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Charatcharoenwitthaya N, Nimitphong H, Wattanachanya L, Songpatanasilp T, Ongphiphadhanakul B, Deerochanawong C, Karaketklang K. Epidemiology of hip fractures in Thailand. Osteoporos Int 2024; 35:1661-1668. [PMID: 38832991 DOI: 10.1007/s00198-024-07140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
This retrospective study examining hip fracture incidence, hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50 years and older within the Universal Health Coverage System revealed that the incidence of hip fractures and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022. PURPOSE To examine the annual incidence of hip fractures over 10 years (2013-2022), hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50 years and older within the Universal Health Coverage System. METHODS A retrospective study was conducted. Hip fracture hospitalizations were identified using ICD-10. Data on the number of hip fracture hospitalizations, population aged ≥ 50 years, and hospitalization costs were obtained. The primary outcome was the annual incidence of hip fractures. The secondary outcomes were hip fracture incidence by 5-year age group, the annual hospitalization costs for hip fractures, and the number of hip fractures in 6 regions of Thailand. RESULTS The hip fracture incidence increased annually from 2013-2019 and then plateaued from 2019-2022, with the crude incidence (per 100,000 population) increasing from 112.7 in 2013 to 146.7 in 2019 and 146.9 in 2022. The age-standardized incidence (per 100,000 population) increased from 116.3 in 2013 to 145.1 in 2019 and remained at 140.7 in 2022. Increases in the crude incidence were observed in both sexes (34% in females and 21% in males; p < 0.05). The annual hospitalization costs for hip fractures increased 2.5-fold, from 17.3 million USD in 2013 to 42.8 million USD in 2022 (p < 0.001). The number of hip fractures increased in all six regions of Thailand across the 10-year study period. CONCLUSION Osteoporotic hip fractures are a significant health concern in Thailand. The incidence and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022.
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Affiliation(s)
- Natthinee Charatcharoenwitthaya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, 99/209 Pahonyothin Road, Pathumthani, 12120, Thailand.
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Bangkok, 10330, Thailand
| | - Thawee Songpatanasilp
- Department Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Boonsong Ongphiphadhanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Chaicharn Deerochanawong
- College of Medicine, Ministry of Public Health, Rajavithi Hospital, Rangsit University, Bangkok, 10400, Thailand
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Bangkok-Noi, Thailand
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Hestnes I, Solberg LB, Meyer HE, Sundet M, Rimal R, Nordsletten L, Hakestad KA. The hip fracture incidence in the high-risk area Oslo continues to decline. Osteoporos Int 2024; 35:1615-1623. [PMID: 38922398 PMCID: PMC11364682 DOI: 10.1007/s00198-024-07156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024]
Abstract
Oslo in Norway has had the highest incidence of hip fractures in the world. The incidence in Oslo has been thoroughly described every decade since the late 1970s. The incidence in Oslo has previously been higher compared to the rest of Norway but has now decreased to a level below the country average. PURPOSE The purpose of this study was to report the incidence of hip fractures in Oslo in 2019 and compare it with the incidence rates from the previous four decades. METHODS Patients residing in Oslo in 2019 with a new hip fracture identified by searching the Oslo hospital's patient administrative systems and protocols from the operating theaters. The diagnosis was verified through medical records and/or radiographs. To compare with previous studies, the direct standardization method was used with the population of Oslo in 2019 as the standard. RESULTS A total of 758 hip fractures, 70% women, were identified in 2019. The age-standardized incidence rates per 10,000 person-years in 2019 (95% CI) were 45 (41.1-48.8) for women and 30 (25.8-33.8) for men. In women, there has been a continuous decline in age-standardized rates the last three decades and in men the last two decades. The most pronounced decline was seen in the oldest age groups over 70 years. There has been a secular decline in both cervical and trochanteric fractures; however, the decrease in trochanteric fractures was most distinct for males, with more than two times higher risk in 1996/1997 compared to 2019. CONCLUSION Incidence rates for hip fractures in Oslo in 2019 were the lowest rate reported since 1978. The decrease was significant for both men and women. For the first time, the incidence rates are below the national rates of Norway. However, the rates are still among the highest worldwide.
