans in a blinded manner, so as not to increase the risk of overfitting in the proposed methods.

DISCUSSION

This protocol specifies the planned tool development to ensure transparency in the modeling approach, hence improving the validity of the enhanced tool to be developed. Through an unsupervised data review, it is further documented that the planned statistical approaches are feasible and compatible with the data employed.

Epidemiology of Hip Fractures Due to Falls

Background and Objectives: The epidemiological pattern of the hip fracture burden attributable to falls in Central European countries is still insufficiently known. The aim of this study was to assess the regional and national trends of hip fractures due to falls in Central Europe from 1990 to 2019. Materials and Methods: Using the Global Burden of Disease (GBD) 2019 study, this descriptive epidemiological study presents trends in incidence of and Years Lived with Disability (YLDs) from hip fractures due to falls in the region of Central Europe. All estimates (age- and sex-specific rates, and age-standardized rates) were expressed per 100,000. A joinpoint regression analysis was used to assess trends: the average annual percent change (AAPC) with a corresponding 95% confidence interval (95% CI) was calculated. Results: Among all new cases of hip fracture in the population as a whole in Central Europe in 2019, 3.9% in males and 7.0% in females were attributable to falls, while the share of hip fractures due to falls in the population aged 70 and over was 16.9% in males and 20.0% in females. About 400,000 new cases of hip fracture due to falls occurred in the Central European region in 2019 (220,000 among males and 160,000 among females), resulting in 55,000 YLDs (32,000 in females and 22,000 in males). About one-third of all new cases (59,326 in males and 72,790 in females) and YLDs (8585 in males, and 10,622 in females) of hip fractures due to falls were recorded in Poland. From 1990 to 2019, the age-standardized incidence rates of hip fracture due to falls showed a decreasing tendency in females (AAPC = -1.1%), and an increasing tendency in males (AAPC = 0.1%). Both in males and females, YLDs rates of hip fracture due to falls in the Central European region decreased (AAPC = -1.6% and AAPC = -2.4%, respectively). Conclusions: Hip fracture due to falls represents an important health issue in the Central European region, although incidences and YLDs declined in the most recent decades. However, further efforts to reduce the burden of hip fractures attributed to falls are needed.

Alcohol Consumption and Risk of Fractures: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Alcohol consumption remains inconsistently correlated with fracture risk, and a dose-response meta-analysis for specific outcomes is lacking. The objective of this study was to quantitatively integrate the data on the relationship between alcohol consumption and fracture risk. Pertinent articles were identified in PubMed, Web of Science, and Embase databases up to 20 February 2022. Combined RRs and 95% CIs were estimated by random- or fixed-effects models. Restricted cubic splines were used to model linear or nonlinear relationships. Forty-four articles covering 6,069,770 participants and 205,284 cases of fracture were included. The combined RRs and 95% CIs for highest compared with lowest alcohol consumption were 1.26 (1.17-1.37), 1.24 (1.13-1.35), and 1.20 (1.03-1.40) for total, osteoporotic, and hip fractures, respectively. A linear positive relationship between alcohol consumption and total fracture risk was detected (Pnonlinearity = 0.057); the risk was correlated with a 6% increase (RR, 1.06; 95% CI: 1.02, 1.10) per 14 g/d increment of alcohol consumption. J-shaped relationships of alcohol consumption with risk of osteoporotic fractures (Pnonlinearity < 0.001) and hip fractures (Pnonlinearity < 0.001) were found. Alcohol consumption of 0 to 22 g/d was linked to a reduced risk of osteoporotic fractures and hip fractures. Our findings show that any level of alcohol consumption is a risk factor for total fractures. Moreover, this dose-response meta-analysis shows that an alcohol consumption level of 0 to 22 g/d is related to a reduction in the risk of osteoporotic and hip fractures. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022320623).

Psychometric properties of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery: A translation and validation study

Objective

The purpose of this study was to translate and verify the reliability and validity of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery.

Methods

A total of 502 older adult/adults patients after hip fracture surgery were recruited from Liaoning, Shanxi, and Beijing, China. The reliability of the Chinese version of the scale was measured by internal consistency, split-half reliability, and retest reliability, and the validity was evaluated by the content validity index and structure validity index.

Results

The Chinese version of the HFS-SC scale had a Cronbach's alpha coefficient of 0.848, and the Cronbach's alpha coefficients for the five dimensions ranged from 0.719 to 0.780. The split-half reliability of the scale was 0.739, and the retest reliability was 0.759. The content validity index (S-CVI) was 0.932. The five-factor structure, supported by the eigenvalues, total variance explained, and the scree plot accounted for 66.666% of the total variance. In confirmatory factor analysis, the model fit results were as follows, X2/df = 1.847, GFI = 0.914, AGFI = 0.878, PGFI = 0.640, IFI = 0.932, TLI = 0.912, CFI = 0.931, RMSEA = 0.058, PNFI = 0.679. The indicators of the model's fit were within reasonable bounds.

Conclusion

The Chinese version of the self-care scale for older adults undergoing hip fracture surgery has suitable reliability and validity. The scale can be used to assess the level of older adult/adults self-care in China following hip replacement surgery and serves as a useful benchmark for identifying potential intervention targets to raise the level of older adult/adults self-care following hip replacement surgery.

Risk factors for refracture after proximal femur fragility fracture

Introduction

Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF.

Methods

Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated.

Results

From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05-20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08-1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months).

Conclusion

Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.

Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study

This study analyzed the impact of hip fractures on people's health-related quality of life and its socio-demographic disparities in China.

PURPOSE

Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China.

METHODS

Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL.

RESULTS

A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05).

CONCLUSION

Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.

Two-Part Intertrochanteric Femur Fractures with Bisection of the Lesser Trochanter: An Irreducible Fracture Pattern

Objective

To introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter.

Methods

From January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures.

Results

All patients were followed up for an average of 14.2 ± 2.1 months. Clinical fracture union occurred at an average of 10.8 ± 1.5 weeks, while radiographic union occurred at an average of 12.7 ± 1.2 weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair.

Conclusion

Two-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.

Rehabilitation for life: the effect on physical function of rehabilitation and care in older adults after hip fracture-study protocol for a cluster-randomised stepped-wedge trial

Background

A hip fracture is a serious event for older adults, given that approximately 50% do not regain their habitual level of physical function, and the mortality rate is high, as is the number of readmissions. The gap in healthcare delivery, as separated into two financial and self-governing sectors, might be a contributing cause of inferior rehabilitation and care for these patients. Therefore, we aim to assess the effect of continuous and progressive rehabilitation and care across sectors for older adults after hip fracture.

Methods/design

The project is designed as a stepped-wedge cluster randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). Healthcare professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for healthcare professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks of progressive resistance exercises initiated 1–2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors will be conducted. On day, 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital. The primary outcome is a Timed Up and Go Test 8 weeks post-surgery.

