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Stubbs B, Perara G, Koyanagi A, Veronese N, Vancampfort D, Firth J, Sheehan K, De Hert M, Stewart R, Mueller C. Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study. J Am Med Dir Assoc 2020; 21:1893-1899. [PMID: 32321678 PMCID: PMC7723983 DOI: 10.1016/j.jamda.2020.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016. MEASURES Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes. RESULTS In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures. CONCLUSION AND IMPLICATIONS Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - Gayan Perara
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain; ICREA, Barcelona, Spain
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima," Dolo, Venice, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium; University Psychiatric Centre, KU Leuven, University of Leuven, Kortenberg, Belgium
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Katie Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium; Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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Zanjani F, Gruber-Baldini AL, Resnick B, Orwig D, Hochberg M, Magaziner J. The Relationship Between Alcohol Consumption and Hip Fracture Recovery Among Older Adults. J Appl Gerontol 2020; 39:1046-1051. [PMID: 31027444 PMCID: PMC7041881 DOI: 10.1177/0733464819845802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: We examined the relationship between alcohol consumption and hip fracture recovery. Methods: Repeated measures analysis was used to analyze Baltimore Hip Studies (BHS) seventh cohort 12-month prospective data of hip fracture patients. The analytical sample was limited to individuals with baseline and follow-up alcohol data, representing n = 278 sample size, 49% male, and mean age 81 years. Results: In the year prior to fracture, sample reporting indicated 45% nondrinking, 48% one to seven drinks per week, and 7% eight or more drinks per week alcohol levels. There were some changes in alcohol status during the study period (p < .001); 42% remained nondrinkers and 47% remained alcohol consumers, but 8% stopped alcohol use, and 3% reported alcohol consumption after nondrinking at baseline. Alcohol was a predictor (p < .05) of disability and physical function, not showing worse recovery for drinkers. Conclusion: Almost half of the sample consumed alcohol throughout the study period, with no clear indication of negative effects on hip fracture recovery.
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Affiliation(s)
| | | | | | - Denise Orwig
- University of Maryland School of Medicine, Baltimore, USA
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore, USA
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, USA
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Søgaard AJ, Ranhoff AH, Meyer HE, Omsland TK, Nystad W, Tell GS, Holvik K. The association between alcohol consumption and risk of hip fracture differs by age and gender in Cohort of Norway: a NOREPOS study. Osteoporos Int 2018; 29:2457-2467. [PMID: 30006884 DOI: 10.1007/s00198-018-4627-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023]
Abstract
UNLABELLED The association between alcohol consumption and hip fracture differed by gender: Men aged 30-59 years drinking frequently or 14+ gl/week had higher risk than moderate drinkers. No significant association was seen in older men. Women not drinking alcohol had higher risk than those drinking moderately both regarding frequency and amount. INTRODUCTION We aimed to examine alcohol consumption and risk of hip fracture according to age and gender in the population-based Cohort of Norway (1994-2003). METHODS Socio-demographics, lifestyle, and health were self-reported and weight and height were measured in 70,568 men and 71,357 women ≥ 30 years. Information on subsequent hip fractures was retrieved from hospitals' electronic patient registries during 1994-2013. Frequency of alcohol consumption was categorized: never/seldom, moderate (≤ 2-3 times/week), or frequent (≥ 4 times/week), and amount as number of glasses per week: 0, 1-6, 7-13, 14-27, and 28+. Type of alcohol (wine vs. beer/hard liquor) was also examined. Cox's proportional hazards regression was used to estimate hazard ratios (HRs) stratified on gender and baseline age < 60 and ≥ 60 years. RESULTS During median 15-year follow-up, 1558 men and 2511 women suffered a hip fracture. Using moderate drinkers as reference, men < 60 years drinking frequently had multivariable adjusted HR = 1.73 (CI 1.02-2.96) for hip fracture and more than 2.5 times higher risk if they consumed 14+ glasses compared to 1-6 glasses per week. In other groups of age and gender, no statistically significant increased risk was found in those consuming the highest levels of alcohol. Compared to women with moderate or frequent alcohol use, never/seldom-drinking women had the highest fracture risk. In women, use of wine was associated with lower fracture risk than other types of alcohol. CONCLUSIONS Risk of hip fracture was highest in men < 60 years with the highest frequency and amount of alcohol consumption and in non-drinking women.
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Affiliation(s)
- A J Søgaard
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway.
| | - A H Ranhoff
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - H E Meyer
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - T K Omsland
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - W Nystad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
| | - G S Tell
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - K Holvik
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
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Moerman S, Mathijssen NMC, Tuinebreijer WE, Vochteloo AJH, Nelissen RGHH. Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision. Acta Orthop 2018; 89:509-514. [PMID: 30080985 PMCID: PMC6202728 DOI: 10.1080/17453674.2018.1499069] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/11/2018] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In the Netherlands about 40% of hip fractures are treated with a hemiarthroplasty (HA) or a total hip arthroplasty (THA). Although these procedures are claimed to have fewer complications than osteosynthesis (i.e., reoperation), complications still occur. Analyses of data from national registries with adequate completeness of revision surgery are important to establish guidelines to diminish the risk for revision. We identified risk factors for revision. Patients and methods - All patients older than 50 years of age with a hip fracture treated with arthroplasty by orthopedic surgeons and registered in the (national) Dutch arthroplasty register (LROI) were included in the study. In this register, patient characteristics and surgical details were prospectively collected. Revision surgery and reasons for revision were evaluated. A proportional hazard ratio model for revision was created using competing risk analysis (with death as competing risk). Results - 1-year revision rate of HA was (cumulative incidence function [CIF] 1.6% (95% CI 1.4-1.8) and THA 2.4% (CI 2.0-2.7). Dislocation was the most common reason for revision in both groups (HA 29%, THA 41%). Male sex, age under 80 years, posterolateral approach, and uncemented stem fixation were risk factors for revision in both THA and HA. THA patients with ASA classification III/IV were revised more often, whereas revision in the HA cohort was performed more often in ASA I/II patients. Interpretation - After arthroplasty of hip fractures, both a posterolateral approach and an uncemented hip stem have higher risks for revision surgery compared with an anterolateral approach and an cemented stem.
