Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050

Short-term effect of sunshine duration on daily emergency visits for hip fractures in Beijing, China: a time-series study

This study employs a time-series analysis to investigate how sunshine duration associates hip fractures in China and found both short and long durations of sunshine increased the risk of hip fractures. The findings can guide strategies for reducing hip fractures and enhance health education on fracture prevention.

BACKGROUND

Studies on the associations between sunshine duration and emergency visits for hip fractures (HF) are limited. This study aimed to assess the short-term effect of sunshine duration on the risk of emergency visits for HF.

METHODS

Daily emergency visits for HF at Beijing Jishuitan Hospital from 2015 to 2019 and contemporaneous meteorological and air pollutant data were collected. A Poisson generalized linear regression model combined with a distributed lag non-linear model was applied to analyze the lag-exposure-response relationship between sunshine duration and HF. Stratified analysis was performed by gender and age.

RESULTS

A total of 10,874 cases were identified. The overall cumulative exposure-response curve showed a U-shaped relationship between sunshine duration and HF. With 7.2 h as the reference (lowest HF emergency visit risk), significant single-day effects of short sunshine duration (0 h, 2.5th percentile) were observed from the 11th to the 13th day, peaking on lag day 13 (RR = 1.033, 95% CI: 1.003-1.065), while its cumulative effects lasted from lag days 0-11 to 0-14, with the highest RR of 1.327 (95% CI: 1.088-1.619) at lag day 0-14. Significant single-day effects of long sunshine duration (12.7 h, 97.5th percentile) occurred from the 10th to the 12th day, peaking on the 12th day (RR = 1.030, 95% CI: 1.000-1.061), but no cumulative lag effects were found. This U-shaped pattern was consistent across subgroups, especially among female patients and those aged 66-79 years; conversely, the risk of HF-related emergency visits decreased with increasing sunshine duration in patients aged 40-65 years with a relatively high uncertainty.

CONCLUSIONS

Both short and long durations of sunshine are associated with an increased risk of HFs emergency visits. Females and patients aged 66-79 years might be more vulnerable to short sunshine duration.

Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe

INTRODUCTION

Population ageing in Africa is increasing healthcare demands. Hip fractures require multidisciplinary care and are considered an indicator condition for age-related health services. We aimed to estimate current hip fracture incidence in Zimbabwe, compare rates against other regional estimates and estimate future fracture numbers.

METHODS

All hip fracture cases in adults aged ≥40 years, presenting to any hospital in Harare over 2 years, were identified. From this, age- and sex-specific hip fracture incidence rates per 100 000 person-years were estimated using 2022 Zimbabwean Census data and compared with South African and Botswanan estimates. Furthermore, using the United Nations population projections, future hip fracture numbers were estimated to 2052 for Zimbabwe.

RESULTS

In 2022, 1 83 312 women and 1 79 212 men aged ≥40 years were living in Harare (14.9% of the city's population). Over 2 years 243 hip fracture cases, 133 (54.7%) female, mean (SD) age 71.2 (15.9) years, were identified. Most presented to public hospitals (202 [83.1%]) and were fragility hip fractures (211 [86.8%]); high-impact trauma (eg, traffic accidents) was more common in younger men. Presentation delays of >2 weeks were common (37.4%). Incidence rates for adults aged ≥40 years in Harare (observed) and Zimbabwe (estimated) were 33.5 and 53.8/100 000 person-years, respectively. Over age 50, rates increased with age, with the highest rates seen in women aged ≥85 years (704/100 000 person-years). Age-standardised hip fracture incidence rates are broadly comparable between Zimbabwe, Botswana and Black South Africans in those aged 40-69 years; thereafter, rates in Zimbabwean women and men exceed those in Botswana and South Africa. Across Zimbabwe, the number of hip fractures occurring annually is expected to increase more than 2.5-fold from 1709 in 2022 to 4414 by 2052.

CONCLUSION

In Zimbabwe, most hip fractures in adults ≥50 years are fragility fractures, consistent with age-associated osteoporosis; incidence rates exceed those previously reported regionally. Demands on already challenged healthcare systems will increase.

Hip fracture projections up to the year 2060: an analysis based on data from the National Hip Fracture Database (NHFD) for England, Wales, and Northern Ireland

INTRODUCTION

Hip fractures are common and cause a huge socioeconomic burden to patients, their carers, and healthcare services worldwide. Our aim was to examine how much hip fracture numbers would be expected to rise over coming decades, simply as a consequence of the ageing of the population.