Discussion

Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve.

Trial registration

The study is approved by the Regional Scientific Ethics Committees of Southern Denmark (S-20200070) and the Danish Data Protection Agency (20-21854). Registered 9 of June 2020 at ClinicalTrials.gov, NCT04424186.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06321-w.

Safety-Promoting Interventions for the Older Person with Hip Fracture on Returning Home: A Protocol for a Systematic Review

Ageing and physical frailty associated with decrease in muscle and bone mass lead to the older persons' vulnerability and increased risk of falling. It is estimated that one in every ten falls in this age group results in a fracture, leading to a downward spiral in their health status, causing greater dependence, with a progressive functional decline that makes it difficult to return to their functional and social status prior to the fracture. The aim of this study is to identify the available evidence on the interventions that promote the safety of older people with hip fracture after hospital discharge. A search will be performed in MEDLINE and CINAHL databases. Randomised and controlled studies that focus on functional assessment, performance in activities of daily living, level of concern about falls, risk and prevalence of falls, injuries secondary to falls, re-fracture rate and health-related quality of life in hip fracture patients will be included. Two authors will perform the study selection, data extraction, and quality assessment independently. Any disagreements will be resolved through discussion with a third researcher. Methodological quality of the included trials will be evaluated by the Cochrane risk-of-bias criteria, and the Standards for Reporting Interventions in Controlled Trials.

The pattern and trends of disease burden due to low bone mineral density from 1990 to 2019 in China: findings from the Global Burden of Disease Study 2019

Osteoporosis is becoming increasing important health problem in China. This study shows that the disease burden of low bone mineral density (BMD) in China is large and will remain increasing with the growth of aging population. In addition, male low BMD should not be ignored. Although burden of low BMD is partially representative of the real burden of osteoporosis, the information provided in our study could be used to better inform targeted public health prevention and management programs for osteopososis.

PURPOSE

We aim to investigate the pattern and trends of disease burden due to low BMD by gender, year, and age in China from 1990 to 2019.

METHODS

Data on summary exposure value (SEV) and disability-adjusted life years (DALYs) due to low BMD was obtained from the Global Burden of Disease Study 2019, and analyzed by gender, age, and years. Average annual percent change (AAPC) and annual percent change (APC) were calculated to qualify the trends of burden due to low BMD.

RESULT

In 2019, the age-standardized SEV was higher in females than that in males (23.04, 95% UI = [17.25-29.83] and 12.50, 95% UI = [7.71-19.25], respectively), while the total number of DALYs was higher in males than females with 1,698,705.92 (95% UI = 1,281,580.79 to 2,076,364.25) and 1,621,569 (95% UI = 1,266,284.89 to 2,016,399.16), respectively. Though SEV exhibited decreasing trends during 1990 to 2019 in both sexes, the absolute number of DALYs due to low BMD increased steadily and almost doubled in 2019 compared to that in 1990.

CONCLUSION

The burden of low BMD remains large and continues to increase. Although females are prone to low BMD, the disease burden for males should not be ignored.

Costs of patient management over 18 months following a hip, clinical vertebral, distal forearm, or proximal humerus fragility fracture in France-results from the ICUROS study

This observational study prospectively assessed direct and indirect costs related to patient management over 18 months following hip, clinical vertebral, humeral, or distal forearm fracture events in France. It appears that their levels were much higher than the previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.

INTRODUCTION

This prospective observational study assessed the costs related to patient management over the 18-month period following the event of a hip, clinical vertebral, humeral, or distal forearm fracture in France.

METHODS

Individuals aged ≥ 50 years old with the diagnosis of a fragility fracture in six French University Hospitals were enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). All resources used over the defined period and related to fracture and the underlying osteoporosis management were collected by questionnaires at baseline, 4 months, 12 months, and 18 months. Information was collected by direct or phone contact completed by patients' records and interviews of partner, family, and general practitioners. Costs were estimated from a societal perspective, including direct and indirect costs. We implemented recursive partitioning analysis (RPA), a statistical learning algorithm to identify predictors of costs.

RESULTS

Four hundred thirty-one patients (mean age 72.5 years; 84.6% women) were evaluated. Among them, 17.6% had a prior fracture in the last 5 years. Approximately half of the whole group lived alone in the community, and 56.8% were from a low- or middle-income category. Over the 18-month period of evaluation, total costs (including initial fracture-related and follow-up ones) were 23 926 €, 14 561 €, and 6 905 € for the hip, clinical vertebral, and distal forearm fracture, respectively. Over a year, costs related to a humeral fracture were 10 319 €. The RPA identified mobility impairment prior to fracture as a predictor of increase in costs related to fracture.

CONCLUSIONS

Our study for the first time prospectively assessed total costs related to the four main osteoporotic fractures in France. It appears that their levels were much higher than previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.

Predictors of Mortality and Refracture in Patients Older Than 65 Years With a Proximal Femur Fracture

OBJECTIVES

To evaluate potential predictors of subsequent fracture and increased mortality in a population 65 years or older who suffered a proximal femur fragility fracture.

METHODS

This was a longitudinal study that included patients with a proximal femur fragility fracture, referred from the Orthopedics Inpatient Department to the Rheumatology Department's Fracture Liaison Service, from March 2015 to March 2017.

RESULTS

Five hundred twenty-two patients were included, with a median age (IQR) of 84 years (interquartile range [IQR], 11 years), 79.7% (n = 416) female. Nine percent (n = 47) suffered a new fracture, with a median time to event of 298 days (IQR, 331 days). Cumulative probability without refracture at 12 months was 93% (95% confidence interval [CI], 90.2%-95.0%); 22.8% (n = 119) patients died, with median time to death of 126 days (IQR, 336 days). Cumulative survival probability at 12 months was 81.7 (95% CI, 77.9-84.8). Neurologic disease (hazard ratio [HR], 2.30; 95% CI, 0.97-5.50; p = 0.06) and chronic obstructive pulmonary disease (HR, 3.61; 95% CI, 1.20-10.9; p = 0.022) were both predictors of refracture. Age older than 80 years (HR, 1.54; 95% CI, 0.99-2.38; p = 0.052), higher degree of dependence (HR, 1.24;95% CI, 1.09-1.42; p = 0.001), male sex (HR, 1.55; 95% CI, 1.03-2.33; p = 0.034), femoral neck fracture (HR, 0.45; 95% CI, 0.24-0.88; p = 0.018), Charlson score (HR, 2.08; 95% CI, 1.17-3.69; p = 0.012), heart failure (HR, 2.44; 95% CI, 1.06-5.63; p = 0.037), hip bone mass density (HR, 3.99; 95% CI, 1.19-13.4; p = 0.025), hip T score (HR, 0.64; 95% CI, 0.44-0.93; p = 0.021), and β-crosslaps (HR, 1.98; 95% CI, 1.02-3.84; p = 0.042) all predicted a higher mortality.

