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Mohseni V, Fahimfar N, Ansarifar A, Masoumi S, Sanjari M, Khalagi K, Bagherifard A, Larijani B, Janani L, Mansourzadeh MJ, Ostovar A, Solaymani-Dodaran M. Mortality and re-fracture rates in low trauma hip fracture. BMC Geriatr 2024; 24:381. [PMID: 38684943 PMCID: PMC11059755 DOI: 10.1186/s12877-024-04950-1] [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: 10/10/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event. MATERIALS AND METHODS This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture. RESULTS A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively. CONCLUSION Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.
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Affiliation(s)
- Vahideh Mohseni
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ansarifar
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Mansourzadeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
- Minimally Invasive Surgery Research Center, Hazrat-e-Rasool Hospital, Iran University of Medical Science, Tehran, Iran.
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Chiang YW, Chang YJ, Huang HJ, Hsieh CP, Lu YH. Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery? BMC Geriatr 2024; 24:322. [PMID: 38589787 PMCID: PMC11000408 DOI: 10.1186/s12877-024-04936-z] [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: 10/06/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the increasing number of elderly individuals worldwide, a greater number of people aged 80 years and older sustain fragility fracture due to osteopenia and osteoporosis. METHODS This retrospective study included 158 older adults, with a median age of 85 (range: 80-99) years, who sustained hip fragility fracture and who underwent surgery. The patients were divided into two groups, one including patients who joined the post-acute care (PAC) program after surgery and another comprising patients who did not. The mortality, complication, comorbidity, re-fracture, secondary fracture, and readmission rates and functional status (based on the Barthel index score, numerical rating scale score, and Harris Hip Scale score) between the two groups were compared. RESULTS The patients who presented with fragility hip fracture and who joined the PAC rehabilitation program after the surgery had a lower rate of mortality, readmission rate, fracture (re-fracture and secondary fracture), and complications associated with fragility fracture, such as urinary tract infection, cerebrovascular accident, and pneumonia (acute coronary syndrome, out-of-hospital cardiac arrest, or in-hospital cardiac arrest. CONCLUSIONS PAC is associated with a lower rate of mortality and complications such as urinary tract infection, bed sore, and pneumonia in octogenarian and nonagenarian patients with hip fragility fracture.
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Affiliation(s)
- Yu-Wei Chiang
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Yu-Jun Chang
- Big Data Center, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Hui-Jen Huang
- Department of Nursing, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Cheng-Pu Hsieh
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C
| | - Yueh-Hsiu Lu
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C..
- Institute of Biomedical Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C..
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3
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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [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] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Christensen ER, Clausen A, Petersen TG, Skjødt MK, Abrahamsen B, Möller S, Rubin KH. Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities. RMD Open 2023; 9:e003524. [PMID: 38030232 PMCID: PMC10689412 DOI: 10.1136/rmdopen-2023-003524] [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: 07/21/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES This study aimed to examine the risk of mortality following incident and subsequent osteoporotic fractures, the effect of different fracture type combinations, and the mediating role of postfracture morbidity in a Danish population. METHODS We used the National Patient Registry to identify patients ≥60 years with incident major osteoporotic fracture of the hip, vertebrae, wrist or humerus between 2013 and 2018, and controls matched 1:10 on age and sex. Possible mediators were identified using International Classification of Diseases, 10th Revision codes registered in the 6 months following index fracture. HRs were estimated using Cox regression analyses with 95% CIs. The effect of possible mediators was estimated using mediation analyses. RESULTS The study included 106 303 patients and 1 062 988 controls. Mortality following index fracture was highest in the month following hip fractures (HR 10.98 (95% CI 10.23 to 11.79) in women and HR 16.40 (95% CI 15.00 to 17.93) in men). Subsequent hip fractures resulted in the highest HRs for all fracture type combinations. In women, the highest HR was observed in patients with index wrist/subsequent hip fractures (HR 2.43 (95% CI 2.12 to 2.78)). In men, the highest HR was observed in patients with index humerus/subsequent hip fractures (HR 2.69 (95% CI 2.04 to 3.54)). Pneumonia mediated the largest proportion of mortality, but dehydration, urinary tract infection and sepsis were also important factors. CONCLUSIONS The highest mortality risk was found in the month immediately following both index and subsequent fracture. The combination of index and subsequent fractures at different skeletal sites had a substantial impact on the risk of mortality. Postfracture morbidities were found mediate the association.
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Affiliation(s)
| | - Anne Clausen
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tanja Gram Petersen
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Kriegbaum Skjødt
- Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
- Department of Medicine, Gentofte Hospital, Hellerup, Copenhagen, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Holvik K, Ellingsen CL, Solbakken SM, Finnes TE, Talsnes O, Grimnes G, Tell GS, Søgaard AJ, Meyer HE. Cause-specific excess mortality after hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). BMC Geriatr 2023; 23:201. [PMID: 36997876 PMCID: PMC10064567 DOI: 10.1186/s12877-023-03910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Information on cause of death may help appraise the degree to which the high excess mortality after hip fracture reflects pre-existing comorbidities or the injury itself. We aimed to describe causes of death and cause-specific excess mortality through the first year after hip fracture. METHODS For studying the distribution of causes of death by time after hip fracture, we calculated age-adjusted cause-specific mortality at 1, 3, 6 and 12 months in patients hospitalized with hip fracture in Norway 1999-2016. Underlying causes of death were obtained from the Norwegian Cause of Death Registry and grouped by the European Shortlist for Causes of Death. For estimating excess mortality, we performed flexible parametric survival analyses comparing mortality hazard in patients with hip fracture (2002-2017) with that of age- and sex matched controls drawn from the Population and Housing Census 2001. RESULTS Of 146,132 Norwegians with a first hip fracture, a total of 35,498 (24.3%) died within one year. By 30 days post-fracture, external causes (mainly the fall causing the fracture) were the underlying cause for 53.8% of deaths, followed by circulatory diseases (19.8%), neoplasms (9.4%), respiratory diseases (5.7%), mental and behavioural disorders (2.0%) and diseases of the nervous system (1.3%). By one-year post-fracture, external causes and circulatory diseases together accounted for approximately half of deaths (26.1% and 27.0%, respectively). In the period 2002-2017, cause-specific one-year relative mortality hazard in hip fracture patients vs. population controls ranged from 1.5 for circulatory diseases to 2.5 for diseases of the nervous system in women, and correspondingly, from 2.4 to 5.3 in men. CONCLUSIONS Hip fractures entail high excess mortality from all major causes of death. However, the traumatic injury of a hip fracture is the most frequently reported underlying cause of death among older patients who survive less than one year after their fracture.
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Affiliation(s)
- Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway.
| | - Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Marie Solbakken
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
| | - Trine Elisabeth Finnes
- Department of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ove Talsnes
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Department of Orthopedics, Innlandet Hospital Trust, Elverum, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne-Johanne Søgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Dijkstra H, Oosterhoff JHF, van de Kuit A, IJpma FFA, Schwab JH, Poolman RW, Sprague S, Bzovsky S, Bhandari M, Swiontkowski M, Schemitsch EH, Doornberg JN, Hendrickx LAM. Development of machine-learning algorithms for 90-day and one-year mortality prediction in the elderly with femoral neck fractures based on the HEALTH and FAITH trials. Bone Jt Open 2023; 4:168-181. [PMID: 37051847 PMCID: PMC10032237 DOI: 10.1302/2633-1462.43.bjo-2022-0162.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip fracture Evaluation with Alternatives of Total Hip arthroplasty versus Hemiarthroplasty (HEALTH) and Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trials. This study included 2,388 patients from the HEALTH and FAITH trials, with 90-day and one-year mortality proportions of 3.0% (71/2,388) and 6.4% (153/2,388), respectively. The mean age was 75.9 years (SD 10.8) and 65.9% of patients (1,574/2,388) were female. The algorithms included patient and injury characteristics. Six algorithms were developed, internally validated and evaluated across discrimination (c-statistic; discriminative ability between those with risk of mortality and those without), calibration (observed outcome compared to the predicted probability), and the Brier score (composite of discrimination and calibration). The developed algorithms distinguished between patients at high and low risk for 90-day and one-year mortality. The penalized logistic regression algorithm had the best performance metrics for both 90-day (c-statistic 0.80, calibration slope 0.95, calibration intercept -0.06, and Brier score 0.039) and one-year (c-statistic 0.76, calibration slope 0.86, calibration intercept -0.20, and Brier score 0.074) mortality prediction in the hold-out set. Using high-quality data, the ML-based prediction models accurately predicted 90-day and one-year mortality in patients aged 50 years or older with a FNF. The final models must be externally validated to assess generalizability to other populations, and prospectively evaluated in the process of shared decision-making.
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Affiliation(s)
- Hidde Dijkstra
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatric Medicine, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacobien H F Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Engineering Systems and Services, Faculty Technology Policy Management, Delft University of Technology, Delt, Netherlands
| | - Anouk van de Kuit
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopaedic Surgery, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Marc Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Laurent A M Hendrickx
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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7
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Omer M, Ngo C, Ali H, Orlovskaya N, Cheong VS, Ballesteros A, Garner MT, Wynn A, Martyniak K, Wei F, Collins BE, Yarmolenko SN, Asiatico J, Kinzel M, Ghosh R, Meckmongkol T, Calder A, Dahir N, Gilbertson TA, Sankar J, Coathup M. The Effect of Omega-9 on Bone Viscoelasticity and Strength in an Ovariectomized Diet-Fed Murine Model. Nutrients 2023; 15:nu15051209. [PMID: 36904208 PMCID: PMC10005705 DOI: 10.3390/nu15051209] [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: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Few studies have investigated the effect of a monosaturated diet high in ω-9 on osteoporosis. We hypothesized that omega-9 (ω-9) protects ovariectomized (OVX) mice from a decline in bone microarchitecture, tissue loss, and mechanical strength, thereby serving as a modifiable dietary intervention against osteoporotic deterioration. Female C57BL/6J mice were assigned to sham-ovariectomy, ovariectomy, or ovariectomy + estradiol treatment prior to switching their feed to a diet high in ω-9 for 12 weeks. Tibiae were evaluated using DMA, 3-point-bending, histomorphometry, and microCT. A significant decrease in lean mass (p = 0.05), tibial area (p = 0.009), and cross-sectional moment of inertia (p = 0.028) was measured in OVX mice compared to the control. A trend was seen where OVX bone displayed increased elastic modulus, ductility, storage modulus, and loss modulus, suggesting the ω-9 diet paradoxically increased both stiffness and viscosity. This implies beneficial alterations on the macro-structural, and micro-tissue level in OVX bone, potentially decreasing the fracture risk. Supporting this, no significant differences in ultimate, fracture, and yield stresses were measured. A diet high in ω-9 did not prevent microarchitectural deterioration, nevertheless, healthy tibial strength and resistance to fracture was maintained via mechanisms independent of bone structure/shape. Further investigation of ω-9 as a therapeutic in osteoporosis is warranted.
