Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study

Declining incidences of hip fractures are reported from western countries. Norway has among the highest rates in the world. The aim of this study was to investigate trends in total hip fracture rates in Norway between 1999 and 2008 and risk of second hip fractures. All hospitalizations given a hip fracture diagnosis code (International Classification of Diseases (ICD) 9 or ICD 10) (cervical, trochanteric or subtrochanteric) in Norwegian hospitals were retrieved with accompanying surgical procedure codes and additional diagnoses. A total of 93,123 hip fractures were identified between 1999 and 2008 in persons ≥50?years. Annual incidences of hip fractures were calculated and tested for trends. Rates of first and second hip fractures (2006–2008) were compared. The age-standardized total incidence of hip fracture decreased by 13.4?% (95?% confidence interval (CI): 11.0–15.6) in women and 4.8?% (95?% CI: 0.7, 8.7) in men. Age-adjusted rates of second hip fractures did not change in the observation period. In those with a prior hip fracture, the age-standardized risk of a subsequent hip fracture was 2.5-fold (95?% CI: 2.5, 2.6) in women, and 4.6-fold (95?% CI: 4.5, 4.7) in men. Total hip fracture rates declined in both genders during 1999–2008, whereas rates of second hip fractures did not change.     

Hip fractures in women with breast cancer

The authors investigated whether the incidence of first hip fracture, an indicator of osteoporosis, is lower in breast cancer patients, who are assumed to have higher levels of endogenous estrogens, than in other women. A population-based Swedish cohort comprising 9,673 women with invasive breast cancer diagnosed from 1958 through 1983 was followed up with respect to the occurrence of a first hip fracture during the period 1965-1983. Overall, the number of observed acute fractures (n = 387) was slightly higher than expected (n = 348.6) (standardized incidence ratio (SIR) = 1.1, 95% confidence interval (CI) 1.0-1.2). Risk for trochanteric fractures was slightly higher than expected (SIR = 1.2, 95% CI 1.0-1.4), but risk for cervical fractures was not (SIR = 1.0, 95% CI 0.9-1.1). Risk for trochanteric fracture decreased with increasing age at breast cancer diagnosis, reaching standardized incidence ratios close to unity after the age of 70 years. Duration of follow-up appeared to be unrelated to the risk of either type of fracture. The authors conclude that the incidence of first hip fracture is not lower in breast cancer patients than in other women.     

北京市髋部骨折发生率流行病学研究

为了解北京市髋部骨折发生率，调查了北京市所有能收治骨折的７６所医院１９８８￣１９９２年髋部骨折的出院病例。为避免遗漏非住院治疗的髋部骨折，在北京城区随机抽样２１１３名５０岁以上妇女进行入户调查以了解过去骨折史。应答率９７％。所有资料经多方面、系统的有效性核实。基于１９９０年人口普查资料，计算出北京市年龄标化后的髋部骨折发生率女性为８８／１０万，男性为９７／１０万。用同样方法和人群标化的其它国家和地     

Trends in hospital admissions for fractures of the hip and femur in England, 1989-1990 to 1997-1998

BACKGROUND: Fractures of the hip are a major public health issue. Suggestions of a recent stabilization of age-specific admission rates would have implications for health service planning, thus we investigated this using hospital data. METHOD: Hospital episode statistics for England, 1989-1990 to 1997-1998, were examined for admissions and deaths for fractures of the hip and femur in NHS hospitals in patients aged 45 years and over. RESULTS: Age-standardized admission rates increased by 32 per cent between 1989-1990 and 1997-1998 in men, and by 30 per cent in women. The increase in admission rates was almost entirely confined to the period 1989-1990 to 1991-1992, with very little change after this. The proportion of admissions ending in death during the study period decreased in both men (-35 per cent) and women (-40 per cent) but this change was largely confined to the early years of the study. The number of admissions from hip and femoral fractures in people aged 65 years and over is projected to increase from about 57,300 in 1997-1998 to 69,500 by 2021-2022. CONCLUSIONS: Age-specific rates of admission appear to be stabilizing, which is in contrast to previous trends. The lack of any decrease in hospital admission and mortality rates over the last 5 years is of concern. The management of osteoporosis-induced fractures in hospitals, the prevention and treatment of osteoporosis in primary care and the prevention of falls should be seen as priorities for the NHS to help reduce the burden of disease from osteoporosis in the elderly.     

Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989.

Whereas fractures related to osteoporosis have become a pressing public health concern, relatively few epidemiologic studies have focused on vertebral fractures. To shed further light on the occurrence of this injury, we collected data from the Health Care Financing Administration on 151,986 discharges listing a diagnosis of vertebral fracture over a 4-year period. After adjusting for age, white women experienced the highest rates of discharge, at 17.1 per 10,000 per year, followed by white men (9.9 per 10,000), black women (3.7 per 10,000), and black men (2.5 per 10,000). Among white women, discharge rates rose exponentially from 5.3 discharges per 10,000 population at age 65 to nearly 47.8 per 10,000 at age 90. White men, black women, and black men experienced less dramatic age-related increases in discharge rates. The similarity of these patterns to discharge rates for hip fracture suggests that the race-sex differences in vertebral fracture discharge rates may be due to differences in the incidence of vertebral fracture.     

Dynamic hip screw versus 3 parallel screws in the treatment of garden 1 + 2 and garden 3 + 4 cervical hip fractures

OBJECTIVE: The main objective of this study was to evaluate the failure rate following operations of undisplaced and displaced cervical hip fractures with a dynamic hip screw compared with 3 parallel screws. DESIGN: The study was retrospective. The minimum follow-up time was 1 year. The data tta collested between January 1990 and December 1993. SETTING: University Hospitals. PATIENTS: A total of 456 patients (352 women and 104 men) with cervical hip fractures were included. The mean age was 80 years (range 51-100 years). INTERVENTION: This was internal fixation of the fractured hip with a dynamic hip screw or 3 parallel screws. MAIN OUTCOME MEASURES: Failure was defined as nonunion, fixation failure or avascular necrosis and reoperation was found indicated. The 3 months mortality rate, the wound infection rate, the delay between admission and time of surgery and the blood transfusion requirement were also recorded. RESULTS: A total of 456 cervical hip fractures were operated with a dynamic hip screw or 3 parallel screws. The failure rate for fractures treated with a dynamic hip screw was 14/98 = 14% for Garden 1 + 2 fractures and 43/108 = 40% for Garden 3 + 4 fractures. The failure rate for fractures treated with 3 parallel screws was similar: 23/154 = 15% for Garden 1 + 2 fractures and 38/196 = 40% for Garden 3 + 4 fractures. The average follow-up time was 2.5 years. CONCLUSION: Operation of cervical hip fracture with a dynamic hip screw or 3 parallel screw seem to give similar results.     

Incidence of hip fractures, United States, 1970-83

Hip fractures are a major cause of morbidity and mortality in the United States. Twenty to 40% of persons who fracture their hips die within 6 months of the injury, and many survivors need long-term care. To assess the public health impact of hip fractures in the United States, we analyzed sample-based data from the National Hospital Discharge Survey, National Center for Health Statistics, for the United States for the period 1970-83. For these years, an estimated annual average of 197,000 persons 45 years of age or older was hospitalized for hip fractures. The age-, race-, and sex-adjusted hospitalization rates for hip fractures rose from 28.9 per 10,000 persons in 1970 to 30.9 per 10,000 in 1983 (P less than .01). Hospitalization rates rose exponentially by successive 10-year age groups, with persons 85 years of age or older having the highest rate (251.4 per 10,000). For each age group, women had hospitalization rates twice those of men, and whites had hospitalization rates twice those of other races. Never-married and divorced persons had higher hospitalization rates than currently married persons. The percentage of mortality before discharge from hospital fell from 11% in 1970 to 6% in 1983, with most of the decrease occurring among persons 75 years of age or older. The age-adjusted mean length of hospital stay declined 24%, from 23.9 days in 1970 to 18.2 days in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors associated with hospitalization for ambulatory care sensitive conditions in municipalities

OBJECTIVES: To describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability. METHODS: An ecological study was carried out in 34 municipalities in the area served by the Hospital Virgen de las Nieves in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated. RESULTS: A total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate. CONCLUSIONS: Variability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.     