CONCLUSIONS

Neurologic disease and chronic obstructive pulmonary disease may increase the risk of subsequent fracture after a hip fracture. Male sex, age, autonomy degree, femur bone mass density/T score, fracture type, Charlson score, diabetes mellitus, heart failure, and β-crosslaps had significant impact on survival. The authors highlight β-crosslaps as a potential serological marker of increased mortality in clinical practice.

Romosozumab versus Teriparatide for the Treatment of Postmenopausal Osteoporosis: A Systematic Review and Meta-analysis through a Grade Analysis of Evidence

OBJECTIVE

To provide a systematic review about the efficacy and safety of romosozumab and teriparatide for the treatment of postmenopausal osteoporosis.

METHOD

Randomized controlled trials (RCTs) were searched from electronic databases, including PubMed (1996 to June 2019), Embase (1980 to June 2019), Cochrane Library (CENTRAL, June 2019), Web of Science (1998 to June 2019), and others. The primary outcomes included the following: the percentage change in bone mineral density of lumbar spine and total hip from baseline at month 6 and month 12 in each group. The secondary outcomes included the following: the percentage change in bone mineral density of femoral neck from baseline at month 6 and month 12 in each group and the incidence of adverse events at month 12 in each group.

RESULTS

Four studies containing 1304 patients met our selection criteria. The result of our analysis indicated that romosozumab showed better effects in improving BMD of lumbar spine (month 6: MD = 3.54, 95% CI [3.13, 3.94], P<0.001; month 12: MD = 4.93, 95% CI [4.21, 5.64], P<0.001), total hip (month 6: MD = 2.27, 95% CI [0.62, 3.91], P = 0.007; month 12: MD = 3.17, 95% CI [2.68, 3.65], P<0.001), and femoral neck (month 6: MD = 2.30, 95% CI [0.51, 4.08], P = 0.01; month 12: MD = 3.04, 95% CI [2.29, 3.78], P<0.001). Also, the injection-site reaction was less (month 12: RR = 2.84, 95% CI [1.22, 6.59], P = 0.02), but there were no significant difference in the incidence of serious adverse events (month 12: RR = 0.78, 95% CI [0.46, 1.33], P = 0.37) and death (month 12: RR = 0.61, 95% CI [0.08, 4.62], P = 0.63).

CONCLUSION

Based on the available studies, our current results demonstrate that romosozumab was better than teriparatide both in terms of efficacy and side effects.

Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS)

Little is known about factors that lead to excess mortality post-fracture. This study demonstrated that 5-year mortality is lower in older adults who recovered to their pre-fracture health-related quality of life (HRQoL) at 12-months compared to those who did not recover. Our results highlight the importance of post-fracture interventions known to improve HRQoL.

INTRODUCTION

Fragility fractures lead to increased mortality and decreased health-related quality of life (HRQoL) in older adults, although whether an association exists between these outcomes remains uncertain. The aim of this study was to determine whether recovery of HRQoL 12-month post-fracture is associated with lower 5-year mortality.

METHODS

This data linkage study included 524 adults (mean age: 70.2 years; 79.2% women) with fragility fracture (150 hip, 261 distal forearm, 61 vertebral, 52 humerus) from the Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS). HRQoL was measured using the EQ-5D-3L and all-cause mortality post-fracture was ascertained from the Australian National Death Index (NDI). Cox proportional hazards models were used to assess the association between HRQoL recovery (vs. non-recovery) and all-cause mortality within 5 years.

RESULTS

Overall, 279 participants (53.2%) recovered to their pre-fracture HRQoL at 12-month follow-up. There were 70 deaths (13.4%) during the 5-year post-fracture. Mortality rate was the highest in hip fracture participants (24.7%), followed by vertebral (16.4%), humeral (13.5%), and distal forearm fracture participants (6.1%). After adjustment for age, pre-fracture HRQoL, and fracture site, mortality risk was lower in participants who recovered to their pre-fracture HRQoL at 12-months compared to those who did not recover (HR = 0.56, 95% CI: 0.33-0.96, p = 0.034).

CONCLUSION

This study provides evidence that HRQoL recovery post-fracture is associated with improved 5-year survival in older adults. The extent to whether current interventions known to improve HRQoL post-fracture could prevent some of these deaths is unknown.

Four-month outcome after proximal femur fractures and influence of early geriatric rehabilitation: data from the German Centres of Geriatric Trauma DGU

This study analyzed the outcome of orthogeriatric patients with hip fracture 4 months after surgery. The overall mortality rate was 12.2%. Sixty-five percent presented a degradation in walking ability, and 16% had to move to a nursing home. Early geriatric rehabilitation reduces the mortality rate and increases the rate of anti-osteoporotic treatment.

PURPOSE

Hip fractures are increasingly common with severe consequences. Therefore, the German Trauma Society (DGU) implemented an orthogeriatric co-management and developed the concept for certified Centre for Geriatric Trauma DGU. The patients' treatment data and the optional 120 days of follow-up were collected in the Registry for Geriatric Trauma DGU (ATR-DGU). This study analyzed these 4-month treatment results.

METHODS

A retrospective analysis of the ATR-DGU was conducted. Outcome parameters were the rate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life (QoL) 120 days post-surgery. The influence of the early geriatric rehabilitation (EGR) was evaluated using a regression analysis.

RESULTS

The follow-up data from 9780 patients were included. After 120 days, the mortality rate was 12.2%, the readmission rate 4%, and the re-surgery rate 3%. The anti-osteoporotic treatment increased from 20% at admission to 32%; 65% of the patients had a degradation in walking ability, and 16% of the patients who lived in their domestic environment pre-surgery had to move to a nursing home. QoL was distinctly reduced. The EGR showed a positive influence of anti-osteoporotic treatment (p<0.001) and mortality (p=0.011) but led to a slight reduction in QoL (p=0.026).

CONCLUSION

The 4-month treatment results of the ATR-DGU are comparable to international studies. The EGR led to a significant rise in anti-osteoporotic treatment and a reduction in mortality with a slight reduction in QoL.

Elderly hip fracture patients: surgical timing and factors to consider

PURPOSE OF REVIEW

Hip fractures of the elderly population are a common trauma and numbers are increasing due to ageing societies. Although this is an ordinary low energy impact injury and surgical repair techniques show good results, the perioperative course is characterized by an unparalleled disproportionate perioperative morbidity and mortality.

RECENT FINDINGS

Most studies focus on outcome-related data. Little is known on how to prevent and treat adverse sequelae, ranging from mild physical challenges to neurobiological disorders and death.

SUMMARY

Although the contribution of the anaesthetic technique per se seems to be small, the role of the anaesthesiologist as a perioperative physician is undisputed. From focusing on comorbidities and initiating preoperative optimization to intraoperative and postoperative care, there is a huge area to be covered by our faculty to ensure a reasonable outcome defined as quality of postoperative life rather than merely in terms of a successful surgical repair. Protocol-driven perioperative approaches should be employed focusing on pre, intraoperative and postoperative optimization of the patient to facilitate early repair of the fracture that may then translate into better outcomes and hence alleviate the individual patient's burden as well as the socioeconomic load for society.

