Abstract
Orthopaedic Out of Bed Project (OOBP): Improving Early Mobilisation Following Femoral Fracture Using a Therapy-Led Education Programme
Rene Gray, Melissa Taylor and Ryan Bullock
James Paget University Hospital, James Paget University Hospital, James Paget University Hospital
Aims: Delayed mobilisation following hip fracture surgery is detrimental to patients and health systems. The aim of our service improvement project was to increase the number of patients mobilised by the day after femoral fracture surgery and increase the percentage mobilised by the wider acute multi-disciplinary team and not just physiotherapists. Methods: The model for improvement was used, with two Plan-Do-See-Act (PDSA) cycles completed between 2020 and 2022. A ward-based education programme aimed at increasing confidence and competence of the trauma ward healthcare assistants (HCAs) to complete mobilisation for the first time was developed and delivered in the ward environment. Results: On completion of the therapy-led intervention, the percentage of patients mobilised by the day after surgery increased from a mean average of 60% in 2019 to 79% in 2022. The number of patients mobilised by HCAs prior to physiotherapy assessment increased from 2% prior to and 30% following the intervention. Conclusions: The programme improved HCA confidence and competence using a rehabilitation ethos to mobilise patients following hip fracture surgery. This work has demonstrated positive implications for orthopaedic trauma services and the patients who receive them. It reduces the single point of failure of relying on a physiotherapist to mobilise a patient through increasing multidisciplinary confidence and capability on the ward to perform the task. In turn, this increases physiotherapy capacity to provide acute rehabilitation, which is another important part of femoral fracture recovery. This novel approach could be utilised in other clinical environments with minor adjustments.
Extent of Informal Caregiving to Older Home-Dwelling Persons After Hip Fracture: A Prospective Cohort Study
Jonas Ammundsen Ipsen 1,2 , Bjarke Viberg 1,2,3 , Eva Draborg 2 and Inge Hansen Bruun 1
1 Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, 2 University of Southern Denmark, Odense, Department of Orthopaedic Surgery and Traumatology, 3 Odense University Hospital, Odense
Aims: To explore the extent of informal caregiving to older home-dwelling persons after hip fracture. Methods: This prospective study is part of a ‘stepped-wedge cluster randomised trial (Rehabilitation for Life). The study encompasses a regional hospital and the six municipalities of the catchment area. In Denmark, Formal care is a public service and informal care (IC) is provided by family/friends. Inclusion criteria was 65+ home-dwelling persons cognitively un- impaired, after hip fracture. Exclusion criteria: short life expectancy and revised surgery. IC was reported in diaries and collected biweekly for 12 weeks after discharge. Outcome was total amount of IC the first 12 weeks after discharge, presented as median and interquartile range. As a sub-analysis, the median amount of IC was used as cut-off for a high and low dependent group. Results: A total of 226 person’s participated, median age was 78 years (73-84) and 60% were women. Ninety-one percent received IC median 28 hours (10, 64). Week 1-2, 72% received IC median 8 hours (0, 28). At week 11-12, 35% received IC median 0 hours (0, 7). Fourty- seven percent were high dependent of IC median 66 hours (46-107), fifty-three percentent were low-dependent of IC median 11 hours (2-20). The high dependent persons had lower mobility and Barthel-20 scores (P = 0.02 and P = 0.00) and less frequently lived alone (P = 0.04). Conclusions: Ninety-one percent received IC and median was 28 hours. IC amount and proportion declined during the 12 weeks. At discharge, person’s high dependent on IC had more difficulties with everyday activities and relied more on partners.
Multiple Organisational Factors Predict Hospital Costs and Patient Mortality in the Year Following Hip Fracture in England and Wales: the Reduce Record-Linkage Cohort Study
Petra Baji 1,2 , Rita Patel 1 , Andrew Judge 1,3,4,5,6 , Antony Johansen 7,8 , Jill Griffin 1 , Tim Chesser 1 , Xavier L Griffin 10,11 , Muhammad K Javaid 3 , Estela C Barbosa 12 , REDUCE Study Group 13 , Yoav Ben-Shlomo 1 , Elsa M R Marques 1 and Celia L Gregson 1,14
1 University of Bristol, Bristol, UK, 2 Corvinus University of Budapest, Budapest, Hungary, 3 University of Oxford, Oxford, UK; Biomedical Research Centre at 4 University Hospitals Bristol 5 Weston NHS Foundation Trust and the 6 University of Bristol, Bristol, UK, 7 University Hospital of Wales, and School of Medicine, Cardiff University, 8 National Hip Fracture Database, Royal College of Physicians, London, UK, Royal Osteoporosis Society, Bath, UK, 9 Southmead Hospital, North Bristol NHS Trust, Bristol, UK, 10 Barts Bone and Joint Health, Barts and 11 The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Royal London Hospital, Barts Health NHS Trust, London, UK, University of Oxford, Oxford, UK, Violence and Society Centre, School of Policy & Global Affairs, 12 City University of London, London, UK, 13 UKPRP VISION Consortium, London, UK, University Hospitals Bristol and Weston NHS Foundation Trust, UK, 14 Royal United Hospital NHS Foundation Trust Bath, Bath, UK
Aims: To identify modifiable hospital-level organisational factors that are associated with long- term patient outcomes and costs after hip fracture. Methods: We used national record-linkage of 178,757 patients (≥60 years) with hip fracture in 172 hospitals in England & Wales (2016-19). We linked patient-level hospital admissions, National Hip Fracture Database and mortality data with 231 metrics from 18 hospital-level organisational audits/reports. Multilevel models identified organisational factors, adjusted for patient case-mix, associated with cumulative mortality, days spent in hospital, and inpatient costs over 365-days. Results: Patients had mean age 82.7 (SD 8.6) years, 70.6% female, and 50,354 (28.2%) had died after a year. Patients spent a mean 31.7 (SD 32.1) days in hospital incurring inpatient costs of £14,642 (SD £9017) per patient, ranging from £10,787 to £22,729 between hospitals. Eleven organisational factors were independently associated with mortality, 24 with days in hospital and 25 with inpatient costs. Having all patients assessed by an orthogeriatrician within 72 hours of admission was associated with a mean cost saving of £529 (95%CI £148 to £910) per patient, and a 15% lower 365-day mortality. Consultant orthogeriatrician attendance at clinical governance meetings and the provision of physiotherapy to patients on weekends were associated with cost savings of £356 (£188 to £525) and £676 (£67 to £1285) per patient respectively, and with fewer days in hospital. Conclusions: Multiple, potentially modifiable, hospital-level organisational factors associated with important clinical outcomes and costs were identified, that should inform initiatives to improve the effectiveness and efficiency of hip fracture services.
