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Mahmud M, Muscatello DJ, Rahman MB, Osborne NJ. Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants. Osteoporos Int 2024; 35:1573-1584. [PMID: 38806788 PMCID: PMC11364661 DOI: 10.1007/s00198-024-07115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/27/2024] [Indexed: 05/30/2024]
Abstract
The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. PURPOSE Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69 years at recruitment during 2006-2010. METHOD We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. RESULTS At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile. CONCLUSION Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.
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Affiliation(s)
- Mafruha Mahmud
- School of Population Health, University of New South Wales, Sydney, Australia.
| | | | - Md Bayzidur Rahman
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Kirby Institute, UNSW, Kensington, Australia
- The School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Nicholas John Osborne
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- European Centre for Environment and Human Health, University of Exeter, Truro, TR1 3HD, UK
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2
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Bennett SE, Gooberman-Hill R, Clark EM, Paskins Z, Walsh N, Drew S. Improving patients' experiences of diagnosis and treatment of vertebral fracture: co-production of knowledge sharing resources. BMC Musculoskelet Disord 2024; 25:165. [PMID: 38383386 PMCID: PMC10880218 DOI: 10.1186/s12891-024-07281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Osteoporosis involves changes to bones that makes them prone to fracture. The most common osteoporotic fracture is vertebral, in which one or more spinal vertebrae collapse. People with vertebral fracture are at high risk of further fractures, however around two-thirds remain undiagnosed. The National Institute for Health and Care Excellence (NICE) recommends bone protection therapies to reduce this risk. This study aimed to co-produce a range of knowledge sharing resources, for healthcare professionals in primary care and patients, to improve access to timely diagnosis and treatment. METHODS This study comprised three stages: 1. In-depth interviews with primary care healthcare professionals (n = 21) and patients with vertebral fractures (n = 24) to identify barriers and facilitators to diagnosis and treatment. 2. A taxonomy of barriers and facilitators to diagnosis were presented to three stakeholder groups (n = 18), who suggested ways of identifying, diagnosing and treating vertebral fractures. Fourteen recommendations were identified using the nominal group technique. 3. Two workshops were held with stakeholders to co-produce and refine the prototype knowledge sharing resources (n = 12). RESULTS Stage 1: Factors included lack of patient information about symptoms and risk factors, prioritisation of other conditions and use of self-management. Healthcare professionals felt vertebral fractures were harder to identify in lower risk groups and mistook them for other conditions. Difficulties in communication between primary and secondary care meant that patients were not always informed of their diagnosis, or did not start treatment promptly. Stage 2: 14 recommendations to improve management of vertebral fractures were identified, including for primary care healthcare professionals (n = 9) and patients (n = 5). Stage 3: The need for allied health professionals in primary care to be informed about vertebral fractures was highlighted, along with ensuring that resources appealed to under-represented groups. Prototype resources were developed. Changes included help-seeking guidance and clear explanations of medical language. CONCLUSIONS The study used robust qualitative methods to co-produce knowledge sharing resources to improve diagnosis. A co-production approach enabled a focus on areas stakeholders thought to be beneficial to timely and accurate diagnosis and treatment. Dissemination of these resources to a range of stakeholders provides potential for substantial reach and spread.
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Affiliation(s)
- Sarah E Bennett
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| | - Emma M Clark
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, United Kingdom
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, United Kingdom
| | - Nicola Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom
| | - Sarah Drew
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Schloemann DT, Ricciardi BF, Thirukumaran CP. Disparities in the Epidemiology and Management of Fragility Hip Fractures. Curr Osteoporos Rep 2023; 21:567-577. [PMID: 37358663 DOI: 10.1007/s11914-023-00806-6] [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: 06/06/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures. RECENT FINDINGS There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.