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Affiliation(s)
- Mahmoud Omer
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Christopher Ngo
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Hessein Ali
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Nina Orlovskaya
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Vee San Cheong
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
| | | | | | - Austin Wynn
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Kari Martyniak
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Fei Wei
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Boyce E. Collins
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Sergey N. Yarmolenko
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Jackson Asiatico
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Michael Kinzel
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Ranajay Ghosh
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Teerin Meckmongkol
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
- Department of General Surgery, Nemours Children’s Hospital, Orlando, FL 32827, USA
| | - Ashley Calder
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Naima Dahir
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | | | - Jagannathan Sankar
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Melanie Coathup
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
- Correspondence: ; Tel.: +1-407-266-7184
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8
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Hata T, Shima H, Nitta M, Ueda E, Nishihara M, Uchiyama K, Katsumata T, Neo M. The Relationship Between Duration of General Anesthesia and Postoperative Fall Risk During Hospital Stay in Orthopedic Patients. J Patient Saf 2022; 18:e922-e927. [PMID: 35532998 DOI: 10.1097/pts.0000000000001021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We performed a retrospective observational study to investigate the relationship between general anesthesia duration and postoperative falls of hospitalized patients who underwent orthopedic surgery. METHODS We used electronic medical record data and incident report data from the Osaka Medical and Pharmaceutical University Hospital. The study included 4,042 patients admitted to the Department of Orthopedic Surgery from 2014 to 2018, and the following exclusion criteria were applied: no surgery, less than 18 years of age, and fall between admission and surgery. This study only considered falls that occurred within 21 days of surgery. The multivariate logistic regression model adjusted for patient background was used to determine the risk of falling according to the duration of general anesthesia. RESULTS After exclusions, 3,398 patients were included in the analysis. Among them, 45 patients (1.32%) had fallen, of whom 7 (15.6%) were injured and 2 (4.4%) experienced fractures. Multivariate logistic regression analysis to determine the adjusted odds ratio showed that longer general anesthesia duration was an independent risk factor for postoperative falls. In addition, cardiovascular disease had significantly higher associations with postoperative falls. CONCLUSIONS In the postoperative care of orthopedic patients, the risk of falling should be assessed by considering the duration of general anesthesia in addition to the traditional fall risk factors. Furthermore, falls could be prevented by educating patients and their caregivers about the risk and mobilizing staff to support postoperative patients at a higher risk of falls when they walk in the hospital.
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Ruiz-Romero MV, Calero-Bernal ML, Carranza-Galván AB, Fernández-Moyano A, Blanco-Taboada AL, Fernández-Ojeda MR. [What risk factors are associated with mortality and readmissions in osteoporotic hip fracture?]. J Healthc Qual Res 2022; 37:303-312. [PMID: 35165076 DOI: 10.1016/j.jhqr.2021.11.004] [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: 08/24/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Hip fracture in the elderly leads to long hospital stays, readmissions and mortality. OBJECTIVE To identify risk factors associated with mortality and readmissions in elderly with hip fracture. PATIENTS AND METHODS Prospective observational study in people over 65years with hip fracture between October-2017 and November-2018, followed for 12months (128 patients). STATISTICAL ANALYSIS SPSS vs27.0. RESULTS 6 (4.7%) patients were readmitted at 1 month; at year 24 (19.4%); 55 (44.4%) consulted for emergencies; 4 (3.1%) died during admission, and 26 (20.3%) in 12months; hospital stay 6.5 (SD: 4.80) days. Those with a previous Barthel less than 85 (6 [8.5%] vs 0 [0%]; P=.037) and less EuroQol5D (6 [10.0] vs 0 [0%]; P=.011) were readmitted more at one month. Those taking anticoagulants (OR: 3.33 (1.13-9.81); P=.003) and those with high surgical risk (18 [23.4%] vs 1 [5.6%]) were readmitted more after one year; P=.038). There was higher intra-episode mortality with renal failure (OR: 34.2 [3.25-359.93]; P=.003) and decompensated heart failure (OR: 23.8 [2.76-205.25]; P=.015). Higher mortality at one year in those older than 85years (OR: 4.3 [1.48-12.49]; P=.007); in those taking benzodiazepines (OR: 2.86 [1.06-7.73]; P=.038); if Barthel was less than 85 (OR: 2.96 [1.1-7.99]; P=.027) and if EuroQol5D was low (0.249 vs 0.547; P=.025). Those operated after 72h (24 [57.1%] vs. 29 [38.2%]; P=.047) consulted more for the emergency department. CONCLUSIONS Renal failure and cardiac decompensation increased intra-episode mortality. Older age, benzodiazepines, and previous low functionality and low EuroQol5D increased mortality at one year. They were readmitted more if higher surgical risk, previously anticoagulated and worse quality of life and functionality.
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Affiliation(s)
- M V Ruiz-Romero
- Unidad de Calidad, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
| | - M L Calero-Bernal
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - A B Carranza-Galván
- Hospitalización de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - A Fernández-Moyano
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Centro Universitario de Enfermería San Juan de Dios, Bormujos, Sevilla, España
| | - A L Blanco-Taboada
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - M R Fernández-Ojeda
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Centro Universitario de Enfermería San Juan de Dios, Bormujos, Sevilla, España
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10
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Wang PW, Yao XD, Zhuang HF, Li YZ, Xu H, Lin JK, Liu WG. Mortality and Related Risk Factors of Fragile Hip Fracture. Orthop Surg 2022; 14:2462-2469. [PMID: 36017769 PMCID: PMC9531092 DOI: 10.1111/os.13417] [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: 12/21/2020] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To explore the mortality of patients with fragile hip fractures and assess the death‐associated risk factors. Methods A total of 690 patients with osteoporotic hip fractures (age, 50–103 years) that were treated from January 2010 to December 2015 were enrolled and followed‐up in this study and the clinical data were retrospectively collected. Three months, 1 year, and the total mortality were measured. Mortality‐related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications. The mortality of each group was compared by chi‐square test or corrected chi‐square test for univariate analysis, and the factors with statistically significant mortality difference confirmed by univariate analysis were analyzed by binary logistic multivariate analysis. Results The 3‐month mortality was 7.69%, the 1‐year mortality was 15.60%, and the total mortality of the follow‐up time was 24.06%. The 1‐year and total mortality during the follow‐up of the patients were higher in the >75‐year‐old group than those in the ≤75‐year‐old group (p = 0.000, respectively); were higher in the male patients than that in the female patients (p = 0.042; p = 0.017, respectively); were significantly lower in the operation group than that in the non‐operation group (p = 0.000, respectively); were significantly lower in the patients that underwent the operation in ≤5 days than the patients that underwent the operation within >5 days (p = 0.008; p = 0.000, respectively); were significantly lower in patients with >2 kinds of combined medical diseases than those with ≥2 kinds of chronic diseases (p = 0.000, respectively); were significantly lower in patients receiving anti‐osteoporosis treatment than in patients not receiving anti‐osteoporosis treatment (p = 0.000, p = 0.002, respectively). Binary logistic regression analysis showed that the independent risk factors affecting mortality included advanced age >75‐years‐old (OR = 5.653, p = 0.000), male (OR = 1.998, p = 0.001), non‐surgical treatment (OR = 9.909, p = 0.000), the number of combined medical diseases ≥2 (OR = 1.522, p = 0.042), and non‐anti‐osteoporosis treatment (OR = 1.796, p = 0.002). Conclusion Age, whether or not surgical treatment was performed, the number of medical diseases, and whether or not anti‐osteoporosis treatment was performed were independent risk factors for 3‐month and 1‐year mortality in patients with fragile hip fractures.
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Affiliation(s)
- Pei-Wen Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Xue-Dong Yao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Hua-Feng Zhuang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Yi-Zhong Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Hao Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Jin-Kuang Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Wen-Ge Liu
- Department of Orthopaedic Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
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11
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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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12
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Ko YS, Jeong Y, Park JW, Lee YK, Koo KH. Effects of the Revised Reimbursement Guideline for Anti-Osteoporosis Medication in South Korea. J Bone Metab 2022; 29:191-196. [PMID: 36153855 PMCID: PMC9511126 DOI: 10.11005/jbm.2022.29.3.191] [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: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Korean National Health Insurance (NHI) reimbursement guideline was revised in May 2015 with the aim of preventing secondary osteoporotic fractures. Here we compared the: (1) rate of bone mineral density (BMD) measurements; (2) prescription rate of anti-osteoporosis medication within 3 months after hip fracture surgery (HFS); (3) incidence of a second hip fracture; and (4) first-year mortality rate after HFS. METHODS This before-after study used the revised reimbursement system as a reference period. We retrospectively reviewed the medical records of 515 patients who underwent HFS at a tertiary referral hospital between January 2014 and December 2016. The period 1 group underwent HFS in 2014, while the period 2 group underwent HFS in 2016. RESULTS Despite the fact that there was no significant intergroup difference in BMD measurement rate, the period 2 group had a higher prescription rate for anti-osteoporosis drugs within 3 months of HFS. However, the incidence of a second hip fracture did not differ between groups. The first-year mortality rate was higher in the period 1 versus period 2 group. CONCLUSIONS Revision of the NHI guideline in May 2015 was associated with an increased prescription rate of anti-osteoporosis medication in osteoporotic hip fracture patients.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yeonsuk Jeong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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13
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Tai TW, Hwang JS, Li CC, Hsu JC, Chang CW, Wu CH. The Impact of Various Anti-Osteoporosis Drugs on All-Cause Mortality After Hip Fractures: A Nationwide Population Study. J Bone Miner Res 2022; 37:1520-1526. [PMID: 35689432 DOI: 10.1002/jbmr.4627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 06/04/2022] [Indexed: 12/27/2022]
Abstract
Anti-osteoporosis treatment following hip fractures may reduce the overall mortality rate. However, the effects of different drugs on mortality is still unclear. This population-based cohort study aimed to identify the degree of reduced mortality after various anti-osteoporosis regimens following hip fracture surgery. We conducted this cohort study to identify patients with newly diagnosed osteoporosis and hip fractures from 2009 to 2017 using the Taiwan National Health Insurance Research Database (NHIRD). The subsequent use of anti-osteoporosis medication following hip fracture surgery was collected and analyzed. National death registration records were retrieved to determine mortality. A total of 45,226 new cases of osteoporotic hip fracture were identified. Compared with patients who did not receive further treatment, patients who had ever used oral bisphosphonates (alendronate and risedronate, hazard ratio [HR] 0.81; 95% confidence interval [CI], 0.78-0.84), ibandronate (HR 0.76; 95% CI, 0.67-0.86), zoledronic acid (HR 0.70; 95% CI, 0.64-0.76), and denosumab (HR 0.64; 95% CI, 0.60-0.68) showed lower all-cause mortality rates. Patients treated with bisphosphonates had a lower mortality risk than those treated with selective estrogen receptor modulators (HR 0.81; 95% CI, 0.75-0.87). Patients treated with zoledronic acid showed a lower mortality risk than those treated with oral bisphosphonates (HR 0.89; 95% CI, 0.82-0.97). However, patients receiving denosumab and zoledronic acid did not show a significant difference in mortality (HR 0.94; 95% CI, 0.85-1.03). Different anti-osteoporosis treatments for postsurgical patients were associated with different levels of decline in mortality. Generally, longer durations of drug use were associated with lower mortality. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason C Hsu
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan.,Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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14
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Nguyen PV, Hjelholt TJ, Heide-Jørgensen U, Pedersen AB. Postoperative complications, mortality, and quality of in-hospital care among hip fracture patients with Parkinson's disease. Injury 2022; 53:2150-2157. [PMID: 35296377 DOI: 10.1016/j.injury.2022.03.015] [Citation(s) in RCA: 2] [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: 07/29/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to investigate the association between Parkinson's disease (PD) and postoperative complications, mortality, and quality of in-hospital care in patients with hip fracture. METHODS We included patients aged 65+ years with an incident hip fracture from 2004-2017, registered in the Danish Multidisciplinary Hip Fracture Registry. Patients with PD were identified using diagnosis codes prior to hip fracture. Using log-binomial regression, we calculated both 30-day crude and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) for the following outcomes: any hospital-treated infections, pneumonia, urinary tract infection, sepsis, community-treated infections, cardiovascular events, mortality, and fulfilment of quality indicators of in-hospital care. Analyses were adjusted for age, sex and Charlson comorbidity index score. RESULTS We identified 77,550 hip fracture patients of which 1,915 had PD. Compared to non-PD, patients with PD had higher risk of any hospital-treated - (aRR = 1.27 (CI: 1.10-1.45) and community-treated infection (aRR = 1.22 (CI: 1.13-1.32)), pneumonia (aRR = 1.38 (1.11-1.69)), urinary tract infection (aRR of 1.58 (CI: 1.28-1.92)) and sepsis (aRR = 1.18 (CI: 0.67-1.89)), but a reduced risk of cardiovascular events (aRR = 0.59 (CI: 0.41-0.82)). The aRR for 30-day mortality was 1.11 (CI: 0.97-1.27) for PD vs non-PD patients, and the aHR for 1-year mortality was 1.19 (CI: 1.09-1.30). The aRRs for fulfillment of all relevant quality indicators was about 1 for PD vs non-PD patients. CONCLUSION Hip fracture patients with PD have a higher risk of infections and mortality within 30 days after surgery after adjustment for sex, age, and comorbidity. They do, however, receive comparable quality of in-hospital care after hip fracture compared to non-PD patients.