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Affiliation(s)
- I Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - L B Solberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway
| | - H E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - M Sundet
- Department of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway
| | - R Rimal
- Institute of Basic Medicine, Department of Biostatics, OCBE, University of Oslo, Oslo, Norway
| | - L Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K A Hakestad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Tveit B. Fragility and Resilience: Stories of Recovering From Hip Fractures in the Oldest-Old Age. QUALITATIVE HEALTH RESEARCH 2024; 34:386-397. [PMID: 38029277 PMCID: PMC10996292 DOI: 10.1177/10497323231215954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This study uses a narrative approach to explore the experiences of adults in the oldest stage of old age after they suffered a hip fracture. The focus was on participants' perceptions and descriptions of the traumatic event, the recovery process, and the impact of the fracture on their lives. The study had a longitudinal design and included interviews with 10 participants (mean age 89) who had suffered hip fractures. Up to three semi-structured interviews were conducted with each of the participants (a total of 27 interviews) over a 3-month period. The first interviews were at the hospital, the second at municipal rehabilitation facilities, and the third at the participants' homes. The material was analysed by means of narrative analysis. The results show how the incident affected the participants' active and meaningful lives and how they seemed to mobilise their resources and motivation to train and recover to be able to come back home and resume the life they had before the hip fracture. The study provides nuances in the understanding of how a hip fracture can impact lives in old age. The stories emphasise the resources and capacity for resilience elderly people can possess and the importance of listening to the individual life stories, situation, personal goals, and needs when planning services for elderly people recovering from a hip fracture.
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Affiliation(s)
- Bodil Tveit
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Surís X, Rodríguez C, Llargués E, Pueyo-Sánchez MJ, Larrosa M. Trend and Seasonality of Hip Fractures in Catalonia, Spain: Exploring the Influence of Climate. Calcif Tissue Int 2024; 114:326-339. [PMID: 38340169 PMCID: PMC10957628 DOI: 10.1007/s00223-024-01182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 02/12/2024]
Abstract
To describe the secular trend and seasonality of the incidence of hip fracture (HF) and its relationship with climatic variables during the period 2010-2019 in Catalonia in people aged ≥ 65 years. The results were analyzed by sex, age groups (65-74, 75-84, and ≥ 85), and types of fracture (extracapsular and intracapsular). Data on sex, age, type of fracture, year, and month of hospitalization of patients admitted with a diagnosis of HF between January 1, 2010 and December 31, 2019 were collected. Crude and standardized HF incidence (HFi) rates were obtained. Data on the monthly mean of climatological variables (temperature, insolation, icy days, rain, relative humidity, atmospheric pressure, and wind force) were obtained from the network of meteorological stations in Catalonia. Time series analytical statistics were used to identify trends and seasonality. Linear regression and a seasonal autoregressive integrated moving average (ARIMA) were used to analyze the relationship of each climatic parameter with fracture rates. In addition, generalized additive models were used to ascertain the best predictive model. The total number of HF episodes was 90,149 (74.1% in women and 25.9% in men). The total number of HFs increased by 6.4% between 2010 and 2019. The median age (SD) was 84.5 (7.14) and 54% of patients were ≥ 85 years of age. Extracapsular fractures were the most common (55%). The standardized incidence rates decreased from 728.1/100,000 (95% CI 738.6-769.3) to 624.5/100,000 (95% CI 648.7-677.0), which represents a decrease of 14.2% (p < 0.05). The decline was greater at older ages. There were seasonal variations, with higher incidences in autumn (27.2%) and winter (25.7%) and lower rates in summer (23.5%) and spring (23.6%). Seasonality was more pronounced in elderly people and men. In the bivariate regression analysis, high temperatures and greater insolation were negatively associated with the HF rate, while the number of icy days, rainy days, and high relative humidity were associated with a higher incidence of fractures in all age groups and sexes. In the regression analysis using the seasonal ARIMA model, only insolation had a consistently significant association with overall HFi, after adjusting by trend and other climatic parameters. While the global number of HFs grew in Catalonia due to increases in the elderly population, the standardized HF rate decreased during the years 2010-2019. There was a seasonal trend, with predominance in the cold months and correlations with climatic parameters, especially with insolation.