Economic burden of osteoporosis in the world: A systematic review

Background: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures and deterioration of bone tissue. It is also associated with an increased risk of fracture that is the most important complication of osteoporosis. The knowledge about costs and economic aspects of osteoporosis plays an important role in making policies and planning measures for the prevention and management of this disease; hence, this study systematically investigated the available evidence on the costs associated with osteoporosis worldwide. Methods: In this systematic review, electronic searches were performed on various online databases, including PubMed, Embase, Scopus, web of science, ProQuest, and Cochrane. The timeframe selected for searching articles was from 1980 to 2018. Results: Of a total of 1989 papers, 28 papers were included in the study on the basis of inclusion criteria. Based on the data extracted from the mentioned studies, the mean age of people with osteoporotic fractures was 50 years, with the highest costs associated with hip fractures. Conclusion: Our review indicated that the cost of osteoporosis carries a significant economic burden on countries in the world. The main cost drivers in this study were Fracture-related costs. The direct annual cost of treating osteoporotic fractures of people on average is reported to be between 5000 and 6500 billion USD in Canada, Europe and the USA alone, not taking into account indirect costs such as disability and loss of productivity. Prevention of this disease can significantly reduce the costs incurred by the health system.

Association of the Sp1 binding site and -1997 promoter variations in COL1A1 with osteoporosis risk: The application of meta-analysis and bioinformatics approaches offers a new perspective for future research

As a complex disease, osteoporosis is influenced by several genetic markers. Many studies have examined the link between the Sp1 binding site +1245 G > T (rs1800012) and -1997 G > T (rs1107946) variations in the COL1A1 gene with osteoporosis risk. However, the findings of these studies have been contradictory; therefore, we performed a meta-analysis to aggregate additional information and obtain increased statistical power to more efficiently estimate this correlation. A meta-analysis was conducted with studies published between 1991-2020 that were identified by a systematic electronic search of the Scopus and Clarivate Analytics databases. Studies with bone mineral density (BMD) data and complete genotypes of the single-nucleotide variations (SNVs) for the overall and postmenopausal female population were included in this meta-analysis and analyzed using the R metaphor package. A relationship between rs1800012 and significantly decreased BMD values at the lumbar spine and femoral neck was found in individuals carrying the "ss" versus the "SS" genotype in the overall population according to a random effects model (p < 0.0001). Similar results were also found in the postmenopausal female population (p = 0.003 and 0.0002, respectively). Such findings might be an indication of increased osteoporosis risk in both studied groups in individuals with the "ss" genotype. Although no association was identified between the -1997 G > T and low BMD in the overall population, those individuals with the "GT" genotype showed a higher level of BMD than those with "GG" in the subgroup analysis (p = 0.007). To determine which transcription factor (TF) might bind to the -1997 G > T in COL1A1, 45 TFs were identified based on bioinformatics predictions. According to the GSE35958 microarray dataset, 16 of 45 TFs showed differential expression profiles in osteoporotic human mesenchymal stem cells relative to normal samples from elderly donors. By identifying candidate TFs for the -1997 G > T site, our study offers a new perspective for future research.

Baseline quality of life in people with hip fracture: results from the multicentre WHiTE cohort study

Aims

To assess the variation in pre-fracture quality of life (QoL) within the UK hip fracture population, and quantify the nature and strength of associations between QoL and other routinely collected patient characteristics and treatment choices.

Methods

The World Hip Trauma Evaluation (WHiTE) study, an observational cohort study of UK hip fracture patients, collects a range of routine data and a health-related QoL score (EuroQol five-dimension questionnaire (EQ-5D)). Pre-fracture QoL data are summarized and statistical models fitted to understand associations between QoL, patient characteristics, fracture types, and operations.

Results

Fitting a multiple linear regression model indicated that 36.5% of the variance in pre-fracture EQ-5D scores was explained by routinely collected patient characteristics: sex (0.14%), age (0.17%), American Society of Anesthesiologists (ASA) score (0.73%), Abbreviated Mental Test Score (AMTS; 1.3%), pre-fracture mobility (11.2%), and EQ-5D respondent (participant, relative, or carer; 23.0%). There was considerable variation in pre-fracture EQ-5D scores between operations within fracture types. Participants with trochanteric fractures reported statistically significant but not clinically relevant lower pre-fracture QoL than those with intracapsular fractures. Participants with intracapsular fractures treated with internal fixation or total hip arthroplasty (THA) reported better QoL than those treated with hemiarthroplasty with the overall fittest group receiving THA.

Conclusion

Pre-fracture QoL varies considerably between hip fracture patients; it is generally higher in younger than older patients, patients with better mobility, and those patients who live more independently. Pre-fracture QoL is significantly associated with a range of patient characteristics (e.g. age, mobility, residency). These data explain ~35% of the variation in QoL.

Cite this article: Bone Joint Res 2020;9(8):468–476.

A systematic review of the indirect and social costs studies in fragility fractures

Fragility fractures (FF) are the main clinical consequence of osteoporosis. FF lead to a loss in quality of life (QL), increased dependency and higher costs due to loss of productivity. Despite this, very few studies have been performed about the indirect or social costs of FF. The objective of this review was to systematically synthesize published evidence regarding indirect costs of FF. We conducted a systematic literature review of empirical studies published as peer review papers between 1998 and 2019. A total of 295 papers were found about costs and osteoporosis. After an iterative process, only 16 papers fit the criteria of selection. Despite the important consequences for QL, only seven studies have included research of the issue and only one about dependency. Treatments are cost-effective, but adherence is low. Multiple fractures, older age and low socioeconomic profile imply higher costs. Most studies are performed using the human capital methodology. The main two variables are loss of productivity and absenteeism. Most of the people included in the samples are out of the active population. Those studies that include a follow-up period vary in a range between 3 months and 2 years. Depending on sample and methodology, the indirect costs (IC) are between 2 and 50%. The direct costs associated with FF generally far outweigh the IC. There is a lack of studies about the effects of treatments and adherence and about the dependency system. The changing role of women in coming generations will increase indirect costs.

Effect of long-term use of unfractionated or low-molecular-weight heparin on bone mineral density in maintenance hemodialysis patients

Introduction

Long‐term use of unfractionated heparin (UFH) or low‐molecular‐weight heparin (LMWH) causes bone loss and osteoporosis in patients not receiving hemodialysis. This study aimed to investigate the effect of UFH and LMWH on bone mineral density (BMD) in patients undergoing maintenance hemodialysis (MHD).