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Affiliation(s)
- Derek T Schloemann
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Caroline P Thirukumaran
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Ilic I, Ristic B, Stojadinovic I, Ilic M. Epidemiology of Hip Fractures Due to Falls. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1528. [PMID: 37763647 PMCID: PMC10533163 DOI: 10.3390/medicina59091528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The epidemiological pattern of the hip fracture burden attributable to falls in Central European countries is still insufficiently known. The aim of this study was to assess the regional and national trends of hip fractures due to falls in Central Europe from 1990 to 2019. Materials and Methods: Using the Global Burden of Disease (GBD) 2019 study, this descriptive epidemiological study presents trends in incidence of and Years Lived with Disability (YLDs) from hip fractures due to falls in the region of Central Europe. All estimates (age- and sex-specific rates, and age-standardized rates) were expressed per 100,000. A joinpoint regression analysis was used to assess trends: the average annual percent change (AAPC) with a corresponding 95% confidence interval (95% CI) was calculated. Results: Among all new cases of hip fracture in the population as a whole in Central Europe in 2019, 3.9% in males and 7.0% in females were attributable to falls, while the share of hip fractures due to falls in the population aged 70 and over was 16.9% in males and 20.0% in females. About 400,000 new cases of hip fracture due to falls occurred in the Central European region in 2019 (220,000 among males and 160,000 among females), resulting in 55,000 YLDs (32,000 in females and 22,000 in males). About one-third of all new cases (59,326 in males and 72,790 in females) and YLDs (8585 in males, and 10,622 in females) of hip fractures due to falls were recorded in Poland. From 1990 to 2019, the age-standardized incidence rates of hip fracture due to falls showed a decreasing tendency in females (AAPC = -1.1%), and an increasing tendency in males (AAPC = 0.1%). Both in males and females, YLDs rates of hip fracture due to falls in the Central European region decreased (AAPC = -1.6% and AAPC = -2.4%, respectively). Conclusions: Hip fracture due to falls represents an important health issue in the Central European region, although incidences and YLDs declined in the most recent decades. However, further efforts to reduce the burden of hip fractures attributed to falls are needed.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Ristic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Traumatology, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Stojadinovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Spinal Surgery, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Compston J. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2022; 17:58. [PMID: 35378630 PMCID: PMC8979902 DOI: 10.1007/s11657-022-01061-5] [Citation(s) in RCA: 163] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
The National Osteoporosis Guideline Group (NOGG) has revised the UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. Accredited by NICE, this guideline is relevant for all healthcare professionals involved in osteoporosis management. INTRODUCTION The UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013 and 2017. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. METHODS Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. RESULTS Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, and models of care for fracture prevention. Recommendations are made for training; service leads and commissioners of healthcare; and for review criteria for audit and quality improvement. CONCLUSION The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and by the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Royal United Hospital NHS Foundation Trust, Bath, UK.
| | - David J Armstrong
- Western Health and Social Care Trust (NI), Nutrition Innovation Centre for Food and Health, Ulster University, and Visiting Professor, Belfast, Northern Ireland
| | - Jean Bowden
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, and Wolstanton Medical Centre, Newcastle under Lyme, UK
| | - Neil J L Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University Hospitals Birmingham & University of Birmingham, Birmingham, UK
| | - Nicholas Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia and Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - Rebecca Low
- Abingdon and Specialty Doctor in Metabolic Bone Disease, Marcham Road Health Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Eugene McCloskey
- Department of Oncology & Metabolism, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Katie Moss
- St George's University Hospital, London, UK
| | - Jane Parker
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Kenneth Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | - Mike Stone
- University Hospital Llandough, Cardiff and Vale University Health Board, Llandough, UK
| | | | - Nic Vine
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Juliet Compston
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
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6
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Ormeño Illanes JCR, Quevedo Langenegger I. Higher latitude and lower solar radiation influence on hip fracture admissions in Chilean older population. Osteoporos Int 2021; 32:2033-2041. [PMID: 33818634 DOI: 10.1007/s00198-021-05910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED Data linking solar radiation with fractures are lacking. We found that lower solar radiation was associated with higher hip fracture admission rates in men from Chile. This supports the idea that solar radiation, a surrogate of vitamin D, may be involved in the development of fractures in older population. INTRODUCTION : To explore the associations between solar radiation and latitude with hip fracture admission rates in people aged 65 years or older in Chile, the country with the greatest variation in solar radiation in the world. METHODS In this ecological study, we investigated the associations between regional solar radiation and latitude with hospitalizations due to hip fracture in population aged 65 years or older, by reviewing national records between 2013 and 2018. We also evaluated the role of sociodemographic factors such as poverty, education, indigenous ethnicity, and rurality rates. RESULTS Between 2013 and 2018, there were 44,328 admissions due to hip fracture in people aged 65 years or older; 77.5% were women and 65.1% were aged 80 years or older. The national admission rate was 389.3 per 100,000 inhabitants (95% CI: 382.4-396.2). The highest admission rate was registered in the Region IX (445.3 per 100,000, 95% CI: 398.3-492.4), which has the highest poverty rates, indigenous ethnicity rates, and rurality rates. We found a north-south increasing gradient of admission rates in men (β=1.5 [95% CI: 0 to 3], p=0.044) and a significant association between solar radiation and admission rates in men (β=-4.4 [95% CI: -8 to 0.8], p=0.02). Admission rates in men were also associated with sociodemographic variables such as poverty (β=2.4 [95% CI: 0 to 4.8], p=0.048) and rurality rates (β=1.2 [95% CI: 0.1 to 2.4], p=0.039). CONCLUSION Regional solar radiation and latitude were associated with hip fracture admission rates in men aged 65 years or older in Chile, with highest admission rates at higher latitudes and lower solar radiation.