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Affiliation(s)
- Xavier Surís
- Master Plan of Musculoskeletal Diseases, Department of Health, C/Travessera de les Corts, 131-159, 08028, Barcelona, Catalonia, Spain.
- Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.
| | - Clara Rodríguez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
- Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Maria J Pueyo-Sánchez
- Assistance and Participation Area. La Unió, Association of Health and Social Entities, Barcelona, Spain
| | - Marta Larrosa
- Master Plan of Musculoskeletal Diseases, Department of Health, C/Travessera de les Corts, 131-159, 08028, Barcelona, Catalonia, Spain
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Wang B, Li H, Yang C, Nie R, Zhang X, Pu C. VDR gene ApaI polymorphism and risk of postmenopausal osteoporosis: a meta-analysis from 22 studies. Climacteric 2023; 26:583-593. [PMID: 37477999 DOI: 10.1080/13697137.2023.2233421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The ApaI polymorphism (G > T, rs7975232) of the vitamin D receptor (VDR) gene in the risk of postmenopausal osteoporosis has been widely researched, and the results have yielded conflicts. Therefore, we performed an updated pooled analysis to comprehensively assess the association between VDR ApaI polymorphism and postmenopausal osteoporosis risk. METHODS We searched eligible studies about ApaI polymorphism and osteoporosis through the PubMed, Embase, CNKI and Wanfang databases; case-control studies containing available genotype frequencies of A/a were chosen. We used the odds ratio with 95% confidence interval to assess the strength of this association. Sensitivity analysis and publication bias assessment were performed. Trial sequential analysis (TSA) was performed to evaluate a sufficient sample. RESULTS Twenty-two studies assessed the relationship between ApaI polymorphism and the risk of osteoporosis in postmenopausal women. The comprehensive analyses showed no significant association for ApaI polymorphism with postmenopausal osteoporosis in the overall population, equally valid for Asian and Caucasian subgroups with any genetic model. TSA still indicated the results were robust. CONCLUSION The present meta-analysis suggests that the VDR ApaI genotype may not affect the risk of postmenopausal osteoporosis in Asians and Caucasians.
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Affiliation(s)
- B Wang
- The Key Laboratory of Sports and Rehabilitation, Yuxi Normal University, Yunnan, China
- The Faculty of Physical Education, Yuxi Normal University, Yunnan, China
| | - H Li
- Department of Human Anatomy, School of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong, P.R. China
| | - C Yang
- The Faculty of Physical Education, Yuxi Normal University, Yunnan, China
| | - R Nie
- The Faculty of Physical Education, Yuxi Normal University, Yunnan, China
| | - X Zhang
- The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - C Pu
- The Key Laboratory of Sports and Rehabilitation, Yuxi Normal University, Yunnan, China
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El Miedany Y, El Gaafary M, Gadallah N, Mahran S, Fathi N, Abu-Zaid MH, Tabra SAA, Shalaby RH, Abdelrafea B, Hassan W, Farouk O, Nafady M, Ibrahim SIM, Ali MA, Elwakil W. Incidence and geographic characteristics of the population with osteoporotic hip fracture in Egypt- by the Egyptian Academy of Bone Health. Arch Osteoporos 2023; 18:115. [PMID: 37688741 DOI: 10.1007/s11657-023-01325-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