Methods

Patients undergoing MHD using UFH or LMWH as anticoagulants were enrolled. BMD (in g/cm²), T‐score and Z‐score (BMDs) were measured at the lumbar spine and femur neck using dual‐energy X‐ray absorptiometry (DXA) at baseline and 2 years later. Patient demographics and clinical indices were collected. Correlation analysis was used to identify significant predictors of bone loss. Multiple linear regression was used to explore the relationship between heparin type and bone loss progression.

Findings

A total of 104 patients were enrolled and completed the baseline BMD test; 72 completed the test again 2 years later. Six patients were excluded because they used both UFH and LMWH. Although BMD decreased in some patients in the UFH group, a slight increase in the BMD was observed on an average in the LMWH group after 2 years. The mean change in BMD (in g/cm²) [0(−0.03,0.04) vs. 0.04(0,0.06), P = 0.023], T‐score [0(−0.40,0.30) vs. 0.35(−0.03,0.53), P = 0.038], and Z‐score [0.10(−0.30,0.40) vs. 0.45(0.08,0.63), P = 0.031] in the lumbar spine in the UFH group was lower than those in the LMWH group. Femur neck BMD did not change significantly. In a linear regression model, after adjusting for diabetes mellitus, parathyroid hormone, and serum phosphate, we did not find an association between heparin substances and BMD.

Discussion

UFH might be associated with loss of lumbar spine BMD in patients undergoing MHD.

Effects of Orem's Self-Care Model on the Life Quality of Elderly Patients with Hip Fractures

Background

Hip fractures of elderly patients are a public health problem worldwide, mostly lying in bed for a long time; therefore, the importance of life quality in such patients is an issue beyond question. Orem's self-care model is a nursing pattern which is introduced with the purpose of improving the self-care ability of individuals, especially the patients suffering from diseases with limits on activity.

Objective

The aim of this study was to determine the effects of Orem's self-care program on life quality of senile patients with hip fractures.

Methods

A randomized clinical trial study was conducted on 130 eligible old patients suffering from hip fractures who were selected using easy sampling methods and allocated randomly into two groups of experiment and control. The data were collected through validated questionnaires including visual analogue scale (VAS) and Barthel index for them. The experiment group was treated according to Orem's self-care model, and the control group was treated on the basis of the traditional care model. The data of complications including pneumonia, deep venous thrombosis, urinary infection, wound problem, and bedsore were also gathered.

Results

As revealed, mean scores of VAS and Barthel index one week after operation in the experiment group were significantly different from the control one (P < 0.05, P ≤ 0.001). The changes of VAS and Barthel index six weeks postoperatively of the two groups were also statistically significant (P < 0.05, P ≤ 0.001). Compared with the control group, the difference of complications reduced significantly in the experiment group (P < 0.05). Accordingly, educational intervention according to Orem's self-care model seemed to be effective in promoting self-care ability for these senile patients.

Conclusions

According to the obtained results, a self-care program based on Orem's model for elderly patients with hip fractures can improve life quality and reduce perioperative complications significantly. Therefore, it is recommended that this nursing program should be taken into account as a part of treatment measures for these patients.

Cost-effectiveness analyses of interventions to improve osteoporosis care in France

Osteoporosis (OP) is responsible for an important economic burden, but OP care is far from meeting therapeutic guidelines. Some interventions were effective to improve OP management. Our objective was to evaluate the cost-effectiveness of these interventions. Structural interventions and interventions consisting in sending educational material were dominant strategies.

PURPOSE

Osteoporosis (OP) causes many osteoporotic fractures worldwide and an important economic burden as a result. OP care is far from meeting treatment guidelines, but in a recent meta-analysis, we showed that some interventions were effective to improve appropriate bone mineral density (BMD) and treatment prescriptions. In the context of limited resources, it is of major importance to measure these interventions' efficiency. Our objective was to evaluate the cost-effectiveness of existing effective intervention types.

METHODS

We used a decision tree incorporating Markov models to compare costs and benefits (quality-adjusted life-years or QALYs) between usual care and three intervention types: structural (I), direct educational through conversation (II), and indirect educational by sending material (III). We adopted the collectivity perspective and chose a 30-year time horizon. The model included efficacy of interventions and risk of further fracture or death, depending on BMD T-score results and OP management, obtained from published literature. The model was populated to reflect a French setting. Deterministic and probabilistic sensitivity analyses were conducted. Costs were presented in 2018 euros (€).

RESULTS

Interventions type I and III were dominant strategies compared with usual care (cost-saving with a QALY gain). Our results were consistent through sensitivity analyses.

CONCLUSION

Our results suggest that structural interventions and indirect interventions to improve OP care (BMD and OP treatment prescription), in women 50 years old with a first fragility fracture, were dominant strategies.

Timing of Hip-fracture Surgery in Elderly Patients: Literature Review and Recommendations

The incidence of hip fractures is rapidly increasing with an aging population and is now one of the most important health concerns worldwide due to a high mortality rate. The effect of delayed surgery on postoperative outcomes has been widely discussed. Although various treatment guidelines for hip fractures in the elderly exist, most institutions recommend that operations are conducted as soon as possible to help achieve the most favorable outcomes. While opinions differ on the relationship between delayed surgery and postoperative mortality, a strong association between earlier surgery and improvement in postoperative outcomes (e.g., length of hospital stay, bedsore occurrence, return to an independent lifestyle), has been reported. Taken together, performing operations for hip fractures in the elderly within 48 hours of admission appears to be best practice. Importantly, however, existing evidence is based primarily on observational studies which are susceptible to inherent bias. Here, we share the results of a literature search to summarize data that helps inform the most appropriate surgical timing for hip fractures in the elderly and the effects of delayed surgery on postoperative outcome. In addition, we expect to be able to provide a more accurate basis for these correlations through a large-scale randomized controlled trial in the future and to present data supporting recommendations for appropriate surgical timing.

Burden of fractures in France: incidence and severity by age, gender, and site in 2016

PURPOSE

Fractures are common events, but the exact incidence and severity of fractures have not been clearly determined for most anatomical sites. We estimated the incidence and severity of fractures in France regardless of the anatomical site.

METHODS

Observational cross-sectional study in France in 2016 based on the national health data system. All incident fractures in patients 20 years and older were included. We determined the anatomical fracture site (12 sites) and the severity using a 4-point scale (outpatient care, hospitalization, surgery, and in-hospital death).

RESULTS

We identified 562,094 incident fractures, predominantly occurring in women (319,858: 56.9%); with a mean age of 63.6 years, and an exponential increase after the age of 70 years. Distal upper limb (172,591: 30.7%), distal lower limb (84,602: 15.1%), and femoral neck (78,766: 14.0%) accounted for more than one-half of all fractures. Sex and age of onset distributions varied widely according to fracture sites, with earlier onset for distal lower limb fractures (mean age: 54.2 years) and distal upper limb fractures (mean age: 55.2 years) with a men predominance for skull fractures. Only 105,165 (18.7%) fractures were treated on an outpatient basis; 11,913 (2.1%) in-hospital deaths occurred in patients with a mean age of 79.5 years. High mortality was observed for skull (12.9%), rib (4.9%), and femoral fractures (femoral neck 4.3% and proximal lower limb 4.2%).