Socioeconomic Factors Impact on Patient-Reported Outcome Measures After Hip Fractures by Cato Kjærvik
Cato Kjærvik, Jan-Erik Gjertsen, Eva Stensland, Odd Søreide
Nordland Hospital Trust, Vesteraalen Hospital, Stokmarknes, Norway - UiT the Arctic University of Norway, Tromsø, Norway, Norwegian Hip Fracture Register, Haukeland University Hospital, Bergen, Norway - Department of Clinical Medicine, University of Bergen, Bergen, Norway, UiT the Arctic University of Norway, Tromsø, Norway Tromsø, Norway, Centre for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway
Aims: We aimed to investigate if and to what extent socioeconomic factors had an impact on patient-reported outcome measures (PROMs) after hip fractures. Methods: Data on 35,818 patients reported to the Norwegian Hip Fracture Register 2014-2018 were coupled to data in the Norwegian Patient Register and Statistics Norway. Level of education (LE) was grouped in three levels (primary, secondary, and tertiary). Household income (HI) the year prior to injury was categorized in quartiles. The association between LE/HI and PROMs adjusted for age, sex, and ASA class was outlined by multiple linear regression analyses and impact was expressed by regression coefficients (RC). PROMs were pain from the operated hip (Visual analogue scale (VAS) 0-100, 100 is worst) and self-perceived health (EQ-VAS 0-100, 100 is best) and were reported 4-, 12-, and 36- months post-surgery. Results: At 4 months increasing LE reduced VAS-pain (Regression Coefficient (RC) -2.00 SE 0.28, P < 0.001) and increased EQ-VAS (RC 0.95 SE 0.29, P = 0.001). At 36 months these associations were stronger (RC -2.44 SE 0.39, P < 0.001 and RC 1.88 SE0.42, P < 0.001 respectively). Higher HI reduced VAS-pain at 4 months (RC -0.49 SE 0.20, P = 0.014) and 12 months (RC -0.94 SE 0.25, P < 0.001). Higher HI increased EQ-VAS at 4 months (RC 1.04 SE 0.20, P < 0.001) and 36 months (RC 1.42 SE 0.29, P < 0.001). Conclusions: Higher LE and higher HI were independently associated with less pain from the operated hip and higher self-perceived health. Socioeconomic factors may affect PROMs after hip fractures. Clinical relevance of the findings requires further clarification.
Prevalence of Osteoporosis, Sarcopenia, and High Falls Risk in Thai Older Adults: A Nationwide Community-Based Survey
Nath Adulkasem 1 , Apichat Asavamongkolkul 1 , Pojchong Chotiyarnwong 1 , Ekasame Vanitcharoenkul 1 , Chandhanarat Chandhanayingyong 1 , Panai Laohaprasitiporn 1 , Krabkaew Soparat 1 and Aasis Unnanuntana 1
1 Siriraj Hospital, Mahidol University, Bangkok, Thailand
Aims: Thailand has become an aging society. Epidemiological information regarding degenerative musculoskeletal disorders among the Thai elderly, however, is limited. This study aimed to report the prevalence of age-related musculoskeletal diseases, including osteoporosis, sarcopenia, and a high risk of falls among the Thai elderly. Methods: We conducted a nationwide cross-sectional study of the Thai elderly aged >60 years between March 2021 and August 2022. The study population was evenly distributed across Thailand using stratified multi-stage sampling. All participants were evaluated for bone mineral density, skeletal muscle mass, grip strength, and gait speed. Osteoporosis was diagnosed according to the world health organization definition, while sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was determined using the self-rated fall risk questionnaire. Results: A total of 2991 eligible participants were recruited. Of those, 63.1% were female, with a mean age of 69.2 years (range, 60 to 107). The prevalence of osteoporosis, sarcopenia, and high risk of falls were 29.7%, 17.7%, and 38.5%, respectively. Approximately one-fifth of the subjects (18.3%) had at least 2 out of 3 risk factors of sustaining a fragility fracture (osteoporosis, sarcopenia, and high risk of fall), and 3.3% had all three risk factors. Conclusions: This study showed a surprisingly high prevalence of osteoporosis, sarcopenia, and increased fall risk in Thai older adults. Since these conditions are major risk factors for fragility fracture, a modification of the national healthcare policy is required corresponding to an increased prevalence of these conditions in Thailand.
Epidemiology of Common Fractures in Elderly Norwegians 2010—2021
Jørgen Andvig, Andreas Asheim, Gudrun Maria Waaler Bjornelv, Lars Gunnar Johnsen, Sara Marie Nilsen and Johan Håkon Bjørngaard
Helse More & Romsdal HF and ISM NTNU, St Olavs Hospital HF and NTNU, NTNU and UIO, St Olavs Hospital and NTNU, St Olavs Hospital and NTNU, NTNU
Aims: To describe the epidemiology of common fractures in the Norwegian population among individuals 65 years and older. Methods: Data from the Norwegian Patient Registry was used to extract details on all patients 65 years and older who had fractures of the: proximal humerus; distal forearm/wrist; thoracolumbar spine; hip; pelvis; femur; lower leg; or ankle. We identified incident fracture as the first acute contact with the hospital coded with the ICD10 diagnoses corresponding to the specific fracture type. The data was analyzed to establish absolute numbers and rates. We present both the year, month and day of the week that fractures occurred. Results: The total number of fractures in the eight categories increased from 20,400 in 2010 to 24,700 in 2021. The incidence rate fell from 270 to 245 fractures per 10,000 person-years. The fall in incidence was driven by the decrease in hip fractures, from 106 to 81 fractures per person year. The other fractures had near constant incidence rates, except femur fractures, which fell from 9 to 7 fractures per person year. The highest aggregate number of fractures were seen in January (n = 27,405), while the lowest number was seen in May (n = 19,121). Most hospital acute contacts were on Mondays, while Sundays had the lowest numbers. Conclusions: In Norway over the years 2010-21, our study shows a steady decline in incidence rates for hip fractures, while the other most common osteoporotic related fractures have near constant incidence rate. Despite this we find a 21% overall increase in fractures because of population aging.
A Nation-Wide Dual-Energy X-Rays Absorptiometry Study to Establish An Appropriate FRAX Cut-off Values for Osteoporosis Screening in Thailand
Pojchong Chotiyarnwong 1 , Ekasame Vanitcharoenkul1, Chandhanarat Chandhanayingyong1, Panai Laohaprasitiporn 1 , Nath Adulkasem 1 , Ekkapoj Korwutthikulrangsri 1 , Krabkaew Soparat 1 , Aasis Unnanuntana 1 and Apichat Asavamongkolkul 1
1 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 10700.