This work studies the epidemiology of hip fracture in Egypt. While the incidence of hip fracture in Egypt matches that of the Mediterranean region, there was geographic variation in osteoporotic hip fracture incidence between the north and south of Egypt. PURPOSE To assess the incidence of hip fracture in Egypt, with special emphasis on the geographic and demographic variation among the Egyptian population. METHODS The incidence of hip fractures treated in two Egyptian FLS centers was calculated for the period of February 2022-February 2023. Demographic information was recorded for every patient on the national register. All patients completed a baseline questionnaire, had clinical evaluation, fracture risk, falls, and sarcopenia risk assessment. A DXA scan was carried out for every patient. RESULTS The annual incidence of low-energy hip fracture in individuals aged 40 years or more in Egypt in 2022-2023 was 123.34 per 100,000 in women and 55.19 per 100,000 in men. The incidence of hip fractures was higher in south Egypt (113.62) versus north Egypt (64.8). This was consistent for both genders. Bone mineral density was significantly (p < 0.01) lower in south Egypt at both the spine, distal forearm, as well as hip trochanters, whereas there was no significant difference between both locations in terms of the total hip and neck of the femur. Yet, falls risk, sarcopenia, as well as functional disability rates were significantly (p < 0.001) higher in the north. CONCLUSION In Egypt, the hip fracture incidence was higher in the south compared to the north. Several modifiable factors contribute to fragility fracture risk independent of BMD, creating complex interrelationships between BMD, risk factors, and fracture risk.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, England, UK.
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt.
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
| | - Naglaa Gadallah
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Safaa Mahran
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | - Nihal Fathi
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | | | | | - Radwa H Shalaby
- Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | | | - Waleed Hassan
- Rheumatology and Rehabilitation, Benha University, Banha, Egypt
| | - Osama Farouk
- Orthopedic Surgery and Traumatology, Assiut University, Assiut, Egypt
| | - Mahmoud Nafady
- Orthopedic Surgery and Traumatology, Alexandria University, Alexandria, Egypt
| | | | | | - Walaa Elwakil
- Physical Medicine, Rheumatology and Rehabilitation, Alexandria University, Alexandria, Egypt
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Gasparik AI, Lorenzovici L, Pașcanu IM, Csata Z, Poiană C, Dobre R, Bartelick MM. Predictors of mortality for patients with hip fracture: a study of the nationwide 1-year records of 24,950 fractures in Romania. Arch Osteoporos 2023; 18:69. [PMID: 37195371 DOI: 10.1007/s11657-023-01253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Abstract
We conducted a study evaluating incidence rates and influencing factors in Romanian hip fracture patients. Our results showed that the type of fracture and its respective surgical procedure as well as hospital characteristics correlate with mortality. Updated incidences can result in updated treatment guidelines. PURPOSE The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality. METHODS We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15 days. RESULTS Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77 years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033). CONCLUSION Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model.
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Affiliation(s)
- Andrea I Gasparik
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - László Lorenzovici
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Ionela M Pașcanu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Zsombor Csata
- Faculty of Sociology and Social Work, Babeș-Bolyai University of Cluj Napoca, Cluj-Napoca, Romania
- Center for Social Sciences, Institute for Minority Studies, Budapest, Hungary
| | - Cătălina Poiană
- Carol Davila University of Medicine and Pharmacy of Bucharest, Bucharest, Romania
| | - Ramona Dobre
- Carol Davila University of Medicine and Pharmacy of Bucharest, Bucharest, Romania
| | - Miruna M Bartelick
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania.