CONCLUSION

We estimated the incidence of fractures in France by sex and anatomical site. We also showed that fractures remain common and serious life events, especially in older people.

Health-related quality of life and its determinants among patients with hip fracture after surgery in Myanmar

BACKGROUND

Hip fracture has been regarded as a significant international health problem because of its negative impacts on things such as Health-Related Quality of Life (HRQOL). The determinants of HRQOL among patients with hip fracture after surgery during transition of recovery are still not clearly understood.

OBJECTIVE

To study HRQOL factors and determine the predictive power of elements such as age, gender, co-morbid disease, Body Mass Index (BMI), depression or social support on HRQOL among patients with hip fracture after surgery in Myanmar.

DESIGN

Descriptive correlational predictive study.

SETTING

Yangon Orthopaedic Hospital and Mandalay Orthopaedic Hospital in Myanmar.

RESULTS

The mean age was 60 years (range = 18-91). The level of HRQOL at the 6th week after surgery was moderate. In stepwise multiple regression analysis, gender (β = -.109, p = .044), depressive symptoms (β = -.564, p = .000) and social support (β = .287, p = .000) were the determinants of HRQOL. These three factors accounted for 59.1% of variance to explain HRQOL.

CONCLUSION

In order to facilitate a healthy transition, comprehensive rehabilitation, including depressive symptoms screening and enhancing social support, and the health care services with less cost and psychosocial support especially for women, are recommended.

Bone and skeletal muscle changes in oldest-old women: the role of physical inactivity

BACKGROUND

Alterations in bone and muscle parameters related to advanced aging and physical inactivity have never been investigated in oldest-old women.

AIMS

To investigate the impact of physical inactivity on bone mineral density (BMD) and body composition at the systemic and regional levels in oldest-old (> 75 years old) women. We hypothesized that, further to aging, alterations in bone and body composition parameters are exacerbated in the locomotor limbs that have experienced physical inactivity.

METHODS

Whole-body and regional (lower limbs and trunk) BMD and fat-free soft tissue mass (FFSTM) were measured by means of dual-energy X-ray absorptiometry in 11 oldest-old wheelchair-bound women (OIW), 11 oldest-old mobile women (OMW), and 11 young healthy women (YW), all matched for weight (± 10 kg), height (± 10 cm).

RESULTS

Whole-body BMD was reduced by 15% from YW to OMW and 10% from OMW to OIW. Whole-body FFSTM was also reduced from YW to OIW (- 13%). Lower limb BMD was progressively reduced among YW, OMW and OIW (- 23%). Similarly, lower limb FFSTM was reduced among YW (12,816 ± 1797 g), OMW (11,999 ± 1512 g) and OIW (10,037 ± 1489 g). Trunk BMD was progressively reduced among YW, OMW and OIW (- 19%), while FFSTM was similar among the three groups ~ 19801 g.

CONCLUSIONS

The results of the present study suggest that the alterations in bone and body composition parameters are exacerbated in the physical inactive oldest-old. These negative effects of physical inactivity are not confined to the locomotor limbs, and a systemic decline of bone and muscle parameters are likely associated with the physical inactivity.

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

Individuals with low socio-economic status (SES) have a higher risk of dying following hip fracture compared with individuals with high SES. Evidence on social inequalities in non-hip fractures is lacking as well as evidence on the impact of SES on health-related quality of life post fracture.

INTRODUCTION

Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL.

METHODS

PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50 years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately.

RESULTS

A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI - 1 to 10%) among hip fracture patients with low SES compared with high SES.

CONCLUSIONS

We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence.

Burden of illness of hip fractures in elderly Dutch patients

Patients with hip fractures experience reduced health-related quality of life and have a reduced life expectancy. Patients' utilization of healthcare leads to costs to society. The results of the study can be used in future economic evaluations of treatments for hip fractures.

PURPOSE

Hip fractures are associated with high mortality, reduced quality of life, and increased healthcare utilization, leading to an economic burden to society. The purpose of this study is to determine the burden of illness of hip fractures in elderly Dutch patients for specific time periods after surgery.

METHODS

Patients with a hip fracture above the age of 65 were included in the study. In the 1-year period after surgery, patients were asked to complete a set of questionnaires pre-injury (retrospectively), and 1 week, 1 month, 3 months, 6 months and 12 months after surgery. The set of questionnaires included the Euroqol 5D (EQ-5D-3L), the iMTA Medical Consumption Questionnaire (iMCQ) and iMTA Productivity Cost Questionnaire (iPCQ). Health-related quality of life was calculated using Dutch tariffs. Costs were calculated using the methodology described in the Dutch costing manual.

RESULTS

Approximately 20% of patients with a hip fracture died within 1 year. Health-related quality of life was significantly reduced compared to pre-injury values, and patients did not recover to their pre-injury values within 1 year. Total costs in the first year after injury were €27,573, of which 10% were due to costs of the procedure (€2706). Total follow-up costs (€24,876) were predominantly consisting of healthcare costs. Monthly costs decreased over time.

CONCLUSIONS

Hip fractures lead to a burden to patients, resulting from mortality and health-related quality of life reductions, and to society, due to (healthcare) costs. The results of this study can be used in future economic evaluations.

Changing trends in the mortality rate at 1-year post hip fracture - a systematic review

BACKGROUND

Traditionally, the mortality rate at 1-year post hip fracture was quoted as approximately 30% of all hip fractures. There have been recent improvements in hip fracture care in the main driven by national hip fracture registries with reductions in 30-d mortality rates reported.

AIM

To address recent 1-year post hip fracture mortality rates in the literature.

METHODS

Systematic literature review, national hip fracture registries/databases, local studies on hip fracture mortality, 5 years limitation (2013-2017), cohorts > 100, studies in English. Outcome measure: Mortality rate at 1-year post hip fracture.

RESULTS

Recent 1-year mortality rates were reviewed using the literature from 8 National Registries and 36 different countries. Recently published 1-year mortality rates appear lower than traditional figures and may represent a downward trend.

CONCLUSION

There appears to be a consistent worldwide reduction in mortality at 1-year post hip fracture compared to previously published research. Globally, those which suffer hip fractures may currently be benefiting from the results of approximately 30 years of national registries, rigorous audit processes and international collaboration. The previously quoted mortality rates of 10% at 1-mo and 30% at 1-year may be outdated.

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study

PURPOSE

The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life.

METHODS

Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain.

OUTCOMES

daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture.

STATISTICS

Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range).

RESULTS

A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively.