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Affiliation(s)
- Peter Vn Nguyen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Thomas J Hjelholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
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15
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Holvik K, Hjellvik V, Karlstad Ø, Gunnes N, Hoff M, Tell GS, Meyer HE. Contribution of an extensive medication-based comorbidity index (Rx-Risk) in explaining the excess mortality after hip fracture in older Norwegians: a NOREPOS cohort study. BMJ Open 2022; 12:e057823. [PMID: 35501100 PMCID: PMC9062812 DOI: 10.1136/bmjopen-2021-057823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Patients with hip fracture are typically characterised by extensive comorbidities and excess mortality. Methods that account for a wide range of comorbidities are needed when attempting to identify causal associations in registry-based studies. We aimed to study the association between the prescription-based Rx-Risk Comorbidity Index (abbreviated Rx-Risk) and mortality by history of hip fracture, and to quantify the contribution of Rx-Risk in explaining the excess mortality after hip fracture. SETTING In this prospective study, we used nationwide registry data from outpatient care. Rx-Risk was based on filled prescriptions recorded in the Norwegian Prescription Database. Medications were mapped to 46 comorbidity categories by Anatomical Therapeutic Chemical code. Information on hip fractures during 1994-2013 was available from the Norwegian Epidemiologic Osteoporosis Studies hip fracture database, and year of death was obtained from Statistics Norway. We estimated 1-year mortality risk (January through December 2014) according to Rx-Risk score based on dispensed prescriptions in 2013, history of hip fracture, age and sex using Poisson regression. PARTICIPANTS All individuals aged 65 years and older who were alive by the end of 2013 and had filled at least one prescription in an outpatient pharmacy in Norway in 2013 (n=735 968). RESULTS Mortality increased exponentially with increasing Rx-Risk scores, and it was highest in persons with a history of hip fracture across the major range of Rx-Risk scores. Age- and sex-adjusted mortality risk difference according to history of hip fracture (yes vs no) was 4.4 percentage points (7.8% vs 3.4%). Adjustment for Rx-Risk score further attenuated this risk difference to 3.3 percentage points. CONCLUSIONS History of hip fracture and comorbidity assessed by Rx-Risk are independent risk factors for mortality in the community-dwelling older population in Norway. Comorbidity explained a quarter of the excess mortality in persons with a history of hip fracture.
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Affiliation(s)
- Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Vidar Hjellvik
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Gunnes
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Haakon 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 Faculty of Medicine, Oslo, Norway
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16
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Chen YP, Kuo YJ, Liu CH, Chien PC, Chang WC, Lin CY, Pakpour AH. Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study. Ther Adv Musculoskelet Dis 2022; 13:1759720X211028360. [PMID: 35154417 PMCID: PMC8832323 DOI: 10.1177/1759720x211028360] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Hip fractures are a major public health concern among elderly individuals.
This study aimed to investigate potential perioperative factors that predict
1-year functional outcome, quality of life (QoL), care demands, and
mortality in geriatric patients with a hip fracture. Methods: We prospectively enrolled geriatric patients who had undergone hip fracture
surgery in one medical center from December 2017 to December 2019. Basic
demographic data, handgrip strength, and responses to questionnaires for QoL
and activities of daily living (ADL) before the injury were collected at
baseline. QoL, ADL, additional care demands other than family support, and
mortality events were monitored at 1 year after the operation. Results: Among 281 patients with a hip fracture, 39 (13.9%) died within 1 year of the
index operation. The mean follow-up interval for the survivors was 403.3
(range: 358–480) days. Among the 242 survivors, ADL and QoL considerably
decreased at approximately 1 year following hip surgery. Up to 33.9% of the
participants became severely dependent and needed additional care at 1-year
follow up. Prefracture ADL status was the crucial predictor for functional
outcome, QoL, and additional care demand at 1-year follow up. Cox regression
models indicated that male sex, low preoperative serum creatinine, handgrip
strength, long surgical delay after a falling accident, and high Charlson
Comorbidity Index were considerably associated with a high 1-year mortality
risk in the geriatric hip fracture population. Conclusion: Hip fracture has long-lasting effects (e.g. functional loss, decline in QoL,
increased care demands, and high postoperative mortality rate) on the
geriatric population. A robust screening method must be developed for
identifying potential prognostic factors, and a stratified care approach
must be used that accounts for personalized risks to improve functional
outcomes and reduce mortality after hip fracture in geriatric patients,
especially in Taiwan.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Chieh-Hsiu Liu
- Department of Geriatrics and Gerontology, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan
| | - Pei-Chun Chien
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Wei-Chun Chang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Chung-Ying Lin
- Institute of Allied Health Sciences and Departments of Occupational Therapy and Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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17
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Turgut N, Ünal AM. Standard and Newly Defined Prognostic Factors Affecting Early Mortality After Hip Fractures. Cureus 2022; 14:e21464. [PMID: 35223248 PMCID: PMC8860722 DOI: 10.7759/cureus.21464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Early mortality rate in geriatric patients after hip fractures remains very high. Determining the prognostic factors is crucial for decreasing early mortality. This study aimed to evaluate the prognostic risk factors affecting early mortality after hip fracture in the elderly. Methods: Medical records of 335 patients with age 70 years or older who sustained hip fractures which were treated by hemiarthroplasty or proximal femoral nailing between May 2017 and May 2019 were reviewed. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were investigated for validity as the new prognostic markers. The other variables included age, gender, type of surgery, type of implant, type of anesthesia, American Society of Anesthesiologists (ASA) score, presence of comorbidities, delirium, length of hospital stay, time delay to surgery, number of erythrocyte transfusions, and laboratory data were assessed for 30-day, 90-day, and one-year mortality. Univariate analysis and logistic regression analysis were used to determine the associated mortality. Results: Thirty-day mortality rate was 10.4% and was associated with being aged ≥90 years (p-value: 0.013, odds ratio {OR}: 0.13) and ASA score of 4 (p-value: 0.019, OR: 0.22). Ninety-day mortality rate was 21.5% and was associated with age (p-value: 0.002), being aged 80-89 years (p-value: 0.032, OR: 0.43), being aged ≥90 years (p-value: 0.001, OR: 0.13), general anesthesia (p-value: 0.016, OR: 0.41), preoperative high NLR level (p-value: 0.028, OR: 1.05), high blood urea nitrogen (BUN) level (p-value: 0.049, OR:1.02). One year mortality rate was 33.7% and independent significant prognostic risk factors were determined as being aged ≥90 years (p-value: 0.003, OR: 0.23), length of hospital stay (p-value: 0.003, OR: 1.04), and preoperative serum albumin level (p-value: 0.037, OR: 0.6). The other evaluated risk factors were not independently found to be associated with all early mortality time. Conclusion: Patients at or over 90 years old were at risk for all early mortality time points. NLR which is a new and cheap biomarker can be used as a prognostic risk factor for 90-day mortality. The variable of PLR was not found valuable for early mortality.