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Søgaard AJ, Aga R, Holvik K, Meyer HE. Characteristics of fallers who later sustain a hip fracture: a NOREPOS study. Osteoporos Int 2022; 33:2315-2326. [PMID: 35927464 PMCID: PMC9568442 DOI: 10.1007/s00198-022-06490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
UNLABELLED Fall prevention programs have shown inconclusive results concerning hip fracture reduction. We found that fallers with poor health, low societal participation, and use of psychotropics/painkillers had a threefold to fivefold increased hip fracture risk compared to non-fallers without these risk factors. This may help target fall prevention towards high-risk individuals. INTRODUCTION To investigate whether self-reported information on health, societal participation, and drug use in older people, easily obtainable by health care providers, contribute to predict future hip fracture beyond self-reported falls. METHODS We used data from 3801 women and 6439 men aged 70-79 years participating in population-based studies in five counties in Norway 2000-2003. Height and weight were measured. Socioeconomic status, lifestyle, health status, and history of falling were self-reported through questionnaires. Falls last year were dichotomized into one or more versus no falls. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Hazard ratios (HR) with 95% confidence intervals (95% CI) for hip fracture by combinations of risk factors with history of falling were estimated using Cox proportional hazards regression. RESULTS More women (32.4%) than men (27.7%) reported one or more falls during the previous year, and 17.9% of women (n = 682) and 8.9% of men (n = 572) suffered a hip fracture during median 11.6 years of follow-up. Poor health, low societal participation, and use of psychotropics/analgesics among fallers were strong predictors of hip fracture. The presence of all three risk factors and history of falling was associated with HR 2.92 (95% CI 2.10-4.05) for hip fracture in women and HR 4.60 (95% CI 2.71-7.81) in men compared to non-fallers without these factors. CONCLUSION Our study indicates that self-assessment of health, information about activities outside home, and drug use among fallers far better identify high risk of hip fracture in older people than information about falls alone.
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Affiliation(s)
- Anne Johanne Søgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Ruth Aga
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Dahl C, Madsen C, Omsland TK, Søgaard AJ, Tunheim K, Stigum H, Holvik K, Meyer HE. The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway-A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. J Bone Miner Res 2022; 37:1527-1536. [PMID: 35689442 PMCID: PMC9545665 DOI: 10.1002/jbmr.4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/12/2022] [Accepted: 06/04/2022] [Indexed: 11/11/2022]
Abstract
Norway is an elongated country with large variations in climate and duration of winter season. It is also a high-risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (International Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] code S52) and hospitalized hip fractures (ICD-10 codes S72.0-S72.2) from 2008 to 2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008 to 2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (incidence rate ratios [IRRs], 95% confidence intervals [CIs]) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (hazard ratios [HR], 95% CI) were used to estimate the association between temperature and post-hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from -20.2°C to 22.0°C, with a median of -2.0°C in winter and 14.4°C in summer. At low temperatures (<0°C) compared to ≥0°C, there was a 53% higher risk of forearm fracture (95% CI, 51%-55%) and 21% higher risk of hip fracture (95% CI, 19%-22%), adjusting for age, gender, calendar year, urbanization, residential region, elevation, and coastal proximity. When taking the population mortality into account, the post-hip fracture mortality in both men (HR 1.08; 95% CI, 1.02-1.13) and women (HR 1.09; 95% CI, 1.04-1.14) was still higher at cold temperatures. There was a higher risk of forearm and hip fractures, and an excess post-hip fracture mortality at cold ambient temperatures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Cecilie Dahl
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway
| | - Christian Madsen
- Norwegian Institute of Public Health, Department of Health and Inequality, Oslo, Norway
| | - Tone Kristin Omsland
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway
| | - Anne-Johanne Søgaard
- Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | | | - Hein Stigum
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway.,Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | - Kristin Holvik
- Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | - Haakon E Meyer
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway.,Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
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Andreassen BK, Hektoen HH, Axcrona K, Langseth H, Stenehjem JS, Robsahm TE. Prediagnostic Serum-25 Hydroxyvitamin D and Mortality Among Bladder Cancer Patients in the Janus Serum Bank Cohort: Answer to a Short Comment [Response to Letter]. Clin Epidemiol 2021; 13:1061-1062. [PMID: 34803404 PMCID: PMC8599866 DOI: 10.2147/clep.s345565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Helga H Hektoen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Jo S Stenehjem
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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11