CONCLUSIONS

Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis

We aimed to assess the impact of timing of surgery in elderly patients with acute hip fracture on morbidity and mortality. We systematically searched MEDLINE, the Cochrane Library, Embase, PubMed, and trial registries from 01/1997 to 05/2017, as well as reference lists of relevant reviews, archives of orthopaedic conferences, and contacted experts. Eligible studies had to be randomised controlled trials (RCTs) or prospective cohort studies, including patients 60 years or older with acute hip fracture. Two authors independently assessed study eligibility, abstracted data, and critically appraised study quality. We conducted meta-analyses using the generic inverse variance model. We included 28 prospective observational studies reporting data of 31,242 patients. Patients operated on within 48 hours had a 20% lower risk of dying within 12 months (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.66-0.97). No statistical significant different mortality risk was observed when comparing patients operated on within or after 24 hours (RR 0.82, 95% CI 0.67-1.01). Adjusted data demonstrated fewer complications (8% vs. 17%) in patients who had early surgery, and increasing risk for pressure ulcers with increased time of delay in another study. Early hip surgery within 48 hours was associated with lower mortality risk and fewer perioperative complications.

The epidemiology and economic burden of hip fractures in Israel

Background

Hip fractures increase the risks of mortality and major morbidity in the elderly. Hip fractures are associated with chronic pain, reduced mobility, disability and increasing dependence. We evaluated the direct costs incurred to the Israeli healthcare system in 2013 as a result of hip fracture injuries in elderly patients.

Methods

Hip fractures costs evaluation consisted of first-year and long-term direct costs. Data on the incidence of hip fractures resulting in hospitalizations were retrieved from the Israeli Ministry of Health’s (MOH) Central Database of Hospital Admissions. Hospitalization, rehabilitation and nursing utilization rates and costs were estimated based on the professional literature and according to the MOH’s price list.

Results

During 2013, 6285 elderly patients were hospitalized in Israel due to hip fractures. Direct costs of hip fracture, comprising hospitalization, rehabilitation and nursing costs incurred during the first year after the injury, were estimated at 454 million New Israeli Shekels (NIS; 83,841 NIS per person). Long-term nursing care costs in 2013 were 265 million NIS, with an average cost of approximately 49,000 NIS for 1600 elderly persons receiving long-term nursing care as a result of a hip fracture. Overall, the total direct costs of hip fracture in the elderly population in Israel in 2013 were 719 million NIS.

Conclusions

The direct costs of hip fractures in Israel among the elderly are approximately 719 million NIS per year. The majority of costs are associated with the first year following the injury. To reduce healthcare costs in Israel, changes in the country’s healthcare policy on hip fractures are required. For example, there is a need for a program for detecting high- risk populations, and for early intervention following the injury.

Electronic supplementary material

The online version of this article (10.1186/s13584-018-0235-y) contains supplementary material, which is available to authorized users.

School-based exercise interventions effectively increase bone mineralization in children and adolescents

Osteoporosis and fragility fractures have become major global public health concerns, and they can be prevented by maximizing peak bone mass during childhood and adolescence with weight-bearing physical activity, which can result in stronger and healthier bones that significantly decrease the risk of osteoporosis and fragility fractures in adulthood and the elderly years. From a public health perspective, implementing weight-bearing physical activity for children and adolescents is best achieved with school-based exercise interventions, and a review of school-based exercise interventions was conducted to determine their effectiveness in increasing bone mineral density (BMD) and/or bone mineral content (BMC). Seventeen studies were reviewed, all school-based exercise interventions utilized jumping exercises, and 15 of the 17 studies found at least one significant increase in measures of BMD and/or BMC for the total body, and/or at the hip, vertebrae, and/or wrist. One study that found no significant differences did report significant increases in bone structural strength, and the other study with no significant differences had exercises that measured and reported the lowest ground reaction forces (GRFs) of only 2–3 times body weight (BW), whereas the other studies that showed significant increase(s) in BMD and/or BMC had exercise with measured and reported GRFs ranging from 3.5 × to 8.8 × BW. School-based exercise interventions are time- and cost-efficient and effective in increasing BMD and/or BMC in children and adolescents, but must incorporate high-intensity exercise, such as high-impact jumping of sufficient GRFs, in order to significantly increase bone mineralization for osteoporosis and fragility fracture prevention later in life.

Health-related quality of life during the first year after a hip fracture: results of the Mexican arm of the International Cost and Utility Related to Osteoporotic Fractures Study (MexICUROS)

We investigated changes in health-related quality of life (HRQoL) due to hip fracture in Mexican adults aged ≥ 50 years during the first year post-fracture. Mean accumulated loss was 0.27 quality-adjusted life years (QALYs). HRQoL before fracture was the main contributor to explain the loss of QALYs.

INTRODUCTION

We aimed to estimate the health-related quality of life (HRQoL) loss over 1 year in patients sustaining a hip fracture in Mexico.

METHODS

Individuals aged ≥ 50 years old with diagnosis of a low-energy-induced hip fracture enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) composed the study population. After a recall of their own pre-fracture status, HRQoL was prospectively collected in three phases over 12 months of follow-up using EQ-5D-3L. The UK preference weight set was applied to calculate the utility values. The accumulated quality-adjusted life years (QALYs) loss in the first year post-fracture was estimated using the trapezoid method. Multivariate regression analysis allowed identifying determinants of QALYs loss.

RESULTS

One hundred ninety-three patients (mean ± SD age 77.2 ± 9.9 years; 80% women; 15.5% with prior fracture in the last 5 years; 78% in low-income category) were evaluated. Mean (95% CI) utility value before fracture was 0.64 (0.59-0.68). It dropped to 0.01 (0.01-0.02) immediately after fracture and then improved to 0.46 (0.42-0.51) and 0.60 (0.55-0.64) at 4 and 12 months post-fracture, respectively. Disregarding fracture-related mortality, accumulated QALYs loss over the first year was 0.27 (0.24-0.30) QALYs. Mobility, self-care, and usual activities were the most affected domains throughout the whole year. HRQoL before fracture was the main contributor to explain the loss of QALYs.

CONCLUSIONS

Hip fractures reduce dramatically the HRQoL, with the loss sustained at least over the first year post-fracture in Mexico. The utility values derived from this study can be used in future economic evaluations.