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Tai TW, Li CC, Huang CF, Chan WP, Wu CH. Treatment of osteoporosis after hip fracture is associated with lower all-cause mortality: A nationwide population study. Bone 2022; 154:116216. [PMID: 34571203 DOI: 10.1016/j.bone.2021.116216] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Mortality after osteoporotic hip fractures is high. Postoperative care is as important as surgery itself to prevent a second fracture and improve outcomes, and the effect of anti-osteoporosis treatment after hip fractures on overall mortality is controversial. This nationwide population study aimed to determine whether anti-osteoporosis treatment might reduce overall mortality after hip fracture surgery. METHODS We conducted this cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients admitted for surgery due to hip fractures from 2008 to 2018. The subsequent use and duration of anti-osteoporotic medication and other parameters were analyzed, and national death registration records were retrieved to investigate mortality. RESULTS A total of 59,943 patients admitted for hip fracture surgery were identified. The 22,494 patients (37.5%) who received anti-osteoporotic medication showed a lower all-cause mortality rate compared with the 37,449 patients (62.5%) who did not receive further treatment (hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.67-0.70, p < 0.0001). Patients who received anti-osteoporotic medication for more than 1, 2, and 3 years exhibited propotional reductions in all-cause mortality (HR & 95%CI: 0.57 (0.54-0.60), 0.42 (0.38-0.46), and 0.29 (0.26-0.33) respectively). CONCLUSION Anti-osteoporosis treatment was associated with lower all-cause mortality after hip fracture surgery. A longer duration of treatment was also associated with lower mortality. Postoperative treatment for osteoporosis is crucial for patients with hip fracture.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Feng Huang
- Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, I-Lan, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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19
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Yoshitaka T, Shimaoka Y, Yamanaka I, Tanida A, Tanimoto J, Toda N, Akimori T, Hamawaki J. Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People. Prog Rehabil Med 2022; 7:20220026. [PMID: 35633759 PMCID: PMC9110876 DOI: 10.2490/prm.20220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their
activities of daily living (ADL). This study aimed to identify and analyze factors
associated with ADL following hip fracture treatment. Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in
our hospital were enrolled. Among these, 103 patients who underwent acute- to
recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the
functional independence measure (mFIM) score was ≥70 before the fracture were finally
included in this study. Single and multiple regression analyses were performed to
identify the factors correlated with ADL. The mFIM at hospital discharge was set as the
outcome variable, and various clinical factors, such as fracture type, surgical
technique, serum and biological data, mini-mental state examination (MMSE) score, and
serial mFIM scores, were used as explanatory variables. Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at
discharge, and MMSE had the larger effect on the outcome. Receiver operating
characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an
MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks
postoperatively compared with those with an MMSE score of ≥21. Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL
outcomes following hip fracture. Cognitive impairment was the most important factor
affecting ADL; treatment and postoperative rehabilitation should be carefully considered
for cognitively disturbed patients from the acute phase after hip fracture.
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Affiliation(s)
- Teruhito Yoshitaka
- Department of Orthopedic Surgery, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan
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20
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Zhao S, Zhao W, Du D, Zhang C, Zhao T, Zheng L, Jin L, Gu M, Xu J, Yang Z. Effect of bisphosphonate on hip fracture in patients with osteoporosis or osteopenia according to age: a meta-analysis and systematic review. J Investig Med 2021; 70:837-843. [PMID: 34893517 DOI: 10.1136/jim-2021-001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 02/05/2023]
Abstract
This meta-analysis and systematic review investigated the efficacy of bisphosphonates on the incidence of hip fracture (IHF) in patients of different ages with osteoporosis or osteopenia. We searched Web of Science, Embase, the Cochrane Database, and PubMed from inception to January 10, 2021, for trials reporting the effects of bisphosphonates on the IHF. We included only randomized, double-blind, placebo-controlled clinical trials. We pooled data using a random-effects meta-analysis with risk ratios (RRs) and reported 95% CIs. We also used the Cochran Q and I² statistics to assess the heterogeneity in the results of individual studies. The primary endpoints were the total numbers of people in the bisphosphonates and placebo groups and the numbers of IHFs during the follow-up periods. Bisphosphonates reduced the IHF with an overall effect (RR: 0.66; 95% CI: 0.56 to 0.77; zoledronic acid: RR: 0.60; 95% CI: 0.46 to 0.78; risedronate: RR: 0.74; 95% CI: 0.59 to 0.94, and alendronate: RR: 0.61; 95% CI: 0.40 to 0.95). The result of the heterogeneity assessment was I²=0, p=0.97. In all age groups (all ages, ≥55 years old, ≥65 years old), bisphosphonates reduced the IHF. In the ≥55 years old and ≥65 years old age groups, the RR and 95% CI were 0.63 and 0.43 to 0.93, and 0.60 and 0.44 to 0.81, respectively. Bisphosphonate reduced the IHF in the general population and all age groups (≥55 years old and ≥65 years old). Zoledronic acid, risedronate and alendronate reduced the IHF in osteoporosis or osteopenia populations. The association between bisphosphonate and the IHF does not appear to be influenced by age.
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Affiliation(s)
- Sichun Zhao
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Wen Zhao
- Department of Clinical Immunology, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Dongpeng Du
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Chunhao Zhang
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Tao Zhao
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Liwen Zheng
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Leiming Jin
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Minghao Gu
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Junfeng Xu
- Department of Orthopedics, Chengdu BOE Hospital, Chengdu, Sichuan, China
| | - Zhonghua Yang
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
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21
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Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, Søgaard AJ, Omsland TK. Re: "Hip Fracture and Mortality: A Loss of Life Expectancy Interpretation" by Thao T Ho-Le and Tuan V Nguyen. J Bone Miner Res 2021; 36:2459-2460. [PMID: 34087018 DOI: 10.1002/jbmr.4383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Cecilie Dahl
- University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- University of Oslo, Institute of Health and Society, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- University of Oslo, Institute of Health and Society, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri M Solbakken
- University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Berit Schei
- Norwegian University of Science and Technology, Institute of Community Medicine and Nursing, Oslo, Norway.,Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway
| | - Anne-Johanne Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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22
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Fujimaki T, Ando T, Hata T, Takayama Y, Ohba T, Ichikawa J, Takiyama Y, Tatsuno R, Koyama K, Haro H. Exogenous parathyroid hormone attenuates ovariectomy-induced skeletal muscle weakness in vivo. Bone 2021; 151:116029. [PMID: 34111645 DOI: 10.1016/j.bone.2021.116029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
Osteoporosis commonly affects the elderly and is associated with significant morbidity and mortality. Loss of bone mineral density induces muscle atrophy and increases fracture risk. However, muscle lipid content and droplet size are increased by aging and mobility impairments, inversely correlated with muscle function, and a cause of reduced motor function. Teriparatide, the synthetic form of human parathyroid hormone (PTH) 1-34, has been widely used to treat osteoporosis. Although PTH positively affects muscle differentiation in vitro, the precise function and mechanisms of muscle mass and power preservation are still poorly understood, especially in vivo. In this study, we investigated the effect of PTH on skeletal muscle atrophy and dysfunction using an ovariectomized murine model. Eight-week-old female C57BL/6J mice were ovariectomized or sham-operated. Within each surgical group, the mice were divided into PTH injection or control subgroups. Motor function was evaluated based on grip strength, treadmill running, and lactic acid concentration. PTH receptor was expressed in skeletal muscle cells and myoblasts. PTH inhibited ovariectomy-induced bone loss but not uterine atrophy or increased body weight; PTH not only abolished ovariectomy-induced reduction in grip strength and maximum running speed, but also significantly reduced the ovariectomy-induced increase in lactic acid concentration (compared with that observed in the vehicle control). PTH also abrogated the ovariectomy-induced reduction in the oxidative capacity of muscle fibers, their cross-sectional area, and intramyocellular lipid content, and induced cell proliferation, cell migration, and muscle differentiation, while reducing lipid secretion by C2C12 myoblasts via the Wnt/β-catenin pathway. PTH significantly ameliorated muscle weakness and attenuated exercise-induced lactate levels in ovariectomized mice. Our in vitro study demonstrated that PTH/Wnt signaling regulated the proliferation, migration, and differentiation of myoblasts and also reduced lipid secretion in myoblasts. Thus, PTH could regulate several aspects of muscle function and physiology, and may represent a novel therapeutic strategy for patients with osteoporosis.
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Affiliation(s)
- Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Takanori Hata
- Department of Neurology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yoshihiro Takayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Jiro Ichikawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Rikito Tatsuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Katsuhiro Koyama
- Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Causes of death among 93.637 hip fracture patients- data based on the Danish National Registry of causes of death. Eur J Trauma Emerg Surg 2021; 48:1861-1870. [PMID: 34590173 DOI: 10.1007/s00068-021-01791-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Excess mortality among hip fracture patients is well documented. Less is known, however, about the causes of death in this group of patients, although existing literature suggests that bronchopneumonia and cardiovascular diseases constitute the leading causes of death. In this study, we investigated the causes of death in Danish hip fracture patients, who died within 30-days after sustaining a hip fracture, with a focus on differences in causes of death between men and women and between different age groups. Furthermore, the frequency of potentially preventable causes of death such as pneumonia, urinary tract infections and thromboembolic events was examined. METHODS All Danish patients aged 18 or more suffering from a hip fracture in the period 2002-2012 were examined for inclusion into the study. Data were collected from the Danish National Patient registry. The last month of 2012 being December was left out since we were looking at 30-days mortality. Logistic regression analysis was used to test the association between 30-day mortality with each of the causes of death adjusted for age, sex and CCI in multivariable models with results presented as odds ratios (OR) with 95% confidence intervals. RESULTS During this period, 93,637 patients sustained a hip fracture. Of these, 9504 patients died within 30-days and were included in the study. For patients dead within 30-days after sustaining a hip fracture, the two leading medical causes of death were cardiovascular disease (21.1%) and pneumonia (10.5%) when looking at both genders. A frequent cause of death especially in the younger age group of women less than 50 years old were infections (other than pneumonia) (18.2%) especially urinary tract infections. Pulmonary embolism accounted for 3.9% of causes of deaths in hip fracture patients. CONCLUSION In this study, cardiovascular disease and pneumonia were overall the leading medical causes of death in patients dead within 30-days after sustaining a hip fracture. Apart from pneumonia, another potentially preventable infection in younger female hip fracture patients was urinary tract infections. Pulmonary embolism, another potentially preventable cause of death might be underreported in Danish death certificates.
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24
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Wang Z, Chen M, Luo X, Xiong X, Ma F. Effectiveness of optimised care chain for hip fractures in elderly Chinese. Int J Health Plann Manage 2021; 36:1445-1464. [PMID: 34519092 DOI: 10.1002/hpm.3261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report. METHODS We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis. RESULTS This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC. CONCLUSIONS This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.
