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Dawod MS, Alisi MS, Saber YO, Abdel-Hay QA, Al-Aktam BM, Alfaouri Y, Alfraihat LB, Albadaineh AA, Abuqudiri AZ, Odeh RM, Altamimi AAR, Alrawashdeh MA, Alebbini MM, Abu-Dhaim OA, Al-Omari AA, Alaqrabawi I, Alswerki MN, Abuawad A, Al Nawaiseh MR, Hammad Y, Al-Ajlouni J. Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study. Int J Gen Med 2022; 15:6591-6598. [PMID: 35991940 PMCID: PMC9385130 DOI: 10.2147/ijgm.s373313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Elderly hip fractures represent a global health care burden. Several reports expected a massive increase in the incidence of hip fractures by the next few decades. Knowing the epidemiology of hip fractures is crucial for planning health care policies. The purpose of this study is to provide a nationwide epidemiological overview of hip fractures in Jordan and to report the perioperative outcomes that may help to improve the delivered healthcare. . Methods We conducted a retrospective study at 2 university hospitals and 2 major governmental hospitals in Jordan. We reviewed the records for all patients (age >55 years) who were diagnosed with hip fractures over a 3 years duration (2019–2021). We documented the patient’s characteristics and the perioperative data (including preoperative, intraoperative, and postoperative details including the 1-year mortality). Results The total number of included patients was 1268; more than half (53.7%) were females. The mean age is 75 years (SD 9.7). The most common fracture type was trochanteric (66.2%). 7% of patients had a prior contralateral hip fracture. The average time from admission to surgery was 2.96 days (SD 2.63). The surgery was done within 48 hours for 56.7% of patients. Approximately, one-third of all patients (34.5%) received a blood transfusion. The average length of hospital stay is 7.44 days (SD 5). The overall rate of postoperative thromboembolic events, readmission within 1 month, and revision for the same surgery are 2.4%, 10.7%, and 3% respectively. The 1-month, 6-month, and 12-month mortality rates are 4.5%, 9.1%, and 12.8% respectively. Conclusion The annual incidence of elderly hip fractures in Jordan is approximately 96 per 100,000 individuals. The 1-year mortality rate of hip fractures in Jordan is 12.8%. Both findings are in the lower range of nearby Arab countries.
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Affiliation(s)
- Mohd Said Dawod
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, Mutah University, Al Karak, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan.,Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | | | | | | | | | | | | | - Anas A R Altamimi
- Department of General and Specialized Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mutaz A Alrawashdeh
- Department of Special Surgery, Division of Orthopaedic Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohanad M Alebbini
- Department of Special Surgery, Division of Orthopaedic Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Omran A Abu-Dhaim
- Department of Special Surgery, Division of Orthopaedic Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali A Al-Omari
- Department of Special Surgery, Division of Orthopaedic Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Ihab Alaqrabawi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad N Alswerki
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Abdelrahman Abuawad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad R Al Nawaiseh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan Hammad
- Orthopedic Department, North Middlesex University Hospital, London, UK
| | - Jihad Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Arshad A, Ibrahim MT, Arshad H, Hammad MB, Sheikh SA, Khan AH, Jafri L, Nadeem S. Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan. Arch Osteoporos 2021; 16:25. [PMID: 33559020 DOI: 10.1007/s11657-021-00895-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/14/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis remains under-recognized and sub-optimally managed in Pakistan, with a lack of awareness that minimal impact hip fracture is a manifestation of low bone mineral density (BMD). PURPOSE Hip fracture is often the first clinical presentation of osteoporosis and an opportunity to intervene and reduce future fracture risk. Our aim was to understand the current practices in Pakistan related to bone health in patients presenting with a hip fracture. METHODS This is a retrospective study at a tertiary care center in Pakistan of patients admitted with a hip fracture. Data collected includes previous fracture history, known preceding diagnosis of low BMD medication details, comorbidities, and DXA results. RESULTS Two hundred ten patients were studied. The mean age of patients was 73.1 years, with 112 (53.3%) women. Most (195 (92.9%)) had presented with a low-impact hip fracture, with 17 (8.1%) reporting previous history of fracture. None had been treated with osteoporosis medications prior to fracture. Nineteen (9%) were on calcium and vitamin D supplements prior to fracture; of the minority who were screened, all were vitamin D deficient and subsequently discharged on vitamin D supplements. No one was prescribed medications to reduce fracture risk at discharge. CONCLUSION This study reveals that patients admitted with minimal impact hip fractures in Pakistan are rarely evaluated for low BMD and not started on osteoporosis medications even after presenting with a typical osteoporosis-related fracture. This underscores the need for health provider education about osteoporosis as a major cause for hip fractures and the need to intervene for future fracture risk reduction.