Aims: With the limitation of dual-energy x-ray absorptiometry (DXA) accessibility, the Fracture Risk Assessment Tool (FRAX®) was recommended as an initial tool for assessing fracture risk in older adults. Our objective is to determine an appropriate FRAX cut-off for the screening of osteoporosis in Thais. Methods: A sample size calculation and randomization of the area for data collection from all 6 regions were made by the National Statistic Agency of Thailand. The mobile DXA machine was used. Participants aged 60 years or older who could ambulate independently were included. Eleven FRAX questions were employed. The receiver operating characteristic (ROC) curve of osteoporosis and FRAX 10-year probabilities of hip fracture (HF) and major osteoporotic fractures (MOF) without bone mineral density were plotted, and the area under the curve (AUC) was analyzed. A sensitivity of at least 0.8 was chosen for the cut-off value. Results: Of 2991 subjects, 889 subjects (29.7%) from 12 provinces of Thailand were diagnosed with osteoporosis. The AUC of HF for osteoporosis diagnosis was 0.750 (95% confidence interval (CI) 0.731-0.769), while the MOF was 0.725 (95% CI 0.705-0.744). The FRAX cut-off value for HF was 1.5% (sensitivity = 0.82 and specificity = 0.51), while the MOF was 4.5% (sensitivity = 0.82 and specificity = 0.47). Conclusions: FRAX could be used for osteoporosis screening. Here, we report FRAX cut-off values of 1.5% and 4.5% for HF and MOF in Thai older adults. These numbers should be considered for implementation in clinical practice guidelines for osteoporosis management in Thailand.
Progressive Exercise Versus Best Practice Advice for Adults Aged 50 years or Over After Ankle Fracture: The After Pilot Multicentre Randomised Controlled Trial
David Keene 1 , Matthew Costa 2 , Nicholas Peckham 2 , Elizabeth Tutton 2 , Vicki Barber 2 , Susan Dutton 2 , Sally Hopewell 2 , Anthony Redmond 3 , Keith Willett 2 and Sarah Lamb 1
1 University of Exeter, 2 University of Oxford, 3 University of Leeds
Aims: The aim of this multicentre external pilot parallel-group randomised controlled trial (RCT) was to assess feasibility of a definitive trial comparing rehabilitation approaches after ankle fracture. Methods: Participants were aged 50 years and over with an ankle fracture from five UK hospitals. Participants were allocated 1:1 via a central web-based randomisation system to best practice advice (one session of physiotherapy, up to two optional additional advice sessions) or progressive exercise (≤6 physiotherapy sessions). Feasibility outcomes were participation rates, intervention adherence and retention. Registration: ISRCTN16612336. Results: Sixty-one of 112 (54%) eligible patients participated, exceeding the 25% progression criteria. Recruitment progression criteria was 1.5 participants per site per month, 1.4 was observed. At least one intervention session was delivered for 28/30 (93%) of best practice advice and 28/31 (90%) of progressive exercise participants, exceeding the 85% progression criteria. For those providing follow-up, the proportion reporting performance of home exercises in the best practice advice and the progressive exercise groups at 3 months was 20/23 (87%) and 21/25 (84%), respectively. Mean time from injury to starting physiotherapy was 74.1 days (95%CI 53.9 to 94.1 days) for best practice advice and 72.7 days (95%CI 54.7 to 88.9) for progressive exercise. Follow-up rate at 6-months was 28/30 (93%) for best practice advice and 26/31 (84%) for progressive exercise. Conclusions: Feasibility of a definitive trial was established. Main issues being addressed for the ongoing definitive trial are intervention modifications to enable earlier provision of rehabilitation and ensuring similar rates of follow-up in each group.
Quality of Care and Mortality in Hip Fracture Patients in the Course of the COVID Pandemic. A Population-Based Cohort Study
Alma B. Pedersen 1 , Nickolaj Risbo 1 , Bjarke L. Viberg 2,3 , Henrik Palm 4 , Niels Dieter Röck 2
1 Aarhus University Hospital, Denmark, 2 Odense University Hospital, 3 University of Southern Denmark, 4 Copenhagen University Hospital Bispebjerg, Denmark
Aims: We assessed the quality of in-hospital care for hip fracture (HF) patients in Denmark and subsequent mortality before and during the early stages of COVID pandemic. Methods: We obtained data on HF patients, quality indicators, mortality and comorbidity from the Danish medical databases in the COVID period (11 Marts 2019 to 27 January 2021, overall and in five separate periods), and compared to a pre-COVID period (13 March 2019 to 10 March 2020). We calculated the proportion of patients (%) that have fulfilled >80% of the relevant quality indicators (a composite score). We used Cox regression to calculate hazard ratios (HR) comparing 30-day mortality in COVID period with pre-COVID period, adjusting for age, gender, comorbidity and residence. Results: A total of 6575 were treated for HF in the pre-COVID period, and 5919 in the COVID period. Overall, there was no difference in patient characteristics between pre-COVID and COVID period. The composite score was 73% in pre-COVID period, compared to 73% to 80% in the five COVID periods. 30-day mortality was 9.5% in pre-COVID period, compared to 10.8% in the overall COVID period, but varied from 10% to 11.9% in five COVID periods. HR for mortality was 1.15 (1.02-1.30) in the overall COVID compared to pre-COVID period. HRs varied from 1.07 (0.89-1.29) to 1.31 (1.06-1.62) in five COVID periods. We observed regional variations in the HRs when comparing overall COVID with pre-COVID period. Conclusions: The quality of in-hospital care for HF patients in Denmark was higher in the COVID compared to pre-COVID period. Unfortunately, 30-day mortality was also higher.
Hip Fracture in Centenarians: Factors Associated with 30-day Mortality
Cristina Ojeda-Thies, Cristina Bermejo-Boixareu, Ainhoa Guijarro-Valtueña, Bernardo Abel Cedeño- Veloz, María Gonzalo-Lázaro, Laura Navarro-Castellanos, Rocío Queipo-Matas, Paloma Gómez- Campelo, Ana Royuela-Vicente, Juan Ignacio González-Montalvo and Pilar Sáez-López
University Hospital, Madrid, Spain, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain University Hospital of Navarra, Pamplona, Spain., La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain., European University of Madrid, Madrid, Spain., La Paz Institute for Health Research - Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, IDIPHISA, CIBERESP, Madrid, Spain., Fundación Alcorcón University Hospital, Madrid, Spain.