METHODS

We used data from the National Hip Fracture Database on the volume of hip fractures occurring in England, Wales and Northern Ireland in the year 2019 (n = 67,210). We projected future numbers of hip fractures by applying this number, assuming stable rates, to population growth forecast data provided by the Office for National Statistics up to the year 2060.

RESULTS

By 2060, the number of hip fractures occurring in England, Wales and Northern Ireland are projected to increase by 107 % (n = 139,105). In males, there was an estimated increase of 130 % compared with 97 % in females. There was an estimated increase across all age ranges, however the oldest age groups demonstrated the largest relative increases. The estimated increase for those aged 90 years or over was as high as 348 % and 198 % for males and females, respectively.

CONCLUSION

As a consequence of future ageing of the population, the demand on the health service posed by people with hip fracture is projected to more than double by the year 2060. Policymakers should be striving to mitigate against the huge public health impact of these projections by maximising fracture prevention strategies as far as possible and by improving the quality of hip fracture care.

[Translated article] Socioeconomic status, osteoporosis and fragility fractures

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first-year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment. In Spain, a higher risk of fractures has been described in people with a low-income level, residence in rural areas during childhood and low educational level. The civil war cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

Risk factors associated with surgical site infection following orthopaedic surgery in South Africa and Sub-Saharan Africa: a scoping review protocol

OBJECTIVE

The objective of the scoping review will be to understand and describe risk factors associated with surgical site infection (SSI) in an orthopaedic surgery population in Sub-Saharan Africa and South Africa. This paper describes the protocol that will be used for the scoping review.

METHOD

A comprehensive literature search will be conducted using MEDLINE (PubMed), CINAHL (EBSCO), Embase and Cochrane Libraries to identify articles meeting the inclusion criteria, including both published and grey literature, in order to provide a broad overview of the reported risk factors associated with patients who have undergone an orthopaedic surgery with an outcome of SSI within 90 days of a procedure. Additional studies will be sourced by exploring the reference list of included eligible studies. By using a combination of the Population, Exposure, Outcome framework, terms and synonyms related to each category, in different variations, along with Boolean operators (AND, OR, NOT) in the search strategy, identified comprehensive and relevant literature for the scoping review.

RESULTS

It is anticipated the results will provide a baseline of risk factors that will inform the development of a risk assessment tool for clinical use.

CONCLUSION

This protocol will inform the development of a scoping review to describe factors associated with SSIs following orthopaedic surgery in Sub-Saharan Africa and South Africa.

A Novel Internal Fixation Design for the Treatment of AO/OTA-31A3.3 Intertrochanteric Fractures: Finite Element Analysis

OBJECTIVE

AO/OTA 31-A3.3 intertrochanteric fracture is the most unstable type of intertrochanteric fracture, with a high rate of postoperative complications and implant failure. We have designed a new intramedullary fixation, proximal femoral totally bionic nail (PFTBN), for the treatment of A3.3 intertrochanteric fracture. To test its biomechanical performance, we adopted the method of finite element analysis and compared PFTBN with proximal femoral nail antirotation (PFNA) and proximal femoral bionic nail (PFBN, another internal fixation we previously designed for stable intertrochanteric fractures).

METHODS

Mimics, 3-matic, ANSYS, and other software were used to construct a highly precise and realistic 3D digital model of the human femur. An AO/OTA 31-A3.3 intertrochanteric fracture of the femur was constructed according to the 2018 classification of AO/OTA, and then assembled with PFNA, PFBN and PFTBN models, respectively. The stress distribution and displacement distribution of the three groups of constructs were tested under three times the body weight load and one-foot standing configuration.

RESULTS

In terms of maximum stress and maximum displacement, the PFTBN group outperforms the PFBN group, and the PFBN group, in turn, surpasses the PFNA group. The maximum stress of PFTBN group was 408.5 Mpa, that of PFBN group was 525.4 MPa, and that of PFNA group was 764.3 Mpa. Comparatively, the maximum stress in the PFTBN group was reduced by 46.6% when contrasted with the PFNA group. Moreover, the stress dispersion within the PFTBN group was more evenly distributed than PFNA group. Regarding maximum displacement, the PFTBN group displayed the least displacement at 5.15 mm, followed by the PFBN group at 7.32 mm, and the PFNA group at 7.73 mm. Notably, the maximum displacement of the PFTBN group was 33.4% less than that observed in the PFNA group. Additionally, the relative displacement between the fragment and implant at the tip of pressure screw or helical blade was 0.22 mm in the PFTBN group, 0.34 mm in the PFBN group, and substantially higher 0.51 mm in the PFNA group.