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Affiliation(s)
| | - I Quevedo Langenegger
- Endocrinology Section, Department of Internal Medicine, School of Medicine, University of Concepción, Concepción, Chile
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Glynn J, Hollingworth W, Bhimjiyani A, Ben-Shlomo Y, Gregson CL. How does deprivation influence secondary care costs after hip fracture? Osteoporos Int 2020; 31:1573-1585. [PMID: 32240332 DOI: 10.1007/s00198-020-05404-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED We studied the association between deprivation and healthcare costs after hip fracture. Hospital costs in the year following hip fracture were £1120 higher for those living in more deprived areas. Most of this difference was explained by pre-existing health inequalities which should be targeted to reduce this disparity. INTRODUCTION To quantify differences in hospital costs following hip fracture between those living in higher and lower deprivation areas of England, we investigate pre- and post-fracture variables that explain the association. METHODS We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011-March 2015) and national mortality data to identify patients admitted with hip fracture aged 60+ years. Hospital care was costed using 2017/2018 national reference costs, by index of multiple deprivation quintile. Three generalised linear model regressions estimated associations between deprivation and costs and the pre- and post-fracture variables that mediate this relationship. RESULTS Patients from the most deprived areas had higher hospital costs in the year post-fracture (£1,120; 95% CI £993 to £1,247) than those from the least deprived areas. If all patients could have incurred similar costs to those in the least deprived quintile, this would equate to an annual reduction in expenditure of £28.8 million. Pre-fracture characteristics, particularly comorbidities and anaesthetic risk grade, accounted for approximately 50% of the association between deprivation and costs. No evidence was found that post-fracture variables, such as transfer to a residential or nursing home, contributed to the association between deprivation and costs. CONCLUSIONS Socioeconomic inequalities are associated with substantial costs for the NHS after hip fracture. We did not identify post-fracture targets for intervention to reduce the impact of inequalities on post-fracture costs. The case for interventions to reduce comorbid conditions, improve health-related behaviours and prevent falls in deprived areas is clear but challenging to implement.
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Affiliation(s)
- J Glynn
- Health Economics at Bristol, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - W Hollingworth
- Health Economics at Bristol, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - A Bhimjiyani
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Forsén L, Søgaard AJ, Holvik K, Meyer HE, Omsland TK, Stigum H, Dahl C. Geographic variations in hip fracture incidence in a high-risk country stretching into the Arctic: a NOREPOS study. Osteoporos Int 2020; 31:1323-1331. [PMID: 32095840 PMCID: PMC7280325 DOI: 10.1007/s00198-020-05346-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED There are geographic variations in hip fracture incidence rates across Norway, with a lower incidence in the coastal areas of the southwest and in the Arctic north, contrary to what may be expected with regard to vitamin D exposure from sunlight. The regional differences have become smaller in recent years. INTRODUCTION To investigate geographic variation in hip fracture incidence within Norway and regional differences in time trends. METHODS All hip fractures treated in Norwegian hospitals 2002-2013 were included, and demographic information was obtained from Statistics Norway. Age-standardized incidence rates were calculated separately for 19 counties. Incidence rate ratios with 95% confidence intervals for county differences and time trends were estimated using Poisson regression. RESULTS Age-standardized number of hip fractures per 10,000 person-years varied between counties from 69 to 84 in women and from 34 to 41 in men. The highest rates were observed in the southeastern capital city of Oslo, while rates were low in the four northernmost counties. There was an east-west gradient, with lower incidence in the coastal southwest compared with the southeast. Women showed a statistically significant decline during 2002-2013 in almost all counties (up to 31%). In men, only a few counties showed a decline. In both genders, hip fracture rates at age 80 in the combined five counties with the highest rates were significantly higher than in the combined five counties with the lowest rates across the period, although the trends converged over time. CONCLUSIONS In Norway, the hip fracture incidence was lower in the north compared with the south. In addition, we observed an east-west gradient with the highest incidence in the southeast and lower incidence in the coastal southwest. While there has been an overall declining trend in hip fracture incidence over time, regional differences are still apparent.