Hip fracture incidence among the old and very old: a population-based study of 745,435 cases.

Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds. Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively.     

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.     

The incidence of fall injury events among the elderly in a defined population

Falls are a leading cause of death from injury among older persons in the United States, and about one in three older persons falls each year. Yet, reliable estimates of the incidence of fall injury events in a population-based setting are not readily available. Therefore, the authors analyzed population-based surveillance data, between July 1985 and June 1987, from the Study to Assess Falls Among the Elderly, Miami Beach, Florida. The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 per 1,000 for females. Compared with males, females had a higher incidence of fractures other than skull. Males were nearly twice as likely to die, however, following a fall injury event than were females. Of those fall injury events identified through the surveillance system, about 42% resulted in hospital admission. The mean length of hospital stay was 11.6 days overall and was 15.5 days for hip fracture, 9.8 days for skull fracture/intracranial injury, 11.2 days for all other fractures, and 9.1 days for all other injuries. About 50% of fall injury events that occurred at home and required hospital admission resulted in a person being discharged to a nursing home.     

Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974-1986

Routine mortality statistics show that coronary heart disease (CHD) death rates have declined consistently in Auckland men since 1968; in women, death rates declined between 1968 and 1986 but since 1981 there may have been a reduction in the rate of decline. Data from CHD registers conducted in Auckland, New Zealand in 1974, 1981, and since 1983 as part of the WHO MONICA Project, have been used to investigate the validity and reasons for the decline in the age group 35-64 years. In Auckland age-standardized sudden coronary death rates in men declined by approximately 2% per year between 1974 and 1986; there was no apparent decline in women. There was also an indication of a decline in age-standardized definite myocardial infarction rates but again only in men; 28 day case fatality in patients with a definite myocardial infarction has not changed significantly in the period 1981-1986. These results validate the mortality trends based on death certificates and in particular the differing recent trends in men and women. The decline in CHD mortality in men without a concomitant change in case fatality and the lack of recent decline in women, suggest that changes in the natural history of the disease rather than treatment are responsible for the mortality trends. Since disease events are rare in absolute numbers, long-term monitoring of coronary heart disease in large population groups will be necessary to usefully study disease trends, particularly in women.     

Improvements in general health among the elderly: a factor in the rising incidence of hip fractures?

Both hip fracture incidence and life expectancy are known to have increased during the last decades. Seventeen studies of hip fracture incidence from Great Britain and Scandinavia were collected from the literature. It was found that there was a good correlation for both men and women between the incidence of cervical but not trochanteric fractures in the 75-79 year age group and the mean life expectancy at 70 years of age at the time in the country concerned. The increased incidence is probably accounted for partly by the increased lifespan of the infirm. It is, however, suggested that increases in life expectancy among a majority of the elderly also entail better general health at any particular age, and that this may lead to a higher level of physical mobility which raises the risk of falls and fractures.     

Consumer product-related injuries in Athens, Ohio, 1980-85: assessment of emergency room-based surveillance

Using the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission, I computed the average annual rates per 1,000 population of consumer product-related injuries in residents of Athens County, Ohio, and seem at one hospital. These rates do not include intentional injuries or injuries to occupants of motor vehicles, to pedestrians hit by motor vehicles, or those occurring on the job or in house fires. Average annual rates for all injuries combined ranged from 102 per 1,000 boys 10-14 years of age to 11.7 per 1.000 men 65-74 years of age. For all males, the annual rate was 53 per 1,000 and for all females, 32 per 1,000. The most common parts of the body injured were the fingers (accounting for 15% of visits), face (12%), ankle (8.5%), hands (8%), and head (7.9%). The most common injury types were lacerations (33%), contusions and abrasions (22%), sprains (16%), and fractures (13%). Hospital admission rates varied by age, sex, type of injury, and part of body injured. Comparison of a sample of NEISS records to emergency room records showed that data were abstracted by clerical personnel with a high degree of accuracy. Review of fractures of the lower leg identified a cluster of injuries in young girls from playground merry-go-rounds. Review of burn injuries identified problems with scald injuries in young adult women and with eye injuries from welding in young men. The system can be used to evaluate injury control measures taken on a local level.     