Aims: We wished to evaluate factors associated with one-month mortality after hip fracture in centenarians. Methods: Patients aged 100 years or older included in the Spanish National Hip Fracture (RNFC) between January 2017 and December 2019 were included. Results: Of the 253 centenarians, 83% were women, 33% had severe dementia, 9% were severely dependent functionally and 36% lived in nursing care homes. Intertrochanteric patterns accounted for 60% of fractures. Surgical delay was ≤48 hours in 52.8%of patients, while length of hospital stay was 8.6 days and in-hospital mortality 10.3%. At 30-day follow-up, 20.9% had died, 1.8% had been readmitted and 4.9% had been reoperated. An association between 30 day-mortality and the following variables was found: male sex (OR 2.13 [1.85-2.43]), surgical delay >48 hours (OR 1.24 1.08-1.42]), cognitive impairment (OR 1.34 [1.11-1.63] and 1.53 [1.27-1.84] for moderate and severe dementia, respectively), anaesthestic risk (OR 8.01 [1.11-58.0], 16.3 [2.24-118] and 54.5 [5.61-530] for ASA categories III, IV and V), while prefacture ambulation (vs FAC 0; OR 0.54 [0.38-0.79], 0.48 [0.37-0.61] and 0.31 [0.24 – 0.40] for FAC 3,4, and 5), peripheral nerve blocks (OR 0.77 [0.63-0.93]) and spinal anaesthesia (OR 0.64 [0.51-0.80) protected against mortality. Multivariate analysis showed only the anaesthetic risk (vs. ASA V; OR 0.25 [0.09-0.70] and 0.43 [0.19-0.96] for ASA II and III), maintained the association with 30-day mortality. Conclusions: Nearly 4 out of 5 centenarians were alive one month after surgery. Comorbidity was the main factor associated with mortality in centenarians with hip fractures.
Effectiveness of the Fragility Fracture Integrated Rehabilitation Management (FIRM) in Older Adults After Hip Fracture Surgery During a 12-Month Postoperative Follow-Up Period: A Multicenter Randomized Controlled Trial
Seung-Kyu Lim 1,2 , Jae-Young Lim 1,2 , Jaewon Beom 1,2 and Bo Ryun Kim 3
1 Soonchunhyang University College of Medicine, 2 Soonchunhyang University College of Medicine Soonchunhyang University Cheonan Hospital, 3 Anam Hospital, Korea University College of Medicine
Aims: To assess the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to conventional rehabilitation method after hip fracture (HF) surgery. Methods: This was a single-blind randomized trial conducted at multiple centers with 203 patients over 65 years of age enrolled in the FIRM program and followed for up to 12 months after HF surgery. Ambulatory function was assessed using the KOVAL and FAC scales at baseline, discharge, and at 3, 6, and 12-month follow-up, along with secondary functional outcomes. The study also evaluated the possibility of independent ambulation and recovery to pre- fracture ambulatory status at 12 months. Results: The FIRM group demonstrated superior improvement in KOVAL and FAC scores and most secondary outcomes, as well as significantly higher rates of independent ambulation (P = 0.017, P = 0.043, and P = 0.016, respectively) and recovery to pre-fracture ambulatory status (P = 0.009, P = 0.007, P = 0.041, and P = 0.016, respectively) at 3, 6, and 12 months compared to the control group. FIRM was an independent predictor of independent ambulation and recovery to previous ambulatory status at 12 months (OR = 2.856, 95% CI 1.128 - 7.227, P = 0.017; OR = 2.847, 95% CI 1.135 – 7.141, P = 0.026, respectively). Pre-fracture KOVAL score, cognitive impairment, and grip strength were also predictive factors for achieving recovery of ambulation at 12 months. Conclusions: The FIRM program following HF surgery resulted in significantly greater improvements in ambulatory function and other secondary outcomes compared to conventional rehabilitation during the 12-month follow-up period. This first South Korean trial emphasizes the importance of multidisciplinary rehabilitation for HF patients.
Association of Young With Intellectual Disability with Osteoporosis Risk: Analysis of the National Health Information Database (NHIS-NHID)
Hyun Jung Lee
Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Aran 13-gil 15, Jeju-si, Jeju 63241, Jeju Special Self Governing Province, South Korea
Aims: This study investigated the risk of developing osteoporosis in young with intellectual disabilities (ID). Methods: A ten-year cohort observed from January 1, 2009, to December 31, 2018, using the NHIS- NHID, was created by enrolling 8221 people in the ID group and 24,682 participants in the control group. The proportions of categorical variables between the ID and control groups were compared using the chi-square test. The incidence of osteoporosis was estimated by dividing the total number of cases by the 1000 person-years at risk. By considering explanatory factors like sex, age, residence, insurance type, and comorbidities in the ID and control groups, the Cox proportional risk regression model was utilized to estimate the hazard ratio (HR) and 95% confidence interval (CI). After performing univariate Cox analysis with each variable, multivariate Cox analysis was performed using significant variables with P < 0.05. Results: Osteoporosis occurred in 107 patients in the ID and 77 in the control group. The incidence of osteoporosis was 1.33/1000 person-years at risk in the ID group and 0.32/1000 person- years at risk in the control group. According to the Cox proportional risk regression model, the adjusted HR for osteoporosis in the ID group was 2.90 (95% CI 2.09 to 4.01). Risk factors associated with osteoporosis were female, medical aid recipient, diabetes, hypertension, and chromosomal abnormalities. Conclusions: This study confirmed the risk of developing osteoporosis in the young ID group. Therefore, early detection of osteoporosis through BMD screening is essential in young patients with ID, which can prevent fractures and growth disorders.
A Systematic Review and Critical Appraisal of Quality Indicators to Assess Optimal Care for Fragility Hip Fracture
Juan Carlos Viveros García, Andrea Olascoaga Gómez de León
Jose Francisco Torres Naranjo, Hospital Regional ISSSTE, León, Mexico, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico, Centro de Investigación Ósea y de la Composición Corporal, Guadalajara, Jalisco, México
Aims: To identify and evaluate quality indicators for fragility hip fracture. Methods: A systematic review of the literature was conducted in July 2022. English-language articles published from 2012 to 2022 in PubMed, Cochrane, and Google Scholar were included. Systematic reviews, meta-analyses, clinical guidelines, and consensus were included. Publications from the Fragility Fracture Network Hip Fracture Registry Working Group were also included. Search strategies included MeSH terms, Boolean operators, and advanced search techniques for hip fracture, quality indicators, quality standards, and key performance indicators. We reviewed abstracts, duplicates, lack of agreement, incorrect identification of the type of published article, and incomplete results were excluded. The Appraisal of Indicators through Research and Evaluation (AIRE) tool was used to establish quality. A result greater than 50% was interpreted as high quality. The level of evidence and recommendation were analyzed using the Scottish Intercollegiate Guidelines Network (SIGN) tool. The study was registered in PROSPERO CRD42022339800. Results: A total of 539 publications were obtained from databases and five from the FFN, 15 articles were included and fifty-four indicators were extracted and evaluated using the AIRE tool, after which ten were removed d, leaving a total of 44 indicators. They were classified by preoperative, intraoperative, or postoperative and type: structure, organization, or results. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework. Identifying indicators with high validity represents the first step in adapting and adopting a proposal that can improve patient outcomes for hip fractures in Mexico.