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Affiliation(s)
- Ainan Arshad
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Hajra Arshad
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Aysha Habib Khan
- Pathology and Lab Medicine Aga Khan University Hospital, Karachi, Pakistan
| | - Lena Jafri
- Pathology and Lab Medicine Aga Khan University Hospital, Karachi, Pakistan
| | - Sarah Nadeem
- Internal Medicine and Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Saad RK, Akiki VC, Rahme M, Ajjour S, Assaad M, El-Hajj Fuleihan GA. Time trends and predictors of hypovitaminosis D across the life course: 2009-2016. Metabolism 2020; 105:154138. [PMID: 31923385 DOI: 10.1016/j.metabol.2020.154138] [Citation(s) in RCA: 12] [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: 10/25/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE We investigated prevalence, determinants, seasonal changes, and time trends in hypovitaminosis D. We derived a desirable serum 25-hydroxy-vitamin D (25OHD) level in adults/elderly by evaluating the 25OHD-parathyroid hormone (PTH) exponential relationship. METHODS We analyzed serum 25OHD data from a large laboratory database (N = 151,705), from a major academic medical center in Lebanon, from 2009 to 2016. We used cross calibration formulas to convert measured 25OHD levels to LC-MS/MS equivalents based on our external quality assurance protocols. RESULTS 6% of the population were children (mean age 11 ± 5 years, 56% girls), 68% were adults (44 ± 13 years, 71% women), and 25% were elderly (74 ± 6 years, 59% women). The prevalence of hypovitaminosis D, in the entire population, was 39%, 29% and 23% at 25OHD cutoffs of 20 ng/ml, 15 ng/ml, and 12 ng/ml, respectively, across all years. Using multivariate analysis, predictors of 25OHD levels below 12, 15 and 20 ng/ml were younger age, male sex, winter months, and inpatient status both in adults and elderly. In children, older age, female sex, winter months, and inpatient status, predicted levels below 15 ng/ml and 20 ng/ml, but only older age, female sex, and winter months predicted levels below 12 ng/ml. There was a significant steady annual increase in 25OHD levels between 2009 and 2016 of 0.9 ng/ml/year (95% CI: 0.7, 1.0) in children, 1.2 ng/ml/year (1.2, 1.3) in adults and 2.6 ng/ml/year (2.6, 2.8) in the elderly. Using best fit non-linear regression models, on a subset of adults and elderly in whom concomitant 25OHD and PTH data was available (N = 4025), PTH levels plateaued at a serum 25OHD level of 26.1 ng/ml. CONCLUSION Secular increase in serum 25OHD levels is observed in Lebanon, but hypovitaminosis D is still prevalent. Our data provides basis for a desirable 25OHD level above 26 ng/ml in adult and elderly Lebanese individuals.
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Affiliation(s)
- Randa K Saad
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vanessa C Akiki
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Maya Rahme
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara Ajjour
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Assaad
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghada A El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon.
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Amar AOS, Hyldstrup L, Nielsen J, Palm H, Jensen JEB. Intensive screening for osteoporosis in patients with hip fracture. Arch Osteoporos 2019; 14:63. [PMID: 31214797 DOI: 10.1007/s11657-019-0612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Opportunities to evaluate, treat, and prevent future osteoporotic fractures are often being overlooked, especially in patients with a prior osteoporotic fracture. We find that an intensive outreach osteoporosis investigation strategy can help increase the number of patients investigated and treated for osteoporosis following a hip fracture. PURPOSE Patients experiencing a hip fracture are subject to an increased risk of subsequent fractures. This suggests an urgent need to develop strategies that will allow a higher number of patients with fragility hip fractures to be investigated and treated for osteoporosis. In accordance, we developed a secondary osteoporosis prevention program and evaluated the results of the program. METHODS In the study period, 1071 patients with a hip fracture were admitted to Hvidovre University Hospital. Eligible patients were offered an osteoporosis investigation program, which included a DXA-scan with vertebral fracture assessment and a medical consultation. The data retrieved from this program were registered and analyzed. The primary goal of the study was to describe the number of subjects, who completed the program, and to characterize the initiated osteoporosis treatment. Secondary outcomes evaluated were prevalence of DXA-verified osteoporosis, changes in T-score due to treatment, and 1-year mortality rate. RESULTS In total, 557 patients were offered participation of which 333 patients completed the full program. Among these, 159 patients had DXA-verified osteoporosis and 192 patients were started treatment. This resulted in a significant higher T-score at the lumbar spine and femoral neck compared with subjects not treated. Additionally, we report a 1-year mortality rate of 27.7% among all patients with hip fracture. CONCLUSION We report that an intensive outreach osteoporosis investigation program can help increase the number of hip fracture patients being tested and treated for osteoporosis. Further, the initiation of treatment can significantly increase the T-score.
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Affiliation(s)
- Anas Ould Si Amar
- Department of Endocrinology, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, DK-2650, Hvidovre, Denmark.
| | - Lars Hyldstrup
- Department of Endocrinology, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, DK-2650, Hvidovre, Denmark
| | - Jette Nielsen
- Department of Endocrinology, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, DK-2650, Hvidovre, Denmark
| | - Henrik Palm
- Head of Department, Department of Orthopedics, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, DK-2650, Hvidovre, Denmark
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