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Affiliation(s)
- Zhaofu Wang
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Meixue Chen
- School of Nursing, Jinan University, Guangzhou, China
| | - Xiaohai Luo
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Xianghua Xiong
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Feng Ma
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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25
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Trevisan C, Gallinari G, Carbone A, Klumpp R. Fifteen years change in acute management of hip fracture patients: 1-year mortality calls for improvements. Injury 2021; 52:2367-2372. [PMID: 33518295 DOI: 10.1016/j.injury.2021.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the past two decades, the average age of hip fractured patients has increased, patients are increasingly fragile and their management is more complex. Most of the literature suggest that care improvement lowered short-term mortality but there is no clear evidence whether mid- and long-term mortality rates are improving. The aim of this study was to evaluate the variations in comorbidities in hip fractured patients over 15 years, the changes in mortality and identify the predictive factors for mortality for identifying the patients at higher risk. MATERIALS AND METHODS Hip fractured patients admitted in hospital in 2000-2001 (192 patients) and 2015-2016 (323 patients) were retrospectively reviewed. Demographic, clinical and management data from the two cohorts were compared. Thirty-day and 1-year mortality were calculated and compare between the two cohorts. A multivariate logistic regression model were performed to identify the most significant predictors of mortality. RESULTS After fifteen years, mean age of hip fracture patients increased by 2.6 years with a 31% increase in comorbidity. The most prevalent comorbidities were hypertension, COPD, diabetes, arrhythmia, renal impairment and dementia. In the 2015-2016 cohort, the age-adjusted mortality at 30 days significantly declined compared to the 2000-2001 cohort (respectively 6.9% vs. 12.5%) but the age-adjusted mortality at 1-year was equivalent. Older age, reduced mobility, higher comorbidity, lateral fractures and male sex were significant risk factors for reduced survival time CONCLUSIONS: After 15 years, there was a significant improvement in 30-days mortality in hip fractured patients despite their increase in comorbidities but this advantage was not observed in 1-year mortality. This suggests the need to implement targeted and longer-term care support for males, older patients and those with greater comorbidities which are at higher risk.
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Affiliation(s)
- Carlo Trevisan
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Italia, Via Paderno 21 - 24065 Seriate (BG), Italy.
| | - Gianluca Gallinari
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Italia, Via Paderno 21 - 24065 Seriate (BG), Italy
| | - Alessandro Carbone
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Italia, Via Paderno 21 - 24065 Seriate (BG), Italy
| | - Raymond Klumpp
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Italia, Via Paderno 21 - 24065 Seriate (BG), Italy
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Li Y, Chen M, Lv H, Yin P, Zhang L, Tang P. A novel machine-learning algorithm for predicting mortality risk after hip fracture surgery. Injury 2021; 52:1487-1493. [PMID: 33386157 DOI: 10.1016/j.injury.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/04/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although several risk stratification models have been developed to predict hip fracture mortality, efforts are still being placed in this area. Our aim is to (1) construct a risk prediction model for long-term mortality after hip fracture utilizing the RSF method and (2) to evaluate the changing effects over time of individual pre- and post-treatment variables on predicting mortality. METHODS 1330 hip fracture surgical patients were included. Forty-five admission and in-hospital variables were analyzed as potential predictors of all-cause mortality. A random survival forest (RSF) algorithm was applied in predictors identification. Cox regression models were then constructed. Sensitivity analyses and internal validation were performed to assess the performance of each model. C statistics were calculated and model calibrations were further assessed. RESULTS Our machine-learning RSF algorithm achieved a c statistic of 0.83 for 30-day prediction and 0.75 for 1-year mortality. Additionally, a COX model was also constructed by using the variables selected by RSF, c statistics were shown as 0.75 and 0.72 when applying in 2-year and 4-year mortality prediction. The presence of post-operative complications remained as the strongest risk factor for both short- and long-term mortality. Variables including fracture location, high serum creatinine, age, hypertension, anemia, ASA, hypoproteinemia, abnormal BUN, and RDW became more important as the length of follow-up increased. CONCLUSION The RSF machine-learning algorithm represents a novel approach to identify important risk factors and a risk stratification models for patients undergoing hip fracture surgery is built through this approach to identify those at high risk of long-term mortality.
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Affiliation(s)
- Yi Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Ming Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Houchen Lv
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
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Chiang MH, Kuo YJ, Chen YP. The Association Between Sarcopenia and Postoperative Outcomes Among Older Adults With Hip Fracture: A Systematic Review. J Appl Gerontol 2021; 40:1903-1913. [PMID: 33870747 DOI: 10.1177/07334648211006519] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hip fracture is a serious clinical event with high morbidity and mortality. Sarcopenia is characterized by age-related loss of muscle mass and function, leading to several adverse health outcomes. In this systematic review, no limitation criteria were used for study selection and 327 studies were identified in the initial search. Of these, 11 studies comprising a total of 2,314 patients were selected. The overall proportion of older adults with hip fracture having sarcopenia was 44%, with a disparity of approximately 10% between men and women. Most studies have indicated that older adults with sarcopenia had poorer postoperative functional recovery than those without sarcopenia; the association between sarcopenia and high postoperative mortality or long hospital stay was heterogeneous. Well-organized studies with longer follow-up periods are warranted.
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Affiliation(s)
- Ming-Hsiu Chiang
- Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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28
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Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, Søgaard AJ, Omsland TK. Increased Mortality in Hip Fracture Patients Living Alone: A NOREPOS Study. J Bone Miner Res 2021; 36:480-488. [PMID: 33403722 DOI: 10.1002/jbmr.4212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29-1.44; HR women = 1.23, 95% CI 1.18-1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25-6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Cecilie Dahl
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri M Solbakken
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Schei
- Institute of Community Medicine and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway
| | - Anne-Johanne Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Hauger AV, Bergland A, Holvik K, Emaus N, Strand BH. Can bone mineral density loss in the non-weight bearing distal forearm predict mortality? Bone 2020; 136:115347. [PMID: 32240848 DOI: 10.1016/j.bone.2020.115347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Low bone mineral density (BMD) is associated with increased risk of fractures and mortality. We investigated if rate of BMD loss in the distal forearm over seven years predicted mortality. METHODS 1725 postmenopausal women and 1879 men aged 50-74 who participated in the longitudinal Tromsø Study waves 4 (1994-95) and 5 (2001-2002) were included. Cox regression models adjusted for lifestyle- and health related variables were used to assess associations between BMD change over seven years and subsequent mortality during up to 17 years of follow-up in participants with normal and low BMD at baseline. RESULTS Baseline BMD decreased and seven-year bone loss increased with increasing age. Overall, mortality rates were higher among those with low versus normal BMD (38 vs 19 per 1000 py in women, 56 vs 34 in men) and at higher bone loss rates (rate ratio high:low = 1.2 in women, 1.7 in men). BMD change was associated with increased mortality only in men with normal baseline BMD. In this group, men with a BMD loss of >4% had significantly higher mortality (HR 1.50, 95% CI 1.21, 1.87) than men with increased or unchanged BMD. BMD change was not significantly associated with increased mortality in women or in men with low BMD at baseline. CONCLUSIONS BMD loss in the distal forearm was associated with increased mortality in men with normal BMD at baseline, but not in women. We found no clear association between BMD loss and mortality in those with low BMD at baseline.
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Affiliation(s)
- Annette V Hauger
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postboks 4 St. Olavs plass, 0130 Oslo, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Marcus Thranes gate 6, 0473 Oslo, Norway.
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postboks 4 St. Olavs plass, 0130 Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Marcus Thranes gate 6, 0473 Oslo, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Bjørn Heine Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Marcus Thranes gate 6, 0473 Oslo, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold, Hospital Trust, Tønsberg, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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Iseri K, Dai L, Chen Z, Qureshi AR, Brismar TB, Stenvinkel P, Lindholm B. Bone mineral density and mortality in end-stage renal disease patients. Clin Kidney J 2020; 13:307-321. [PMID: 32699616 PMCID: PMC7367137 DOI: 10.1093/ckj/sfaa089] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis characterized by low bone mineral density (BMD) as assessed by dual-energy X-ray absorptiometry (DXA) is common among end-stage renal disease (ESRD) patients and associates with high fracture incidence and high all-cause mortality. This is because chronic kidney disease-mineral bone disorders (CKD-MBDs) promote not only bone disease (osteoporosis and renal dystrophy) but also vascular calcification and cardiovascular disease. The disturbed bone metabolism in ESRD leads to 'loss of cortical bone' with increased cortical porosity and thinning of cortical bone rather than to loss of trabecular bone. Low BMD, especially at cortical-rich bone sites, is closely linked to CKD-MBD, vascular calcification and poor cardiovascular outcomes. These effects appear to be largely mediated by shared mechanistic pathways via the 'bone-vascular axis' through which impaired bone status associates with changes in the vascular wall. Thus, bone is more than just the scaffolding that holds the body together and protects organs from external forces but is-in addition to its physical supportive function-also an active endocrine organ that interacts with the vasculature by paracrine and endocrine factors through pathways including Wnt signalling, osteoprotegerin (OPG)/receptor activator of nuclear factor-κB (RANK)/RANK ligand system and the Galectin-3/receptor of advanced glycation end products axis. The insight that osteogenesis and vascular calcification share many similarities-and the knowledge that vascular calcification is a cell-mediated active rather than a passive mineralization process-suggest that low BMD and vascular calcification ('vascular ossification') to a large extent represent two sides of the same coin. Here, we briefly review changes of BMD in ESRD as observed using different DXA methods (central and whole-body DXA) at different bone sites for BMD measurements, and summarize recent knowledge regarding the relationships between 'low BMD' and 'fracture incidence, vascular calcification and increased mortality' in ESRD patients, as well as potential 'molecular mechanisms' underlying these associations.
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Affiliation(s)
- Ken Iseri
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Lu Dai
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Zhimin Chen
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Rashid Qureshi
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
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Zheng X, Jia R, Li Y, Liu T, Wang Z. Omega-3 fatty acids reduce post-operative risk of deep vein thrombosis and pulmonary embolism after surgery for elderly patients with proximal femoral fractures: a randomized placebo-controlled, double-blind clinical trial. INTERNATIONAL ORTHOPAEDICS 2020; 44:2089-2093. [PMID: 32440816 DOI: 10.1007/s00264-020-04610-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elderly patients with proximal femoral fractures face elevated risk of post-operative deep vein thrombosis and pulmonary embolism, due to the lack of suitable treatment plans after surgery and hospital discharge. This study aimed to investigate the effect of omega-3 fatty acid supplementation in the above-described clinical setting. METHODS Five hundred and seven elderly patients (> 60 years of age) suffering from proximal femoral fractures were recruited. After exclusion, 452 eligible patients were assigned in a random manner to receive either omega-3 fatty acids at the daily dose of 1000 mg or placebo, via oral administration for a period of 30 days after surgery. At the end of intervention, the incidences of pulmonary embolism, deep vein thrombosis, and other related complications were compared between the two study groups. RESULTS Incidences of pulmonary embolism as well as deep vein thrombosis, including events leading to fatality, were significantly reduced by the 30-day omega-3 fatty acid intervention. But other related complications, such as haematoma evacuation, post-operative wound bleed, wound infection with frank pus, and other bleed events that required transfusion, were not affected after omega-3 fatty acid consumption. CONCLUSION Daily supplementation of omega-3 fatty acids decreases the risk of pulmonary embolism as well as symptomatic deep vein thrombosis, after surgery among elderly patients with proximal femoral fractures, without causing elevated risk of bleeding episodes.