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Affiliation(s)
- L Forsén
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - A J Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - K Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - H E Meyer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - T K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - H Stigum
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - C Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway.
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Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: A prospective registry-based study. Injury 2020; 51:420-428. [PMID: 31810636 DOI: 10.1016/j.injury.2019.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study investigated which patient and injury characteristics are associated with 12-month mortality rates and living independently after isolated hip fracture. METHODS Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. CONCLUSIONS Characteristics that are associated with social disadvantage, frailty, poor health and reduced independence before injury were associated with increased rates of death and reduced odds of living independently 12 months after isolated hip fracture.
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10
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Mazzucchelli R, Pérez Fernández E, Crespí Villarías N, Tejedor Alonso MÁ, Sáez López P, García-Vadillo A. East-west gradient in hip fracture incidence in Spain: how much can we explain by following the pattern of risk factors? Arch Osteoporos 2019; 14:115. [PMID: 31773387 DOI: 10.1007/s11657-019-0665-3] [Citation(s) in RCA: 5] [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: 04/16/2019] [Accepted: 10/29/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our objective was to analyze the incidence and trend of hip fracture in Spain and its distribution by Autonomous Community (AC). In Spain, the age-adjusted incidence rate of hip fracture is decreasing. There is great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, and climatic factors and cohort effect factors of the civil war explain 96% of this variability. INTRODUCTION In Spain, there is great variability between the different Autonomous Communities (ACs) in the incidence of hip fracture. The objectives of our study are (1) to estimate the incidence rate and trend of hospital admissions for hip fracture in Spain and by ACs and (2) to analyze risk factors/markers that could explain the variability in the incidence and trend between different ACs. METHOD This work includes 2 studies (TREND-HIP and VAR-HIP). TREND-HIP: retrospective, national, observational study based on the administrative database of the National Health System that includes a Minimum Basic Data Set (MBDS) of hospital admissions. VAR-HIP: ecological study based on the analysis of the results obtained in TREND-HIP study, with different risk factors/markers obtained from different sources. RESULTS In the 17 years included in the analysis, there were 744,848 patients diagnosed with hip fracture. The global age-adjusted rate of hip fracture at the national level was 315.38/100,000 person*year (95% CI 312.36-317.45); by AC, the rate varied from 213.97 in the Canary Islands to 363.13 in the Valencia and Cataluña communities. We observe an east-west gradient in Spain. The trend for both sexes was - 0.67% (95% CI 0.9990-0.9957) (p < 0.001). In the analysis of risk factors/markers that explain this distribution, we found significant correlations with genetic factors, demographics, climatic factors and the time a region was on the Republican side of the civil war. The linear regression model that includes the factors that show significant correlation explains 96% of the variability observed. CONCLUSION In Spain, the age-adjusted incidence rate for hip fracture is decreasing. There is a great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, climatic factors and the cohort effect of the civil war explain 96% of this variability.
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Affiliation(s)
- Ramón Mazzucchelli
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Elia Pérez Fernández
- Department of Clinical Research, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | - Pilar Sáez López
- Department of Orthogeriatrics, Hospital Universitario Fundación Alcorcon, Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain
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MacKenzie SA, Ng RT, Snowden G, Powell-Bowns MFR, Duckworth AD, Scott CEH. Periprosthetic atypical femoral fractures exist and are associated with duration of bisphosphonate therapy. Bone Joint J 2019; 101-B:1285-1291. [DOI: 10.1302/0301-620x.101b10.bjj-2019-0599.r2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Aims Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. Patients and Methods This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. Results Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). Conclusion AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285–1291
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Affiliation(s)
| | - Richard T. Ng
- Department of Orthopaedics, University of Calgary, Calgary, Canada
| | - Gorden Snowden
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Chloe E. H. Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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