Direct-Acting Anticoagulant Use in Hip Fracture Patients: Findings From a Large Clinical Cohort
Mads Sundet 1 , Aasmund Godø 2 , Joseph Sexton 1 , Siri Lillegraven 1 , Mette Martinsen 2 , Hans Schmidt Rasmussen 2 , Haldor Valland 2 , Ulf Sundet 1
1 Remedy – Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet, Oslo, Norway, 2 Diakonhjemmet Hospital, Oslo, Norway
Aims: Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anaesthesia (SA) within 48 hours after DOAC intake. The aim of this study was to investigate if surgery is delayed in DOAC users, and if spinal- and general anaesthesia (GA) is associated with mortality in DOAC patients. Methods: Prospective registry data on all surgically treated hip-fracture cases between 2015 and 2021 at a single hospital were analysed. Waiting time before surgery, demographics and comorbidity markers were compared between DOAC and non-DOAC cases. Associations between anaesthetic method (SA or GA) and 30-day and 1-year mortality in DOAC-users were assessed with propensity score matching (PSM), with variables sex, nursing-home dwelling, and age-adjusted Charlson Comorbidity Index (CCI). Results: 3131 cases were included, 464 patients (15%) were using DOAC. DOAC users were older (86.4 vs 82.4 years, P < 0.001), had a higher CCI (2.1 vs 1.6, P < 0.001) and longer average time to surgery than non-DOAC cases (34.2 vs 18.9 hours, P < 0.001). Spinal anaesthesia was used in 80.4% of DOAC patients and 93.1% of non-DOAC patients. PSM analysis showed no significant differences in one-month mortality for DOAC patients operated with SA compared to GA, but a slightly increased risk of one-year mortality (odds ratio 1.14, 95% CI 1.04-1.26). Conclusions: DOAC users waited longer before being operated, indicating postponement of surgery due to concerns of safety. Further analyses are warranted to examine the safety of anaesthesia in DOAC users, to optimize timing of surgery and patient outcomes.
Development And Validation Of Multivariable Prediction Models For In-Hospital Death, 30-Day Death, And Change In Residence After Hip Fracture Surgery And The ‘Stratify-Hip’ Algorithm
Aicha Goubar 1 , Finbarr C. Martin 1 , Catherine Sackley 1 , Nadine E Foster 2 , Salma Ayis 1 , Celia L Gregson 3 , Ian D Cameron 4 , Nicola E. Walsh 5 and Katie J. Sheehan 1
1 School of Life Course and Population Health Sciences, Faculty of Life Science and Medicine, King’s College London, UK, 2 Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia, 3 Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, UK, 4 John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Australia, 5 Centre for Health and Clinical Research, University of the West of England Bristol, UK
Aims: To develop and validate the stratify-hip algorithm (multivariable prediction models to predict those at low, medium, and high risk across in-hospital death, 30-day death, and residence change after hip fracture). Methods: Multivariable Fine-Gray and logistic regression of audit data linked to hospital records for older adults surgically-treated for hip fracture in England/Wales 2011-2014 (development n = 170,411) and 2015-2016 (external validation, n = 90,102). Outcomes included time to in-hospital death, death at 30-days, and time to residence change. Predictors included: age, sex, pre-fracture mobility, dementia, and pre-fracture residence (not for residence change). Model assumptions, performance, and sensitivity to missingness were assessed. Models were incorporated into the stratify-hip algorithm assigning patients to overall low (low risk across outcomes), medium (low death risk, medium/high risk of residence change), or high (high risk of in-hospital death, high/medium risk of 30-day death) risk. Results: For complete-case analysis, 6780 of 141,158 patients (4.8%) died in-hospital, 8693 of 149,258 patients (5.8%) died by 30-days, and 4461 of 119,420 patients (3.7 %) had residence change. Models demonstrated acceptable calibration (observed:expected ratio 0.90, 0.99, and 0.94), and discrimination (area under curve 73.1, 71.1 and 71.5; Brier score 5.7, 5.3, 5.6) for in-hospital death, 30-day death, and residence change, respectively. Overall, 31%, 28%, and 41% of patients were assigned to overall low-, medium-, and high- risk. External validation and missing data analyses elicited similar findings. The algorithm is available at https://stratifyhip.co.uk. Conclusions: The current study developed and validated the stratify-hip algorithm as a new tool to risk stratify patients after hip fracture.
Association Between Adherence to Clinical Care Standards and Mortality Following Hip Fracture: The Australian Experience
Lara Harvey 1 , Morag Taylor 1 , Rebecca Mitchell 2 , Jacqueline Close 1
1 Neuroscience Research Australia, 2 Macquarie University
Aim: The introduction of quality care standards for hip fracture has been associated with improved mortality and health-related quality of life in the United Kingdom and Norway. National hip fracture clinical care standards were introduced in Australia in 2016. This study aimed to determine whether adherence to the standards were associated with reduced mortality in Australia. Methods: Australian and New Zealand Hip Fracture Registry data were linked to hospital, residential aged care facility (RACF) and death data for all individuals aged ≥50 years admitted with a hip fracture to all participating New South Wales hospitals between 2015-2018. Multilevel logistic regression assessed the association of adherence to standards with 30-day and 1-year mortality. Results: Of the 9518 hip fractures, a third (3,180, 33.4%) attained ≥6 of 8 indicators. This proportion increased from 14.1% before introduction of standards to 50.8% in 2018. Mortality was lower for patients who attained ≥6 indictors compared to patients who did not: 30-day mortality 4.3% vs 8.7%, (P < 0.0001) and 1-year mortality 19.1% vs 27.3% (P < 0.0001). After adjustment for age, sex, comorbidities, pre-admission walking status and residential status, patients attaining ≥6 indicators had a 47% (OR 0.53, 95%CI 0.43-0.65) decreased odds of mortality at 30-days, and 32% decreased odds (OR 0.68, 95%CI 0.58-0.79) at 1-year. Conclusions: This study demonstrates an increased attainment of clinical care indicators following the introduction of national clinical care standards, and a significant decrease in mortality with adherence to these indicators. The observed reduction remains after adjustment for factors that may influence care and impact mortality.