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Affiliation(s)
- Xinying Zheng
- Department of Nursing, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Rufu Jia
- Department of Nursing, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China.
| | - Yuanyuan Li
- Department of Anesthesia of West Hospital, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Tingting Liu
- Department of Anesthesia of West Hospital, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Zhijing Wang
- Department of Anesthesia of West Hospital, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
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Iseri K, Carrero JJ, Evans M, Felländer-Tsai L, Berg H, Runesson B, Stenvinkel P, Lindholm B, Qureshi AR. Major fractures after initiation of dialysis: Incidence, predictors and association with mortality. Bone 2020; 133:115242. [PMID: 31958531 DOI: 10.1016/j.bone.2020.115242] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Major fractures (MF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MF occurring after initiation of dialysis (MFfirst). METHODS In Swedish Renal Registry of 9714 incident (2005-2016) dialysis patients (age 68 years, 67% men), we identified all MFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MFfirst. RESULTS During median follow-up of 2.2 years, the crude incidence rate of MFfirst (n = 835) was 23.7/1000 patient-years and that of hip fractures (n = 470) 13.3/1000 patient-years. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, comorbidity, and previous history of MF (MFprevious) were associated with increased risk for MFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased risk. The adjusted fracture incidence rate of MFfirst during the first 90 days following dialysis initiation was higher in patients with MFprevious than in those without MFprevious. MFfirst independently predicted increased all-cause (sub-distribution hazard ratio, SHR, 1.67(95%CI 1.47-1.91)) and CVD (SHR 1.49 (95%CI 1.22-1.84)) mortality. Adjusted mortality rate following hip fractures was higher than for other types of MF. Spline curves showed that mortality following MFfirst was highest during the first 6 months of follow-up. CONCLUSIONS MF are common and associated with increased mortality in incident dialysis patients.
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Affiliation(s)
- Ken Iseri
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Marie Evans
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hans Berg
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Runesson
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Tsai S, Pirruccio K, Ahn J. The brief window of time comprising a wheelchair transfer confers a significant fracture risk on elderly Americans. Public Health 2020; 182:1-6. [PMID: 32105994 DOI: 10.1016/j.puhe.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/23/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Wheelchairs grant increased mobility to their users but can result in injuries of varying severities, including fractures which are often associated with wheelchair transfers. However, this fracture burden remains poorly characterized in elderly Americans. The purpose of this study was to report demographic and environmental risk factors for these injuries. STUDY DESIGN We used data from the National Electronic Injury Surveillance System (NEISS) for the years 2007-2017 to perform a retrospective, cross-sectional analysis of wheelchair transfer fractures in patients aged 65 years and older. METHODS Each yearly sample in the NEISS database was queried between 2007 and 2017 for fractures associated with wheelchair transfers in patients aged 65 years or older. The narrative sections of the database were individually read and reviewed to identify cases in which a patient explicitly transferred into or out of a wheelchair while sustaining said fracture. RESULTS Between 2007 and 2017, the average number of patients aged 65 years and older presenting to US emergency departments was 3924 (95% confidence interval [CI] = 2792-5055). A significantly higher percentage of fractures (61.8%; 95% CI = 56.7%-66.8%) is associated with transferring out of wheelchairs. Moreover, such fractures were often associated with transferring to and from beds (29.9%; 95% CI = 25.4%-34.3%), with the hip (37.5%; 95% CI = 33.3%-41.6%) being the most commonly fractured anatomical region overall. A majority of patients required admission to the hospital (60.2%; 95%CI = 52.4%-68.0%) and most wheelchair transfer fractures occurred at home (44.1%; 95% CI = 36.7%-51.5%), with women (71.9%; 95% CI = 68.3%-75.6%) comprising the majority of these patients. CONCLUSIONS Our findings show that wheelchair transfers are associated with significant risk of severe fracture in elderly Americans. As such, wheelchair transfer events merit extra attention from healthcare providers because they comprise a brief window of time relative to the number of occupancy hours in full-time wheelchair users yet can result in significant morbidity and mortality. Preventative measures and patient education should be encouraged to preserve patient mobility and reduce injury.
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Affiliation(s)
- S Tsai
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - K Pirruccio
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - J Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture. J Formos Med Assoc 2020; 119:1807-1816. [PMID: 32107098 DOI: 10.1016/j.jfma.2020.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/27/2019] [Accepted: 02/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sarcopenia, which is a common risk factor for falls and fractures, affects the functional outcome and mortality in geriatric populations. However, the prevalence of sarcopenia among geriatric Taiwanese patients with a hip fracture is unknown, nor is the effect of sarcopenia on the outcome of hip surgery. METHODS From December 2017 to February 2019, geriatric patients who underwent surgery for a hip fracture were prospectively enrolled. Basic demographic data, responses to questionnaires for dementia screening and quality of life (QoL) and daily living activities (ADL) before the injury were analyzed to identify any association with sarcopenia. The QoL and ADL were monitored at six months after the operation to determine the difference between hip fracture patients with or without sarcopenia. RESULTS Of 139 hip fracture patients, 70 (50.36%) were diagnosed with sarcopenia. Accounting for all confounding factors in the multivariate logistic regression, lower body mass index (BMI), male gender and a weaker handgrip are the risk factors that are most strongly associated with a diagnosis of sarcopenia in geriatric patients with a hip fracture. Hip fracture patients with sarcopenia also have poor ADL and a lower QoL than patients without sarcopenia before the injury and six months after the operation. CONCLUSION A high prevalence of sarcopenia among geriatric hip fracture patients is associated with a poor mid-term outcome following hip surgery. Clinicians must recognize the risk of sarcopenia, especially for male hip fracture patients with a lower BMI and a weaker handgrip.
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Yong EL, Ganesan G, Kramer MS, Howe TS, Koh JSB, Thu WP, Logan S, Cauley JA, Tan KB. Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore. JAMA Netw Open 2020; 3:e1919706. [PMID: 32058551 DOI: 10.1001/jamanetworkopen.2019.19706] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Examining trends in mortality following hip fracture and its associated factors is important for population health surveillance and for developing preventive interventions. OBJECTIVE To examine temporal trends in, and risk factors associated with, mortality following hip fracture over 18 years in Singapore. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study included men and women aged 50 years and older admitted to Singapore hospitals for first hip fracture identified and followed up from 2000 to 2017. Demographic information, fracture type, and Charlson Comorbidity Index (CCI) score were retrieved from nationwide claims data, and mortality data were from the National Death Registry. Data were analyzed from August 2018 to December 2019. MAIN OUTCOMES AND MEASURES Adjusted hazard ratios (aHRs) and their 95% confidence intervals were estimated using Cox proportional hazards regression. Kaplan-Meier life table methods were used to calculate survival following the hip fracture on a cohort basis. The crude survival over time since fracture was compared by sex, age group, ethnicity, CCI, and fracture type. Standardized mortality ratios (SMRs) were calculated using all-cause mortality obtained from Singapore population life tables. RESULTS Among 36 082 first inpatient admissions for hip fractures (mean [SD] patient age, 78.2 [10.1] years; 24 902 [69.0%] female; 30 348 [84.1%] Chinese, 2863 [7.9%] Malay, 1778 [4.9%] Indian, and 1093 [3.0%] other ethnicity), elevated rates of mortality were observed for male sex (aHR, 1.46; 95% CI, 1.41-1.52), Malay ethnicity (aHR, 1.23; 95% CI, 1.15-1.30 vs Chinese ethnicity), older age (aHR, 5.20; 95% CI, 4.27-6.34 for age ≥85 years vs 50-54 years), high CCI score (aHR, 3.62; 95% CI, 3.42-3.84 for CCI ≥6 vs CCI of 0), trochanteric fractures (aHR, 1.11; 95% CI, 1.06-1.16 vs cervical fractures), and earlier cohorts (aHR, 0.59; 95% CI, 0.56-0.62 for 2012-2017 vs 2000-2005). Absolute mortality decreased significantly over time: by 21% in 2006 to 2011 and by 40% in 2012 to 2017, compared with 2000 to 2005. On long-term follow-up, differences in survival associated with sex and ethnicity tended to diminish, whereas differences associated with older age, higher CCI score, and trochanteric fractures increased. In the first year after fracture, reductions in SMR were observed comparing the periods 2013 to 2016 with 2003 to 2007 in women (SMR, 2.05; 95% CI, 1.91-2.20 vs SMR, 2.54; 95% CI, 2.39-2.70, respectively) but not among men (SMR, 3.28; 95% CI, 3.04-3.54 vs SMR, 3.42; 95% CI, 3.18-3.68, respectively). CONCLUSIONS AND RELEVANCE Malay ethnicity, older age, male sex, prefracture comorbidity, and trochanteric fractures were independently associated with increased risk of death, identifying population groups that could be targeted for intervention strategies. The improvement in relative mortality for women but not men suggests the need to develop interventions that improve mortality outcomes for men.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore
| | - Ganga Ganesan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Tet Sen Howe
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Joyce S B Koh
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Win Pa Thu
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore
| | - Susan Logan
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kelvin B Tan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Alarkawi D, Bliuc D, Tran T, Ahmed LA, Emaus N, Bjørnerem A, Jørgensen L, Christoffersen T, Eisman JA, Center JR. Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study. Osteoporos Int 2020; 31:119-130. [PMID: 31654084 DOI: 10.1007/s00198-019-05174-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
Abstract
UNLABELLED Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival. INTRODUCTION Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures. METHODS The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables. RESULTS Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73-2.42 in women and 2.49, 95% CI 2.00-3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21-1.84 and 1.81, 95% CI 1.37-2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52-2.35 and 1.77, 95% CI 1.16-2.71), respectively. CONCLUSION Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.
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Affiliation(s)
- D Alarkawi
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.
| | - D Bliuc
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - T Tran
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - L A Ahmed
- Institute of Public Health, United Arab Emirates University, Al Ain, UAE
| | - N Emaus
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - A Bjørnerem
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - L Jørgensen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - T Christoffersen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
- Finnmark Hospital Trust, Hammerfest, Norway
| | - J A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Clinical School, St Vincent's Hospital, Sydney, Australia
- School of Medicine Sydney, University of Notre Dame, Sydney, Australia
| | - J R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Clinical School, St Vincent's Hospital, Sydney, Australia
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Knauf T, Hack J, Barthel J, Eschbach D, Schoeneberg C, Ruchholtz S, Buecking B, Aigner R. Medical and economic consequences of perioperative complications in older hip fracture patients. Arch Osteoporos 2020; 15:174. [PMID: 33157555 PMCID: PMC7647988 DOI: 10.1007/s11657-020-00843-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. PURPOSE Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. METHODS A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. RESULTS Complications that required surgical revision/treatment (type III) were associated with an increased 6 months' mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. CONCLUSIONS The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.
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Affiliation(s)
- Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany.