Risk-adjusted mortality rates of elderly veterans with hip fractures

PURPOSE: The goal of this research was to estimate 12-month survival rates for a large sample of elderly veterans after hip fracture with a risk-adjusted model and to compare the results of men to those of women. METHODS: The study design was a retrospective, secondary data analysis of national Veterans Health Administration (VHA) Medicare beneficiaries. The study population was 43,165 veterans with hip fracture first admitted to a Medicare-eligible facility during our specified enrollment period of 1999-2002. Measurement was a Cox proportional hazard model or survival analysis of hip fracture patients with an outcome of death over a 1 year period after discharge controlled by age, gender, and selected Elixhauser comorbidities. RESULTS: The unadjusted, 1 year mortality rates (30 days = 9.7%, 90 days = 17.5%, 180 days = 24%, 365 days = 32.2%) were slightly higher than the adjusted rates (30 days = 8.9%, 90 days = 15.6%, 180 days = 21.8%, 1 year = 29.9%). The mortality odds for women 12 months after hip fracture were 18%, compared with 32% for men. The comorbidity adjustment suggested that the presence of metastatic cancer increased the risk of death by almost 4 times compared with those patients without this diagnosis. Other particularly high-risk conditions included congestive heart failure, renal failure, liver disease, lymphoma, and weight loss, each of which increased the 1 year mortality risk by approximately two-fold. CONCLUSIONS: One in 3 elderly male veterans who sustain a hip fracture dies within 1 year. Our work represents the first large study of hip fractures with a predominantly male sample and confirms that men have a higher mortality risk than women, as reported by previous researchers who used smaller samples that were mostly female. Fracture patients with metastatic cancer, renal failure, lymphoma, weight loss, and liver disease have higher mortality risks. The adverse outcomes associated with hip fracture argue for clinical intervention strategies, such as gait and balance testing, and osteoporosis diagnosis that may prevent fractures in both genders.     

Tobacco smoking and risk of hip fracture in men and women

BACKGROUND: Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking. METHODS: Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models. RESULTS: During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking. CONCLUSION: Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.     

Osteoporosis and the risk of hip fracture

The incidence of cervical and intertrochanteric proximal femur fractures at various levels of cervical and intertrochanteric bone mineral density, respectively, was estimated by using population-based data from ongoing studies of osteoporosis and fractures among women residing in Rochester, Minnesota. Hip fractures were uncommon among women with femoral bone density greater than or equal to 1.0 g/cm2, but their frequency increased as bone density declined below that point at both femoral sites. The incidence of cervical femur fractures was estimated at 8.3 per 1,000 person-years among women with cervical bone density less than 0.6 g/cm2, while the estimated incidence of intertrochanteric femur fractures reached 16.6 per 1,000 person-years among those with intertrochanteric bone density less than 0.6 g/cm2. This new approach to the assessment of fracture risk from bone mineral density measurements indicates that osteoporosis is an important underlying cause of hip fractures.     

HIP FRACTURES IN MIDDLE-AGED MEN: A CONSEQUENCE OF EARLY RETIREMENT AND ALCOHOL MISUSE?

From the 1950s to the 1980s the incidence of hip fractures inwomen aged 50–64 and cervical fractures in men of thesame age In Malmö did not increase, whereas the incidenceof trochanteric fracture in men aged 50–64 increased significantly.Significant background factors in men were alcohol misuse, livingalone, early retirement, previous fractures, low weight/heightratio and less severe trauma — more in men with trochantericthan in men with cervical fracture. The deviant lifestyle andsuspected physical inertia in this group of middle-aged menprobably predisposes to osteoporosis and increased fracturerisk.