Factors Associated With Delayed Surgery for Older Hip Fracture Patients: A Retrospective Study
Xinyan Liu, Baochang Qi, Jing Zhang, Xinyi Zhang, Pengpeng Ye, Tingzhuo Liu, Ning Tang, Junyi Peng, Minghui Yang and Maoyi Tian
School of Public Health, Harbin Medical University CN, The Second Affiliated Hospital of Harbin Medical University CN, School of Population Health, Faculty of Medicine and Health, University of New South Wales AU, National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention CN, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine CN
Aims: The aim of this study was to investigate the factors associated with delayed surgery (> 48 hours after admission) for older hip fracture patients. Methods: This was a retrospective study, enrolling older hip fracture patients aged 60 years or older admitted to the Second Affiliated Hospital of Harbin Medical University, from 16 December, 2017 to 24 December, 2021. Data were collected by clinicians from patients’ electronic medical records. Univariate and multivariate logistic regression models were used to determine the associated factors. Results: A total of 872 older hip fracture patients were included, with a mean age of 77.8 years (SD 7.6), and 68.6% were female. There were 758 patients received surgery and the median admission to surgery time was 67.8 (IQR 42.0, 114.8) hours. More than 60% of the patients received surgery more than 48 hours after admission. Type of hip fracture (P = 0.020), history of disease (P = 0.040), diabetes (P = 0.003), multimorbidity (P = 0.023), type of surgery (P = 0.013), pre-operative consultation (P < 0.001), and weekday of admission (P = 0.003) were significantly associated with surgery time. Multivariate logistic regression analyses showed that pre-operative consultation (OR = 5.731, 95% CI: 4.022-8.167, P < 0.001) and admissions from Friday to Sunday (OR = 2.010, 95% CI: 1.416-2.851, P < 0.001) were more likely to lead delayed surgery. Conclusions: Surgery after 48 hours of admission for older hip fracture patients was associated with admission from emergency and pre-operative consultation. This highlighted the need for future quality improvement initiatives.
Potentially Modifiable Factors Associated with Poorer Outcomes After Hip Fracture in Patients With Cognitive Impairment
Morag E Taylor, Lara Harvey, Cathie Sherrington, Maria Crotty, Ian Harris, Jacqueline Close
Neuroscience Research Australia, Sydney, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia, South West Sydney Clinical School, University of NSW, Sydney, Australia; Whitlam Orthopaedic Research Centre, Liverpool, Australia; Ingham Institute of Applied Medical Research, Liverpool, Australia; South West Sydney Local Health District, Liverpool, Australia, Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
Aim: To examine factors associated with poorer outcomes in patients with cognitive impairment admitted with a hip fracture to hospitals participating in the Australian and New Zealand Hip Fracture Registry. Methods: Retrospective cohort study of patients aged ≥50 years with cognitive impairment or known dementia admitted with a hip fracture between 2016-2020 (n = 19,036). Multilevel logistic regression models examined factors associated with new placement to residential aged care facilities (RACF), 30-day mortality and poorer mobility at 120-days adjusting for age, sex, residential status, preadmission mobility, ASA classification, fracture type and surgical fixation. Results: In patients from private residences (n = 3482), delirium increased the odds of discharge to RACF by 51% (95%CI 1.26-1.81), whereas receiving rehabilitation reduced the odds by 59% (95%CI 0.35-0.49). Not being provided with the opportunity to mobilise day-1, delirium and not assessed for delirium increased the odds of 30-day mortality by 96% (95%CI 1.66-2.32), 64% (95%CI 1.38-1.94) and 63% (95%CI 1.35-1.97), respectively (n = 11,997). Not being offered day-1 mobility increased the odds of poorer 120-day mobility by 53% (95%CI 1.13-2.08) while receiving rehabilitation reduced the odds by 34% (95%CI 0.53-0.81). Conclusions: This study has identified that delirium and not providing the opportunity for early mobility and rehabilitation are associated with poorer outcomes after hip fracture in patients with cognitive impairment. These findings suggest that perioperative care should aim to address these potentially modifiable factors. Further research is needed to develop and evaluate models of care designed to address these factors and determine their effectiveness in improving outcomes.
Is Prevalence of Osteosarcopenia High Amongst Hip Fracture Patients?
Ronald Man Yeung WONG1, Hong Tim LAU1, Mei Shuen CHAN1, Chi Yin TSO2, Ning TANG2, Can CUI1, Ning ZHANG1, Wing Hoi CHEUNG1
1Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China, 2Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
Aims: Hip fractures are a global concern and poses a huge socioeconomic burden with significant morbidity and mortality. Osteosarcopenia is a new entity with the presence of both osteopenia/osteoporosis and sarcopenia. Osteosarcopenia increases the risk of mortality, fractures, falls, and functional decline. In fact, approximately 50% of re-fractures occur in the first 2 years after the initial fracture. The aim was to determine the prevalence of osteosarcopenia amongst hip fracture patients. Methods: Elderly patients with fragility hip fractures were included for analysis. Sarcopenia was defined according to the Asian Working Group on Sarcopenia (AWGS) 2019 consensus. Appendicular skeletal muscle mass was analysed using bioelectrical impedance analysis (BIA). Physical performance and muscle strength were assessed by chair stand test and handgrip strength, respectively. Dual-energy X-ray Absorptiometry (DEXA) was used to determine osteopenia/osteoporosis. Osteosarcopenia is defined as a combination of sarcopenia and osteopenia/osteoporosis. Results: This is an ongoing study. 155 patients (35 males and 120 females) with a mean age of 81.3 years, were included in the analysis. Regarding the hip fracture types, 70 were trochanteric fractures and 85 were neck of femur fractures. All hip fractures patients included had undergone operative procedure. The prevalence of osteosarcopenia was 89.0% amongst the hip fracture patients. Conclusions: Our preliminary results show that the prevalence of osteosarcopenia was high amongst patients with hip fractures. This further emphasises the importance of research in this field.