Quality of life and psychological consequences in elderly patients after a hip fracture: a review

Fractures due to fragility of the bone around the hip joint have become a major public health issue, presenting with an increasing incidence due to the growth of the elderly population. The purpose of this review was to evaluate the impact of hip fractures on the quality of life (QoL), health status (HS), functioning, and psychological parameters, and factors influencing the outcome and the appropriate interventions for improvement of elderly patients. A systematic electronic search of the relevant literature was carried out using the CINAHL, Cochrane, EMBASE, Medline (OvidSP), and PubMed databases spanning the time period from their establishment up to January 2017. Forty-nine randomized controlled trials or prospective cohort studies reporting the QoL and psychological outcomes were assessed by using standardized questionnaires. Patients with a hip fracture who were older than 65 years, were included in the analysis. In the majority of elderly patients, the hip fracture seriously affected physical and mental functioning and exerted a severe impact on their HS and health-related QoL (HRQoL). Moreover, most of the patients did not return to prefracture levels of performance regarding both the parameters. The levels of mental, physical, and nutritional status, prior to the fracture, comorbidity, and female gender, in addition to the postoperative pain, complications, and the length of hospital stay, were the factors associated with the outcome. Psychosocial factors and symptoms of depression could increase pain severity and emotional distress. For the displaced femoral neck fractures, the treatment with total hip arthroplasty or hemiarthroplasty, when compared to the treatment with internal fixation, provided a better functional outcome. Supportive rehabilitation programs, complemented by psychotherapy and nutritional supplementation prior to and after surgery, provided beneficial effects on the HS and the psychosocial dimension of the more debilitated patients’ lives. Lack of consensus concerning the most appropriate HRQoL questionnaires to screen and identify those patients with more difficulties in the psychosocial functions, demonstrates the necessity for further research to assess the newer outcome measurement tools, which might improve our understanding for better care of patients with hip fractures.

Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study

OBJECTIVES

This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only.

METHODS

The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period.

RESULTS

The dataset included 503 patients, 25 of whom died between 30 days and four months of injury. There was a statistically significant difference in 30-day HRQoL between those alive (mean 0.331 and standard deviation (sd) 0.360) and those dead (mean 0.156 and sd 0.421) by four months (independent-samples t-test; p 0.022). The estimated difference of 0.175 in HRQoL (95% confidence interval 0.025 to 0.325) was also highly clinically significant.

CONCLUSION

When reporting HRQoL for patients after a hip fracture, excluding patients who die during follow-up leads to an overestimate of the effects of the intervention or treatment pathway. We would recommend that death-adjusted estimates should be used routinely when reporting HRQoL in this population.Cite this article: N. Parsons, X. L. Griffin, J. Achten, T. J. Chesser, S. E. Lamb, M. L. Costa. Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study. Bone Joint Res 2018;7:1-5.

Osteoporotic fractures may impair life as much as the complications of diabetes

RATIONALE, AIMS, AND OBJECTIVES

To compare the effect of osteoporotic fractures and complications of diabetes mellitus on quality of life (QoL).

METHOD

A cross-sectional study was performed in 840 patients with osteoporosis and in 943 patients with diabetes in Hungary to estimate the effect of osteoporotic fractures and microvascular and macrovascular complications of diabetes on QoL using the EQ-5D questionnaire. Ordinary least-squares regression was performed for the analysis to control for age and gender.

RESULTS

The effects of certain of osteoporotic fractures and diabetes complications were similar in size measured by the EQ-5D. Patients with hip fractures and compressions of the vertebrae suffered more than 0.2 drop in their QoL, which is comparable in size to the most severe complications of diabetes, such as vision loss and amputations.

CONCLUSIONS

The use of mortality and premature mortality as the traditional measures of disease burden in public health policy making means that diseases which strongly affect QoL but less survival might not get the necessary priority. This is especially the case in low-income and middle-income countries where studies on QoL are scarce. Our comparative analysis, which showed that osteoporotic fractures reduce QoL as much as major complications of diabetes, highlights the need for comprehensive disease burden assessment, including losses in functionality and QoL, to support decision making.

Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study

Objective

Evaluate the performance of FRAX®, with and without bone mineral densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years.

Methods

Participants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from three cohorts (n=2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating characteristic analysis.

Results

During a mean (SD) follow-up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95% CI 0.72 to 0.79) for MOP fractures and 0.78 (95% CI 0.69 to 0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95% CI 0.74 to 0.82, p=0.25) or hip fractures (0.79, 95% CI 0.69 to 0.89, p=0.72).

AUCs for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD, tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95% CI of the number predicted, both with and without BMD.

Conclusion

FRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.

The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies

This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I² test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability.

Immediate versus delayed surgery for hip fractures in the elderly patients: a protocol for a systematic review and meta-analysis

BACKGROUND

Hip fractures are a major public health problem in elderly populations and are accompanied by high-mortality rates. Whether timing of surgery has an impact on morbidity and mortality has been discussed controversially, numerous studies suggest that the delay of surgery can significantly increase the risk of morbidity and mortality; others report that achieving a stable medical condition is more important than early surgery. The goal of our systematic review is to assess the impact of timing of surgery on health outcomes in patients aged 60 years or older with acute hip fracture. In addition, we will investigate differences in beneficial or harmful effects of timing of surgery in subgroups of patients based on demographic characteristics, physical status, and the use of anticoagulant medications.

METHODS

We will systematically search MEDLINE via Ovid, the Cochrane Library, Embase, PubMed, and clinical trial registries (from 1997 to 2017). In addition, we will search reference lists of pertinent reviews, archives of annual meetings of orthopaedic societies, and contact experts. We will include randomized controlled trials and non-randomized studies assessing the impact of timing of surgery after hip fracture in patients 60 years or older, published in English or German. Our outcomes of interest include health outcomes such as mortality, perioperative complications, functional capacity, and quality of life. We plan to perform meta-analyses if we have at least three sufficiently similar studies. If data are sufficient, we will conduct subgroup-analyses testing for differences between age groups, sex, patients' physical status as assessed with ASA (American Society of Anesthesiologists) scores, and the use of anticoagulation.

DISCUSSION

Since this is the first systematic review on this topic since 2010, our findings will help to inform clinical practice guidelines concerning timing of surgery in hip fractures. Furthermore, our findings could contribute to define an optimal time period for surgery for different groups of patients with acute hip fracture.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017058216.

A Novel Fast Mobile-Window Small Incision Technique for Hip Arthroplasty in the Elderly and Comparison with Conventional Incision

Background

We deeloped a novel technique – fast mobile-window small incision (FMWSI) – a modification of minimally invasive surgery for total hip arthroplasty, which we believe is particularly suited to elderly patients with hip fractures. The present article aimed to introduce this technique and compare the clinical effects between the FMWSI technique and conventional incision (CI) for hip arthroplasty in elderly patients.

Material/Methods

This study included 240 consecutive patients who underwent hip arthroplasty. Half received total hip arthroplasty and half received hemi hip arthroplasty. The 120 patients in each group were further divided into FMWSI and CI groups. The following parameters were compared between the FMWSI and CI groups: length of incision, operation time, bleeding volume, drainage volume, postoperative ambulation time, and Harris score.

Results

Compared with the CI group, the FMWSI group had a significantly shorter incision length, operation time, and postoperative ambulation time, as well as lower bleeding and drainage volumes, irrespective of whether the treatment was total or hemi hip arthroplasty (P<0.05). However, no significant difference was found in the Harris score between the FMWSI and CI groups (P>0.05).

Conclusions

The novel FMWSI technique introduced in this study is a useful method for hip arthroplasty, especially for elderly patients with poor constitutions or tolerance to surgery.