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, DRK-Kliniken Nordhessen, Hansteinstraße 29, 34121, Kassel, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
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Borgen TT, Bjørnerem Å, Solberg LB, Andreasen C, Brunborg C, Stenbro MB, Hübschle LM, Froholdt A, Figved W, Apalset EM, Gjertsen JE, Basso T, Lund I, Hansen AK, Stutzer JM, Omsland TK, Nordsletten L, Frihagen F, Eriksen EF. Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT. J Bone Miner Res 2019; 34:2036-2044. [PMID: 31310352 DOI: 10.1002/jbmr.3827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 11/08/2022]
Abstract
The location of osteoporotic fragility fractures adds crucial information to post-fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross-sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1-SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2 ), total hip (800 versus 876 mg/cm2 ), and lumbar spine (1024 versus 1062 mg/cm2 ); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1-SQ3 fractures (52.0% versus 27.7%), SQ2-SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p < 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1-SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with central fragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patients with peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure, translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fracture prevention, although attention to peripheral fractures should still not be diminished. © 2019 American Society for Bone and Mineral Research. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Tove T Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Lene B Solberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Camilla Andreasen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - May-Britt Stenbro
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Lars M Hübschle
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Anne Froholdt
- Department of Physical Medicine, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Wender Figved
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Baerum Hospital, Baerum, Norway
| | - Ellen M Apalset
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trude Basso
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Ida Lund
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Ann K Hansen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Jens-Meinhard Stutzer
- Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Tone K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Erik F Eriksen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Yu SF, Cheng JS, Chen YC, Chen JF, Hsu CY, Lai HM, Ko CH, Chiu WC, Su YJ, Cheng TT. Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study. BMC Geriatr 2019; 19:290. [PMID: 31660863 PMCID: PMC6819351 DOI: 10.1186/s12877-019-1278-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/12/2019] [Indexed: 01/31/2023] Open
Abstract
Background We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality. Methods We conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001–2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%. Results The 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (all p < 0.0001). In the treated group, the estimated 1-, 3- and 5-year survival rates were higher in those with good adherence than in those with non-adherence (all p < 0.0001). Regarding all-cause mortality, the adjusted hazard ratio in the treated vs. the non-treated group was 0.63 (95% confidence interval 0.58–0.68, p < 0.0001). The good adherence subgroup showed a significantly lower mortality risk than that in the non-adherence subgroup (hazard ratio 0.41, 95% confidence interval 0.32–0.51, p < 0.0001). Conclusions The 1-, 3- and 5-year survival rates were significantly higher in patients receiving anti-osteoporosis medication than in the untreated group. All-cause mortality rates were lower in patients with good adherence to anti-osteoporosis medication.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Chou Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Yuan Hsu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Han-Ming Lai
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Hua Ko
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chan Chiu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Jih Su
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip Fractures: Therapy, Timing, and Complication Spectrum. Orthop Surg 2019; 11:994-1002. [PMID: 31568676 PMCID: PMC6904609 DOI: 10.1111/os.12524] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Investigation of the treatment of femur fractures and the type of femur fracture‐associated complications regarding timing of surgery and length of hospital stay. Methods In this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay. Results Among the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.). In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6–24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow‐up was restrained to ambulatory visits in the clinic. Conclusions Surgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.
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Affiliation(s)
- Dominik Saul
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Juliane Riekenberg
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jan C Ammon
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel B Hoffmann
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
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41
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Smith JS, Shaffrey CI, Kim HJ, Passias P, Protopsaltis T, Lafage R, Mundis GM, Klineberg E, Lafage V, Schwab FJ, Scheer JK, Miller E, Kelly M, Hamilton DK, Gupta M, Deviren V, Hostin R, Albert T, Riew KD, Hart R, Burton D, Bess S, Ames CP. Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity. Neurosurgery 2019; 83:1277-1285. [PMID: 29351637 DOI: 10.1093/neuros/nyx605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE To assess all-cause mortality following ACSD surgery. METHODS ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006). CONCLUSION All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.
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Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | | | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Emily Miller
- Stanford Physical Medicine and Rehabilitation, Redwood City, California
| | - Michael Kelly
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Todd Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - K Daniel Riew
- Department of Orthopaedic Surgery, Columbia University, New York City, New York
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Medical Center, Seattle, Washington
| | - Doug Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shay Bess
- Presbyterian St Lukes Medical Center, Denver, Colorado
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Wang PW, Li YZ, Zhuang HF, Yu HM, Cai SQ, Xu H, Chen ZH, Lin JK, Yao XD. Anti-Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture. Orthop Surg 2019; 11:777-783. [PMID: 31429532 PMCID: PMC6819189 DOI: 10.1111/os.12517] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/25/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To study the effect of anti‐osteoporosis therapies on mortality after hip fracture. Methods This retrospective study was carried out in the Second Affiliated Hospital of Fujian Medical University and enrolled 690 patients 50 years of age and older who were admitted with hip fractures between 2010 and 2015. The patients were followed in 2017: 690 patients aged was from 50 to 103 years. There were 456 women and 234 men. There were 335 patients with fractures of the femoral neck and 355 patients with intertrochanteric fractures of the femur. There were 444 (64.35%) patients who also had internal diseases. The Charlson comorbidity index was 0–6. The anti‐osteoporosis medications were classified into no anti‐osteoporosis medication, calcium + vitamin D supplementations, non‐bisphosphonate medication, and bisphosphonate medication. The physicians followed the patients or family members by personal visit and telephone. Multivariable Cox regression analyses were done with known risk factors for mortality of hip fracture, such as gender, age, number of combined internal diseases, fracture type, place of residence, and Charlson comorbidity index, to show which anti‐osteoporosis medications had significant effects on mortality after adjustment for these variables. Results Out of 690 patients with hip fractures, 149 patients received no anti‐osteoporosis medication, 63 patients received calcium +vitamin D supplementations, 398 patients received non‐bisphosphonate medication, and 80 patients received bisphosphonate medication. The patients were followed between 7 months and 52 months, with the average of 28.53 ± 9.75 months. A total of 166 patients died during the follow‐up period. Of 166 deaths, 43 occurred within 3 months, 65 within 6 months, and 99 within 1 year after the hip fracture. In this study, fracture type, place of residence, and Charlson comorbidity index were not associated with the mortality, and the male gender, age > 75 years, and ≥ 2 combined internal diseases were the independent factors for deaths post‐hip fracture. The cumulative mortality was 36.24% in the patients receiving no anti‐osteoporosis medication. The hazard ratio for mortality after hip fracture with bisphosphonate medication, non‐bisphosphonate medication, and calcium/vitamin D supplementation was 0.355 (95% CI, 0.194–0.648), 0.492 (95% CI, 0.347–0.699) and 0.616 (95% CI, 0.341–1.114), respectively, as compared with no anti‐osteoporosis group. Bisphosphonate and non‐bisphosphonate medications for osteoporosis were significantly associated with the reduction of cumulative mortality post‐hip fracture (P < 0.01). Conclusions Bisphosphonate and non‐bisphosphonate medications for osteoporosis were significantly associated with decreased mortality after fragility hip fracture.
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Affiliation(s)
- Pei-Wen Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Zhong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hua-Feng Zhuang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hai-Ming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Si-Qing Cai
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hao Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhen-Hui Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jin-Kuang Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xue-Dong Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Year to year comparison of 2000-2015 in hip fracture management: same survival rate despite older and more fragile patients. Aging Clin Exp Res 2019; 31:1097-1103. [PMID: 30276632 DOI: 10.1007/s40520-018-1047-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to compare clinical data, comorbidities and survival rates at 30 days and 1 year in two groups with femoral fractures, the first including patients admitted in 2000, and the other including patients admitted in 2015. The hypothesis of the study is that patients admitted in 2015 have more comorbidities and will therefore have a lower survival rate at 30 days and 1 year from trauma. METHODS Patients admitted to the hospital with proximal femoral fractures in 2000 (90 patients) and 2015 (167 patients) were retrospectively reviewed. The following data were collected: age, gender, source of admission, ASA score, comorbidities, time from admission to surgery and length of hospital stay. The Charlson Comorbidity Index (CCI) score, a measure of comorbidity, and the Nottingham Hip Fracture Score (NHFS), a predictor of 30-day and 1-year mortality after hip fracture, were both calculated. RESULTS Patients in the 2015 group were older and more institutionalized before fracture (p < 0.05), with a significant increase in Alzheimer's disease, chronic obstructive pulmonary disease, congestive heart failure and renal impairment. The length of stay was significantly lower in 2015. The NHFS and CCI were significantly higher in 2000. Mortality at 30 days and 1 year did not differ significantly in 2000 when compared to 2015. The CCI had the best predictive ability for mortality in both groups at 30 days and 1 year. CONCLUSIONS The increase of comorbidities was not found to be correlated to increased mortality. This could be explained by enhanced patient management permitting earlier mobilization and weight bearing.
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Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res 2019; 14:203. [PMID: 31272470 PMCID: PMC6610901 DOI: 10.1186/s13018-019-1226-6] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is known that mortality after hip fracture increases compared to the general population; the trend in mortality is a controversial issue. The objective of this study is to examine incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures. METHODS This is a retrospective cohort study that uses the Registry for Hospital Discharges of the National Health System of our hospital. Patients older than 45 having an osteoporotic hip fracture between 1999 and 2015 were identified. Demographic data and comorbidities were obtained. A survival analysis was performed (Cox regression and Kaplan-Meier). Incidence rate, standardized death rate (SDR), trend (Poisson regression), and risk (hazard ratio) were calculated. RESULTS During 1999-2015, in our hospital, there were a total of 3992 patients admitted due to osteoporotic hip fracture. Out of these 3992 patients, 3109 patients (77.9%) were women with an average age of 84.47 years (SD 8.45) and 803 (22.1%) were men with an average age of 81.64 years (SD 10.08). The cumulative incidence of mortality was 69.38%. The cumulative mortality rate for 12 months was 33%. The annual mortality was 144.9/1000 patients/year. The 1-year mortality rate increased significantly by 2% per year (IRR 1.020, CI95% 1.008-1.033). The median overall survival was 886 days (CI95% 836-951). The probability of mortality density for a period of 10 years following a hip fracture was 16% for women and 25% for men (first 90 days). The SDR was 8.3 (CI95% 7.98-8.59). Variables that showed statistically significant association with mortality were aged over 75, masculine, institutionalization, mild to severe liver disease, chronic kidney disease, COPD, dementia, heart failure, diabetes, the Charlson Index > 2 , presence of vision disorders and hearing impairment, incontinence, and Downton scale. CONCLUSIONS For the last 17 years, an increase of mortality for patients with hip fracture and a higher mortality rate in men than in women were observed. Institutionalization combined with comorbidities is associated with a higher mortality.