The Recovery of Mobility Post Hip Fracture as Measured by the New Mobility Score and Patient Perception
Edel McDaid, Dr. Jonathan Hewittand Dr. Mary Walsh
The Royal Hospital Donnybrook, Cardiff University, University College Dublin
Aims: Return to prior mobility after hip fracture is an important patient goal. This study aimed to assess recovery of mobility at 30 and 120 days post hip fracture using the New Mobility Score (NMS) and patient perception. Methods: This prospective cohort study included consecutive patients ≥60 years admitted after hip fracture if they could provide informed consent and participate with or without a proxy. Participants were contacted by telephone or in person at both 30 and 120 days to complete the NMS and questions about recovery of mobility. At day-120, EQ-5D-5L was also completed. Results: Sixty participants, mean age 83.3 years, 70% (n = 42) female, all admitted from home pre- fracture completed day-30 follow-up but only 83% (n = 50) completed day-120 with 3 known to have died. The proportion of participants mobile unaided indoors, outdoors and shopping respectively was 78% (n = 47), 63% (n = 38) and 50% (n = 30) pre-fracture; 5% (n = 3), 2% (n = 1), and 0% at day 30; and 42% (n = 23), 20% (n = 10) and 16% (n = 8) at day 120. At day-120, moderate to severe problems with mobility (EQ-5D-5L score ≥2) were reported by 44% (n = 22). No participant recovered their pre-fracture mobility at day-30. At day-120, of the 28% (n = 14) who recovered (NMS), 64% (n = 9) still reported their mobility as worse than pre-fracture. Conclusions: Most participants did not recover their pre-fracture mobility by 120 days. There was an associated loss in health-related quality of life, primarily in the domain of mobility. This patient group may benefit from access to physiotherapy up to 4 months after hip fracture.
Dosing of Intermittent IV Zoledronic Acid Based on Bone Turnover Marker Assessment Preserves Bone Mineral Density Over Eight Years
Erik Fink Eriksen and Tove Tveitan Borgen
University of Oslo, Faculty of Odontotology, Dept. of Rheumatology, Drammen Hospital, Vestre Viken Hospital Trust
Newer studies have demonstrated that bone turnover markers (BTMs) can reflect antifracture efficacy of antiresorptive agents. Further, dosing intervals of iv. Zoledronic acid (ZOL) > 1 year may exert significant antifracture efficacy. Aims: To test if more infrequent dosing of ZOL based on the BTM procollagen type 1 N- terminal propeptide (S-P1NP) can sustain relevant increases in bone mineral density (BMD), reductions in S-P1NP and fractures. Methods: 202 patients with osteoporosis (89% women, mean age 68 years) got ZOL infusion at baseline and a new infusion when S-P1NP exhibited values above 35 μg/l. We registered S-P1NP, BMD and incident fractures at baseline and every 2 year. The number of patients assessed were 150, 136, 63 and 26 at years 1-2, 3-4, 5-6 and 7-8, respectively. Results: Lumbar spine BMD increased 6.2% from baseline to year 2 and remained stable during follow-up. Median S-PINP decreased from 58.0 μg/L at baseline to 30.9 μg/l at year 2 and 39 μg/l at year 8. Vertebral fractures were found in 10%; 8%; 7% and 5% and nonvertebral fractures in 6%; 5%; 7% and 8% of patients in years 1-2; 3-4; 5-6 and 7-8, respectively. Conclusions: Intermittent dosing of iv. Zoledronic acid based on assessment of S-P1NP with a cut-off of 35 μg/L results in an initial increase followed by a stable BMD, suppression of S- P1NP and stable reduction of fractures over a period of 8 years. This approach reduces healthcare costs and potentially the risk of rare side effects like osteonecrosis of the jaw and atypical femoral fractures.
Cost-Effectiveness of the Scottish Hip Fracture Audit
Luke Farrow, Jenny Hislop, Kirsty Ward, Karen Adam
University of Aberdeen, Health Improvement Scotland, Scottish Hip Fracture Audit, Scottish Hip Fracture Audit
Aims: We set out to quantify the clinical and financial effectiveness of the Scottish Hip Fracture Audit (SHFA) justify its ongoing delivery. Methods: All patients admitted to hospitals involved in hip fracture care across Scotland between 2016-2021 and captured by the SHFA were included. Regression modelling (with adjustment for confounding) was used to determine the association between overall Scottish Standards of Care for Hip Fracture Patients (SSCHFP) attainment and key healthcare outcomes. Costs were determined from the Public Health Scotland Costs Book. Results: 35,956 hip fracture episodes were included. 30-day survival increased from 87.8% in 2017 to 92.1% in 2021. Overall length of stay reduced significantly from 27.3 days to 18.2 days. Mean SSCHFP attainment increased from 6.6 (SD 2.0) in 2016 to 8.6 (SD 2.2) in 2021. Logistic regression analysis with adjustment for age, sex, year, and admitting hospital revealed a 1 unit increase in SSCHFP attainment was associated with a 77% increase in 30- day survival (P < 0.001). Similarly, a 1 unit increase in SSCHFP attainment was associated with an expected reduction in total cost of £600-700. With an estimated audit cost of £508,000 per annum, application of this saving to patients across the included 5-year period revealed a cost saving in the region of £32-37 million. This equated to £11.59 - £13.14 in avoided bed costs for every £1 of investment. Conclusions: The Scottish Hip Fracture Audit provides significant benefits to cost-effective hip fracture care that is an integral part of providing high quality care within a financially constrained healthcare system.
Declining Incidence of Hip Fractures Continues in Oslo, Norway
Ingvild Hestnes 1,2 , Lene B. Solberg 1 , Ragnhild Ø. Støen 1 , Mads Sundet 3 , Lars Nordsletten 1 , Kari Anne Hakestad 1
1 Division of Orthopaedic Surgery, Oslo University Hospital, 2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 3 Division of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway.
Aims: The hip fracture incidence in Oslo has been calculated every decade since the late 1970s. The aims of this study were to investigate the incidence of hip fractures in Oslo in 2019 and compare it with the incidence rates over the last 40 years. Methods: Patients with a new hip fracture reciding in Oslo in 2019 with ICD-10 codes S72.0 and S72.1 were identified by searching the medical diagnosis registers and protocols from the operating theaters. The diagnosis was verified through the medical records, or if the record could not clarify the diagnosis, the patients’ radiographs were examined. The age- and sex-specific annual incidence rates were calculated using a direct standardization method and the ratios compared. Results: In total 758 hip fractures (70% women) were included in 2019. The age-adjusted fracture incidence rates per 10.000 person years for women and men respectively, were 45 and 30 (2019), 56 and 44 (2007), 78 and 48 (1996/97), 84 and 48 (1988/89) and 71 and 38 (1978/79). The corresponding incidence rate ratios (IRR) comparing 2019 to the previous years with 95% CI, women and men respectively, were: 2007 IRR 0.80 (0.53-1.21) and 0.68 (0.41-1.10); 1996/97 IRR 0.58 (0.39-0.84) and 0.62 (0.38-1.0); 1988/89 IRR 0.53 (0.36-0.78) and 0.62 (0.38-1.0); 1978/79 IRR 0.63 (0.43-0.94) and 0.78 (0.42-1.30). Conclusions: The incidence rates of hip fractures in Oslo have decreased over the last four decades and is at the lowest rate since 1978. The decrease was only significant in women.