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Ormeño Illanes JCR, Quevedo Langenegger I. Higher latitude and lower solar radiation influence on hip fracture admissions in Chilean older population. Osteoporos Int 2021; 32:2033-2041. [PMID: 33818634 DOI: 10.1007/s00198-021-05910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED Data linking solar radiation with fractures are lacking. We found that lower solar radiation was associated with higher hip fracture admission rates in men from Chile. This supports the idea that solar radiation, a surrogate of vitamin D, may be involved in the development of fractures in older population. INTRODUCTION : To explore the associations between solar radiation and latitude with hip fracture admission rates in people aged 65 years or older in Chile, the country with the greatest variation in solar radiation in the world. METHODS In this ecological study, we investigated the associations between regional solar radiation and latitude with hospitalizations due to hip fracture in population aged 65 years or older, by reviewing national records between 2013 and 2018. We also evaluated the role of sociodemographic factors such as poverty, education, indigenous ethnicity, and rurality rates. RESULTS Between 2013 and 2018, there were 44,328 admissions due to hip fracture in people aged 65 years or older; 77.5% were women and 65.1% were aged 80 years or older. The national admission rate was 389.3 per 100,000 inhabitants (95% CI: 382.4-396.2). The highest admission rate was registered in the Region IX (445.3 per 100,000, 95% CI: 398.3-492.4), which has the highest poverty rates, indigenous ethnicity rates, and rurality rates. We found a north-south increasing gradient of admission rates in men (β=1.5 [95% CI: 0 to 3], p=0.044) and a significant association between solar radiation and admission rates in men (β=-4.4 [95% CI: -8 to 0.8], p=0.02). Admission rates in men were also associated with sociodemographic variables such as poverty (β=2.4 [95% CI: 0 to 4.8], p=0.048) and rurality rates (β=1.2 [95% CI: 0.1 to 2.4], p=0.039). CONCLUSION Regional solar radiation and latitude were associated with hip fracture admission rates in men aged 65 years or older in Chile, with highest admission rates at higher latitudes and lower solar radiation.
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Affiliation(s)
| | - I Quevedo Langenegger
- Endocrinology Section, Department of Internal Medicine, School of Medicine, University of Concepción, Concepción, Chile
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12
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Sundkvist J, Brüggeman A, Sayed-Noor A, Möller M, Wolf O, Mukka S. Epidemiology, classification, treatment, and mortality of adult femoral neck and basicervical fractures: an observational study of 40,049 fractures from the Swedish Fracture Register. J Orthop Surg Res 2021; 16:561. [PMID: 34526047 PMCID: PMC8442466 DOI: 10.1186/s13018-021-02701-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although femoral neck fractures (FNFs) are common in orthopedic departments, optimal treatment methods remain in dispute. There are few large nationwide studies, including basicervical FNFs (bFNFs), on epidemiology, treatment, and mortality. This nationwide study aims to describe the epidemiology, fracture classification, current treatment regimens, and mortality of undisplaced and minimally displaced (Garden I-II, uFNF), displaced (Garden III-IV, dFNF) and bFNFs in adults. METHODS All FNFs, including bFNFs with a registered injury date between 1 April 2012 and 31 December 2020, were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, injury mechanism, fracture classification, primary treatment, and seasonal variation were analyzed. RESULTS Some 40,049 FNFs were registered in the SFR. The mean age of the patients in the register was 80.3 (SD 11) years and 63.8% (25,567) were female. Of all FNFs, 25.0% (10,033) were uFNFs, 63.4% (25,383) dFNFs, and 11.6% (4,633) bFNFs. Non-surgical treatment was performed in 0.6% (261) of the patients. Internal fixation (IF) (84.7%) was the main treatment for uFNFs and arthroplasty (87.3%) for dFNFs. For bFNFs, IF (43.8%) and hip arthroplasty (45.9%) were performed equally often. Of the 33,105 patients with a 1-year follow-up mortality at 1-year was 20.6% for uFNF, 24.3% for dFNF, and 25.4% for bFNF. CONCLUSION The main treatment of uFNFs is IF with screws or pins. Hip arthroplasty is the predominant treatment for dFNF. bFNF are more common than previously reported and treated with IF or arthroplasty, depending on patient age. These results may help health care providers, researchers and clinicians better understand the panorama of FNFs in Sweden. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Jonas Sundkvist
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
| | - Anders Brüggeman
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Arkan Sayed-Noor
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olof Wolf
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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13
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Pekonen SR, Kopra J, Kröger H, Rikkonen T, Sund R. Regional and gender-specific analyses give new perspectives for secular trend in hip fracture incidence. Osteoporos Int 2021; 32:1725-1733. [PMID: 33712877 PMCID: PMC8387269 DOI: 10.1007/s00198-021-05906-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time. INTRODUCTION Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders. METHODS This observational study was based on all inpatient hospital discharges in 1972-2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model. RESULTS In 1972, women's hip fracture incidence was 1.2-1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women's risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period. CONCLUSION Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future.