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Affiliation(s)
- Sophie Moerman
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft
| | | | | | | | - Rob G H H Nelissen
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Duryee MJ, Dusad A, Hunter CD, Kharbanda KK, Bruenjes JD, Easterling KC, Siebler JC, Thiele GM, Chakkalakal DA. N-Acetyl Cysteine Treatment Restores Early Phase Fracture Healing in Ethanol-Fed Rats. Alcohol Clin Exp Res 2018; 42:1206-1216. [PMID: 29698568 DOI: 10.1111/acer.13765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fracture healing in alcoholics is delayed and often associated with infections resulting in prolonged rehabilitation. It has been reported that binge drinking of alcohol increases oxidative stress and delays fracture healing in rats, which is prevented by treatment with the antioxidant n-acetyl cysteine (NAC). Oxidative stress is a significant factor in pathologies of various organs resulting from chronic alcoholism. Therefore, we hypothesize that treatment with NAC reduces oxidative stress and restores fracture healing in chronic alcoholics. METHODS Rats (10 months old) were pair-fed the Lieber-DeCarli ethanol (EtOH) diet or control diet for 16 weeks. A closed fracture was performed and rats allowed to recover for 72 hours. Rats were divided into 4 groups-control, control + NAC, EtOH, and EtOH + NAC-and injected intraperitoneally with 200 mg/kg of NAC daily for 3 days. Serum and bone fracture callus homogenates were collected and assayed for traditional markers of inflammation, oxidative stress, and bone regeneration. RESULTS The oxidative stress marker malondialdehyde (MDA) was increased in both serum and bone tissue in EtOH-fed animals compared to controls. NAC treatment significantly (p < 0.01) reduced MDA to near normal levels and dramatically increased the index of antioxidant efficacy (catalase/MDA ratio) (p < 0.01). Inflammatory markers tumor necrosis factor-α, interferon-γ, and interleukin-6 were significantly decreased in serum and callus following NAC treatment. NAC treatment reduced EtOH-induced bone resorption as evidenced by significant decreases in C-telopeptide of type-I-collagen levels (p < 0.05) and band-5 tartrate-resistant acid phosphatase levels in the tissue (p < 0.001). CONCLUSIONS Oxidative stress and excessive inflammation are involved in the inhibition of fracture healing by EtOH. In this study, early short-term treatment of EtOH-fed animals with the antioxidant NAC reduced oxidative stress and normalized the innate immune response to fracture in the early phase of fracture healing, thereby restoring the normal onset of bone regeneration.
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Affiliation(s)
- Michael J Duryee
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Anand Dusad
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Carlos D Hunter
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kusum K Kharbanda
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Gastroenterology-Hepatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph D Bruenjes
- Department of Surgery , Creighton University Medical Center, Omaha, Nebraska
| | - Karen C Easterling
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Justin C Siebler
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Surgery , Creighton University Medical Center, Omaha, Nebraska.,Department of Orthopedic Surgery , University of Nebraska Medical Center, Omaha, Nebraska
| | - Geoffrey M Thiele
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Internal Medicine , Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Pathology and Microbiology , University of Nebraska Medical Center, Omaha, Nebraska
| | - Dennis A Chakkalakal
- Veteran Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,Department of Surgery , Creighton University Medical Center, Omaha, Nebraska.,Department of Orthopedic Surgery , University of Nebraska Medical Center, Omaha, Nebraska
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Social to Moderate Alcohol Consumption Provides a Protective Effect for Functional Outcomes After Fixation of Orthopaedic Fractures. J Orthop Trauma 2017; 31:e173-e178. [PMID: 28538456 DOI: 10.1097/bot.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify the association between social and moderate alcohol consumption and functional outcomes after surgical management of orthopaedic fractures. DESIGN Prospective cohort study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Seven hundred eighty-four patients who were operatively treated for an isolated orthopaedic fracture were prospectively followed. Patients were categorized into groups according to self-reported drinking frequencies based on NIAAA guidelines. MAIN OUTCOME MEASUREMENTS SMFA scores at baseline, 3, 6, and 12 months postoperatively; postoperative complications; and subsequent operations. RESULTS There were 367 (46.8%) abstinent, 327 (41.7%) social, 52 (6.6%) moderate, and 38 (4.8%) heavy drinkers. Mean SMFA scores of social and moderate drinkers were significantly lower than those of abstinent patients at 3-, 6-, and 12-month follow-ups, denoting better functional outcomes (social: 24.3 vs. 30.5, P = 0.001; 14.8 vs. 21.5, P < 0.005; and 10.1 vs. 18.8, P < 0.005); (moderate: 18.3 vs. 30.5, P = 0.001; 9.7 vs. 21.5, P = 0.001; and 5.4 vs. 18.8, P < 0.005). Multiple linear regression revealed that social drinking and baseline SMFA scores were the only statistically significant independent predictors of lower SMFA scores at 12 months after surgery. CONCLUSIONS Social to moderate drinking may have a protective effect on functional outcomes at 3, 6, and 12 months after surgery. Social drinking may also have a protective effect on postoperative complications and reoperation rates. Further studies should be performed to fully appreciate the clinical effect of social and moderate drinking after operative treatment of orthopaedic fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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