Projected Hip Fracture Incidence in Scotland
Luke Farrow, Euan Harris, Caroline Martin and Karen Adam
University of Aberdeen, NHS Greater Glasgow & Clyde, Public Health Scotland, Scottish Hip Fracture Audit
Aims: This study forecasts future hip fracture incidence and annual number of hip fractures in Scotland until 2029 to determine the potential burden of an ageing population. Methods: Firstly, data from the Scottish Hip Fracture Audit was utilised to identify the monthly number of patients with hip fracture aged ≥ 50 admitted to a Scottish hospital between 01/01/2017 and 31/12/2021. Exponential Smoothing and Auto Regressive Integrated Moving Average models were then applied to the data and used to calculate projections of future raw totals and annual incidence out to 2029. Adjustments for population change were accounted for by integrating population projections published by National Records of Scotland. Results: Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797, with a respective increase in hip fracture incidence from 313 to 350 per 100,000. By 2029, the averaged projected annual number of hip fractures is 10311, with an incidence rate of 463 per 100,000. The largest percentage increase in hip fracture occurs in the 70-79 age group (57%), with comparable increases in both sexes (30%). Based upon these projections the overall length of stay following hip fracture will increase from 142713 bed days per annum in 2021, to 203412 by 2029, incurring an additional cost of over £25 million. Conclusions: Forecast modelling demonstrates that the annual number of hip fractures in Scotland will rise substantially by 2029, with significant implications for health and social care services. Similar findings are likely in countries with comparable population demographics.
The Incidence of Distal Radius Fractures in Oslo, Norway in 2019
Ingrid Oftebro
Oslo University Hospital, Ullevål
Aims: A low energy fracture in the distal radius is often the first fracture indicating osteoporosis and may be a warning of more fractures to come. It is also the most frequent fracture in adults. In our study, we report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/99 (one-year period). Methods: Patients aged ≥50 years resident in Oslo who sustained a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiography registers. The diagnosis was verified trough medical records. The age- and sex-specific incidence rates were calculated. Results: The total number of distal fractures decreased by 11% from 1998/99 (n = 1109) to 2019 (n = 986). The age-adjusted fracture incidence rates per 10,000 person-years for the age group ≥50 years were 79.5 for women and 19.8 for men in 2019 and 101.9 for women and 25.4 for men in 1998/99. The corresponding incidence rate ratios (IRR) comparing 2019 with 1998/99 were 0.78 (95% CI 0.71-0.86) and 0.78 (95% CI 0.64-0.94) for woman and men respectively. Conclusions: The incidence of distal radius fractures in Oslo has decreased significantly over the last 20 years. Increased focus on osteoporosis and fall-prevention in the older age groups during the last 20 years may be part of the reason. However, due to an ageing population, a high number of fractures may be sustained despite decreasing incidence rates.
Milk Intake and Hip Fracture Risk in Older Icelanders
Sigrun Sunna Skuladottir
Associated professor in Nursing faculty
Aims: This study describes associations between milk intake and hip fracture risk in older Icelanders. The data indicate increased milk consumption is related to lower hip fracture risk. Hip fracture can have a severe effect on the life of older adults. Health authorities recommend milk intake for better bone health. However, previous studies addressing this association have been divergent. Methods: This prospective study included 4614 subjects (mean age 76 years) recruited between 2002 to 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Information on hip fractures occurring between recruitment and the end of 2012 were extracted from hospital records. Results: A total of 14% of participants reported milk intake <0.5 times/day (the lowest category), and 22% of the participants consumed at least milk two times/day (the highest category). Milk consumption was positively related to the volumetric bone mineral density at baseline with a sex- and age-adjusted difference of 9.7 ± 2.5 mg/cm3 between the highest compared to lowest milk intake categories (P < 0.001). During the follow-up, 7.4% of participants had a hip fracture. In the fully adjusted model, we observed an increased risk of incident hip fractures in the lowest compared to the highest milk intake category with a hazard ratio of 1.46 (95%CI: 1.01-2.11). Further analysis indicated a linear relationship between milk intake and fracture risk (P-value for linear trend <0.001). Conclusions: Milk intake is associated with a lower risk of incident hip fracture in a linear way in Icelandic community-dwelling older adults.
Impact of Bisphosphonates on Survival Following Hip Fractures: A Decade-Long Analysis of a Cohort Within a Private Healthcare System
Vera María Eugenia 1 , Perez Betiana Mabel 1 , Diehl María 1 , Plantalech Luisa 1
1 Hospital Italiano de Buenos Aires
Bisphosphonate use after hip fracture is useful for secondary prevention and may reduce post-fracture mortality. Aims: To evaluate long term impact of bisphosphonate use after hip fracture in mortality. Methods: Retrospective cohort study of patients ≥50 years from a closed health system hospitalized for a fragility hip fracture between 07-2005 and 07-2008. Kaplan Meier survival analysis and Cox regression were performed. Propensity score matching (PSM), considering age, sex, previous fracture and comorbidities was used to adjust the prescription bias. Results: We included 965 patients. Median age 81.6 years, female 80.7%. Bisphosphonates were administered to 39% of cases in the year after hip fracture. Mortality in the first year was 14.9% and at 10 years 73.2%. Median survival was 5.6 years. The median survival of patients with hip fracture treated with bisphosphonates was 8.33 years, and for those not treated it was 4.06 years (P < 0.0001), and remained significantly different after PSM (P = 0.022). Multivariate Cox regression showed that secondary prevention with bisphosphonates remains an independent predictor of survival (Hazard-ratio:0,68 [95 CI 0,58-0,80]; P < 0.001), even after adjusting for age, sex, type of fracture, Charlson index and other statistically significant comorbidities (dementia, congestive-heart failure) Conclusions: Bisphosphonates had a positive impact on survival in our study after adjusting by statistically significant covariables. Possible biases include educational level and social support, that were not evaluated. Despite proven benefits, care gap is high in our institution and worldwide.