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Affiliation(s)
- S.-R. Pekonen
- grid.9668.10000 0001 0726 2490School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - J. Kopra
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - H. Kröger
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- grid.410705.70000 0004 0628 207XDepartment of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - T. Rikkonen
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - R. Sund
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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14
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Dahl C, Madsen C, Omsland TK, Søgaard AJ, Tell GS, Holvik K, Meyer HE. Contribution of elevation and residential proximity to the coast in explaining geographic variations in hip fracture incidence. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) study. Osteoporos Int 2021; 32:1001-1006. [PMID: 33247392 DOI: 10.1007/s00198-020-05736-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED A higher risk of hip fracture was found in areas of Norway at higher elevation and farther from the coast. However, the previously seen county variations could not be explained by these geographical factors. INTRODUCTION Norway is an elongated country extending north of the Arctic Circle with substantial coast-inland variation in topography and climate. Differences in hip fracture incidence between counties and a distinct seasonal variation have previously been shown. The aim of the current study was to explore these variations further by considering associations of height above sea level (elevation) and distance to the coast with hip fracture incidence. METHODS All patients with hip fractures admitted to Norwegian hospitals in the period 2009-2018 were included. Individual residential elevation and distance to the coast was calculated in Geographic Information Systems and combined with individual-level population data on all Norwegians 50 years of age or older during the observation period, including hospital information on fractures. Age-standardized incidences rate and incidence rate ratios with 95% confidence intervals (IRR, 95% CI) according to elevation and coastal proximity were estimated. The associations were tested using Poisson models adjusting for sex, urban/rural location of residency, country of birth, and season of hip fracture occurrence. RESULTS From 2009 to 2018, there were 85,776 first hip fractures. There was an increasing risk with higher residential elevation (above versus below mean) for women: IRR = 1.04, 95% CI: 1.02, 1.05), but not for men (IRR = 1.00, 95% CI: 0.97, 1.02). Incidence of hip fracture increased with distance from the coast. Women residing the farthest away from the coast (above versus below mean distance) had a higher age-adjusted incidence of hip fracture compared to those living closer to the coast (IRR = 1.04 (95% CI: 1.02, 1.06), whereas no association was found in men (IRR = 1.00 (95% CI: 1.00, 1.01). Combining elevation and distance to coast showed a higher incidence in women living at high elevation far from the coast compared with women living at low elevation near the coast (IRR = 1.07, 95% CI: 1.04, 1.10). A similar result was found in men but only for hip fractures occurring during March-May (IRR = 1.07, 95% CI: 1.00, 1.15). The previously shown patterns of county differences and seasonal variations were unchanged when considering geography. CONCLUSION We found a somewhat higher incidence of hip fracture in inland residents living in areas of high elevation, as compared to those living in more coastal proximity; however, the geographic variation did not explain county and seasonal differences in fracture incidence in Norway. More in-depth analyses on temperature and climate factors may give further clues.
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Affiliation(s)
- C Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway.
| | - C Madsen
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - T K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway
| | - A-J Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - G S Tell
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - K Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - H E Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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