CONCLUSION

The "lever-reconstruction-balance" theory provides a new perspective for us to understand the mechanical conduction of the proximal femur. Compared with PFNA, in treating A3.3 intertrochanteric fractures PFTBN can better reconstruct the function of lateral wall, restore physiological mechanical conduction, increase postoperative stability, and finally reduce the risk of postoperative cut-out and implant failure. It might be a better alternative for the treatment of A3.3 intertrochanteric fracture.

Socioeconomic status, osteoporosis and fragility fractures

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment. In Spain, a higher risk of fractures has been described in people with a low income level, residence in rural areas during childhood and low educational level. The Civil War cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

Disparities in the Prevalence of Osteoporosis and Osteopenia in Men and Women Living in Sub-Saharan Africa, the UK, and the USA

PURPOSE

To review the rising prevalence of osteopenia and osteoporosis in sub-Saharan Africa and the challenges this poses to governments and healthcare services. Using existing studies, we compare the prevalence of osteopenia and osteoporosis in men and women from sub-Saharan Africa to US and UK cohorts. Context-specific disparities in healthcare are discussed particularly the challenges in diagnosis and treatment of osteoporosis.

RECENT FINDINGS

There are few epidemiological data describing the burden of osteoporosis in sub-Saharan Africa. In the studies and cohorts presented here, osteoporosis prevalence varies by sex, country and area of residence, but is generally higher in African populations, than has previously been appreciated. Risk factors contributing to poorer bone health include HIV, malnutrition and "inflammaging." Reprioritization towards care of ageing populations is urgently required. Equitable access to implementable preventative strategies, diagnostic services, treatments and pathways of care for bone health (for example embedded within HIV services) need now to be recognized and addressed by policy makers.

Clinical profile, risk factors and functional outcomes in women and men presenting with hip fractures in KwaZulu-Natal, South Africa

Rationale Appropriate screening can prevent osteoporotic hip fractures (HF). There is little data on clinical risk factors (CRFs) from Africa.

MAIN RESULT

Subjects with HF had similar CRFs to high income countries and poor functional outcomes post HF.

SIGNIFICANCE

Screening and treatment algorithms to improve outcomes post HF need to be implemented.

PURPOSE

Limited data exist on clinical risk factors (CRFs) for and functional outcomes following hip fractures (HF) in South Africa (SA).

METHODS

In a prospective observational study conducted in two municipalities in KwaZulu-Natal, a structured questionnaire recorded demographic data, CRFs, self-reported chronic medical conditions and functional status. Parametric and non-parametric tests were used to test for differences and the McNemar test for change over time.

RESULTS

The median age of the 287 subjects was 72 years (IQR 64-80 years) with the majority women (67.2%), who were significantly older than men. Two or more comorbidities were present in 76.3%. Hypertension (71.4%) and diabetes (29.6%) were most common. Eleven (3.8%) reported a previous diagnosis of osteoporosis and four (1.4%) prior treatment for osteoporosis. A history of cancer (15.4% v. 1.2%, p < 0.001), previous diagnosis of osteoporosis (17.9% v. 1.6%, p < 0.001) and treatment for osteoporosis (7.7% v. 0.4%, p < 0.001) was significantly more common in private compared to public sector subjects. African subjects had a higher prevalence of HIV infection compared to Indian (12.5% v. 0%, p < 0.001) while Indian subjects were more likely to report two or more comorbidities (p = 0.003) and hypertension (p = 0.005) compared to African subjects. Common CRFs were a previous fracture (32.4%), prior fall (24.7%), weight below 57 kg (23.3%), smoking (19.2%) and alcohol use of more than 3 units per day (17.8%). Less than 5% reported a history of parental HF or glucocorticosteroid use. Functional status was available for 206 subjects. Of the 163 participants who had surgery, 81% were independent prior to the HF, compared to the significantly lower 6.7% and 56.4% at 30 days and 1 year post fracture, respectively. The proportion with some degree of dependency rose significantly from 19% pre-fracture to 43.6%, 1 year post-fracture. Walking up stairs and transfer from bed to chair were the most commonly affected activities.

CONCLUSION

Clinical risk factors for HF are similar to those published internationally and support the use of current risk assessment models in SA. Targeted management and rehabilitation programs are required to improve functional outcomes post-HF.