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Affiliation(s)
- Olalla Guzon-Illescas
- Department of Rehabilitation, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid Spain
| | - Elia Perez Fernandez
- Department of Clinical Investigation, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid Spain
| | | | | | - Marina Peña
- Department of Rehabilitation, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid Spain
| | - Carlos Alonso-Blas
- Emergency Department, Hospital Universitario Clínica Puerta de Hierro de Majadahonda, Majadahonda, Madrid Spain
| | | | - Ramon Mazzucchelli
- Department of Rheumatology, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid Spain
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Kim SY, Lee JK, Oh DJ, Kong IG, Choi HG. Depression and incident hip fracture: A longitudinal follow-up study using a national sample cohort. Medicine (Baltimore) 2019; 98:e16268. [PMID: 31261597 PMCID: PMC6617478 DOI: 10.1097/md.0000000000016268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the risk of hip fracture in depression patients using a nationwide cohort population.Data from the Korean National Health Insurance Service-National Sample Cohort for a population ≥50 years of age from 2002 to 2013 were collected. The 25,197 individuals with depression were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia, with 100,788 individuals comprising the control group. In both the depression and control groups, history of hip fracture was evaluated. Using the International Classification of Disease-10 (ICD-10) codes, depression (F31-F39), and hip fracture (S720, S721, and S722) were investigated. The crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of hip fracture in depression patients were analyzed using a Cox proportional hazard model. Subgroup analyses were conducted according to age and sex.In the depression group, 1.1% (277/25,197) of the subjects had hip fracture, and 0.7% (693/100,095) in the control group had hip fracture (P <.001). The depression group demonstrated a higher adjusted HR for hip fracture than the control group (adjusted HR = 1.46, 95% CI = 1.27-1.68, P <.001). This result was consistent in the ≥65 years old subgroups.The risk of hip fracture was elevated in depression patients.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang
| | - Dong Jun Oh
- Department of Internal medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Il Gyu Kong
- Department of Otorhinolaryngology-Head & Neck Surgery
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
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Pollmann CT, Røtterud JH, Gjertsen JE, Dahl FA, Lenvik O, Årøen A. Fast track hip fracture care and mortality - an observational study of 2230 patients. BMC Musculoskelet Disord 2019; 20:248. [PMID: 31122228 PMCID: PMC6533651 DOI: 10.1186/s12891-019-2637-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. METHODS Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression. RESULTS Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p < 0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15-0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis (p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63-1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group. CONCLUSIONS Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care. TRIAL REGISTRATION The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907 ) 6 December 2016.
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Affiliation(s)
- Christian Thomas Pollmann
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jan-Erik Gjertsen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Fredrik Andreas Dahl
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Olav Lenvik
- Department of Data and Analytics, Akershus University Hospital, Lørenskog, Norway
| | - Asbjørn Årøen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Borgen TT, Bjørnerem Å, Solberg LB, Andreasen C, Brunborg C, Stenbro MB, Hübschle LM, Froholdt A, Figved W, Apalset EM, Gjertsen JE, Basso T, Lund I, Hansen AK, Stutzer JM, Dahl C, Omsland TK, Nordsletten L, Frihagen F, Eriksen EF. High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT. Bone 2019; 122:14-21. [PMID: 30743015 DOI: 10.1016/j.bone.2019.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures. METHODS This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire. RESULTS Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ -2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%. CONCLUSIONS More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.
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Affiliation(s)
- Tove T Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Lene B Solberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Camilla Andreasen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - May-Britt Stenbro
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Lars M Hübschle
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Anne Froholdt
- Department of Physical Medicine, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Wender Figved
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Ellen M Apalset
- Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trude Basso
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Ida Lund
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Ann K Hansen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Jens-Meinhard Stutzer
- Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tone K Omsland
- Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Department of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Erik F Eriksen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Pedersen AB, Heide-Jørgensen U, Sørensen HT, Prieto-Alhambra D, Ehrenstein V. Comparison of Risk of Osteoporotic Fracture in Denosumab vs Alendronate Treatment Within 3 Years of Initiation. JAMA Netw Open 2019; 2:e192416. [PMID: 31002319 PMCID: PMC6481596 DOI: 10.1001/jamanetworkopen.2019.2416] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Head-to-head randomized clinical trials showed greater efficacy of denosumab vs alendronate in improving bone mineral density. Although there is an association of changes in bone mineral density with reductions in fracture risk, the magnitude of the association is not well established. OBJECTIVE To compare the risk of hip and any fracture in patients treated with denosumab and alendronate in routine practice settings. DESIGN, SETTING, AND PARTICIPANTS This Danish nationwide, population-based, historical cohort study of a population with universal access to health care used prospectively collected, individually linked data from Danish health registries with complete follow-up. Cohorts consisted of 92 355 individuals 50 years or older who were new users of denosumab (n = 4624) or alendronate (n = 87 731) from May 2010 to December 2017 after at least 1 year without an antiosteoporosis medication dispensing. EXPOSURES Initiation of denosumab or alendronate. MAIN OUTCOMES AND MEASURES The primary outcome was hospitalization for hip fracture, and the secondary outcome was hospitalization for any fracture. Inverse probability of treatment weights and the intention-to-treat approach were used to calculate cumulative incidences and adjusted hazard ratios (aHRs) with 95% CIs. RESULTS Of the 92 355 included patients, 75 046 (81.3%) were women, and the mean (SD) age was 71 (10) years. The denosumab cohort had a lower proportion of men than the alendronate cohort (12.7% [589] vs 19.0% [16 700]), while age distributions were similar in the 2 cohorts. Within 3 years of follow-up, initiation of denosumab or alendronate was associated with cumulative incidences of 3.7% and 3.1%, respectively, for hip fracture and 9.0% and 9.0%, respectively, for any fracture. Overall, the aHRs for denosumab vs alendronate were 1.08 (95% CI, 0.92-1.28) for hip fracture and 0.92 (95% CI, 0.83-1.02) for any fracture. The aHR of denosumab vs alendronate for hip fracture was 1.07 (95% CI, 0.85-1.34) among patients with a history of any fracture and 1.05 (95% CI, 0.83-1.32) among patients without history of fracture. The aHR for any fracture for denosumab vs alendronate was 0.84 (95% CI, 0.71-0.98) among patients with a history of any fracture and 0.77 (95% CI, 0.64-0.93) among patients with no history of fracture. CONCLUSIONS AND RELEVANCE Treatment with denosumab and alendronate was associated with similar risks of hip or any fracture over a 3-year period, regardless of fracture history.
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Affiliation(s)
- Alma B. Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Grup de Recerca en Epidemiologia de las Malalties Prevalents de l’Aparell Locomotor Research Group, Centro de Investigación Biomédica en Red Fragilidad y Envejcimiento Saludable (CIBERFes), Instituto de Salud Carlos III and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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It was not a hip fracture - you were lucky this time - or perhaps not! A prospective study of clinical outcomes in patients with low-energy pelvic fractures and hip contusions. Injury 2019; 50:913-918. [PMID: 30910240 DOI: 10.1016/j.injury.2019.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prehospital and hospital emergency care guidelines have been developed for patients with suspected hip fracture. Initial radiography can identify a number of patients with other injuries, generally pelvic fractures and hip contusions. Little is known about the prognosis for these patients. The aim of this study is twofold: i) to investigate the injury pattern of patients assessed in prehospital emergency care as suffering from a suspected hip fracture and ii) to compare clinical outcomes between patients with verified hip fracture (HF) and those with other hip injuries (OHI). METHOD The study design was prospective. Older patients with suspected HF after low-energy trauma were identified in prehospital emergency care. Injury type was determined by radiological imaging. Comparisons of length of stay, adverse events, repeated prehospital emergency care and mortality were made between verified HF and OHI cases. RESULTS 449 patients were included, 400 in the HF and 149 in the OHI group (86 hip contusions, 46 pelvic fractures and 17 other injuries/diseases). The HF group had a significantly longer hospital stay (9.5 days vs. 6.3 for the OHI group; p < 0.001) and more adverse events while in hospital (34% vs. 19%; p < 0.001). We found no evidence that the groups differed with regard to other outcomes: mortality during hospital stay (4% vs. 2%, p = 0.42), at 4 (16% vs. 13%; p = 0.35) and 12 months (21 vs. 23%; p = 0.64), the proportion that experienced an adverse event (24% vs. 22%; p = 0.65) and the proportion that required another ambulance transport within 6 months after discharge (40% vs. 34%; p = 0.16). The results were not strongly affected by adjustments for possible confounders. CONCLUSION Older patients who suffer a low-energy pelvic fracture or a hip contusion are common in prehospital and hospital emergency care. These patients need attention as they have poor outcomes in terms of adverse events, mortality and recurrent need for ambulance transport after discharge from hospital. While individualized multidisciplinary care is recommended for hip fracture patients, it might also be suitable for other geriatric hip injuries.
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50
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Predictors of long-term survival after hip fractures?-5-year results of a prospective study in Germany. Arch Osteoporos 2019; 14:40. [PMID: 30879213 DOI: 10.1007/s11657-019-0586-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/01/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED The incidence of hip fractures is increasing due to demographic transition. Data on long-term survival and influencing factors are sparse. Our prospective observational study with 395 patients shows a survival of 38% after 5 years. Significant risk factors were male gender, higher age, lower Barthel Index, lower Charlson Comorbidity Score, lower Mini-Mental State Examination, and delirium during hospitalization. PURPOSE The incidence of hip fractures is increasing due to demographic transition. Until now, they are associated with poor results and high mortality rates. Data on long-term survival and influencing factors are sparse. Therefore, a prospective observational study was conducted. METHODS Patients ≥ 60 years with hip fracture were included in this prospective study between 2009 and 2011. Demographic parameters, as well as ASA Score, pre-fracture Barthel Index and EQ-5D, Mini-Mental State Examination, Charlson Comorbidity Score, fracture type, type of surgical treatment, place of discharge, and arising complications were registered. Outcome parameter was survival during a 5-year follow-up period. RESULTS A total of 539 patients attended to our emergency room during the period of recruitment. The recruitment rate was 75%. A total of 402 patients were included; 7 were lost to follow-up, and 152 (38%) survived the study period. The mortality was more than 25% in the first year after fracture. Subsequently, it was between 7 and 9% per year. In the multivariate analysis, significant risk factors for dying were male gender (p = 0.002), higher age (p < 0.001), lower Charlson Comorbidity Score (p = 0.033), lower Barthel Index (p = 0.024), lower Mini-Mental State Examination (p = 0.002), and occurrence of delirium during hospitalization (p = 0.008). CONCLUSION Our results confirm poor results of geriatric patients after hip fracture. While early results might be influenced by optimal fracture care, long-term results seem to be determined by not changeable patient factors. Nevertheless, more than one third of surviving patients after 5 years justify the elaborate treatment algorithms for these fragile patients.
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