The incidence and annual number of hip fractures have increased worldwide during the past 50 years, and projections have indicated a further increase. During the last decade, however, a down-turn in the incidence of hip fracture has been seen in the western world. We predicted the development of hip fractures in Sweden until the year 2050.
We reviewed surgical records for the period 2002-2012 in the city of Malmö, Sweden, and identified patients aged 50 years or more with a hip fracture. We estimated incidence rates by using official population figures as denominator and applied the rates to population projections each year until 2050. We also made projections based on our previously published nationwide Swedish hip fracture rates for the period 1987-2002. Since the projections are based on estimates, no confidence limits are given.
During the period 2002-2012, there were 7,385 hip fractures in Malmö. Based on these data, we predicted that there would be approximately 30,000 hip fractures in Sweden in the year 2050. Use of nationwide rates for 2002 in the predictive model gave similar results, which correspond to an increase in the number of hip fractures by a factor of 1.9 (1.7 for women and 2.3 for men) compared to 2002.
The annual number of hip fractures will almost double during the first half of the century. Time trends in hip fractures and also changes in population size and age distribution should be continuously monitored, as such changes will influence the number of hip fractures in the future. Our results indicate that we must optimize preventive measures for hip fractures and prepare for major demands in resources.
Efficacy of hip protector pads to prevent hip fracture is controversial. This study was done to evaluate two comparable groups for fracture risk. Two matched cohorts of long-term care residents in Canada, assessing the efficacy of hip protector pads. Evaluation included demographics, medications/diagnoses, cognition (Mini Mental Status Examination (MMSE)), balance (Berg), bone mineral density (calcaneal ultrasound), falls/injuries at baseline and completion. Of the 58 participants, there were two confirmed hip fractures (8%) in the hip pad (one while wearing the pad) and eight (24%) in the control groups. But baseline demographics showed significant differences between hip pad (25) and control groups (33) in MMSE, Berg and osteoporosis treatment, all being less in the hip pad group. This persisted at completion, with a higher mortality in the hip pad group. Baseline differences predisposed the hip pad group to a higher fracture risk, but there were fewer hip fractures in this group. Small numbers, multifactorial nature of hip fractures and the inability to control for many of these variables in the real world make efficacy of hip protector pads difficult to confirm. Hip protector pads should be offered as part of the osteoporosis management of frail elderly, especially in those unable/unwilling to take pharmacotherapy.
BACKGROUND: Hip fracture incidence rates are high, and increase with increasing age. Previous studies have predicted a continued increase in both crude and age-standardized rates. METHOD: We estimated incidence rates, based on a complete and validated register containing verified and individually sequenced hip fractures from 1996-2003, for a population of 500,000 people in Funen County, Denmark. RESULTS: The verified number of the first hip fractures was 6,676, with 520 subsequent fractures. Between 1996 and 2003, the incidence rate of first hip fracture fell by 2.4% per year for males (p = 0.02) and by 1.8% per year for females (p = 0.004). The highest decrease of 3.4% per year (p = 0.02) was seen in 80-84-year-old women. INTERPRETATION: The incidence rate of the first hip fracture has fallen in both sexes. In most age groups, the actual number of fractures has also decreased. The findings emphasize the need for valid projection studies which should include both demographic projections and modeling of the effects of different levels of prevention.
We conducted a 30-month population-based, randomized, controlled trial in 160 elderly women at risk for fractures on the basis of a low baseline BMD. Mainly home-based weight-bearing exercise was effective in improving strength, balance, and gait. INTRODUCTION: Evidence on the effect of exercise on extraskeletal risk factors for hip fractures comes mainly from studies in voluntary low-risk women, and no population-based, long-term interventions have been performed in elderly women with low bone mass. The aim of this study was to determine the effect of long-term weight-bearing exercise on balance, muscle strength, and gait in elderly women at risk for fractures on the basis of a low baseline BMD. MATERIALS AND METHODS: A birth cohort of 1690 women 70-73 years of age were invited to the radius and hip BMD measurements; 96 women were excluded because of medical reasons; 160 women with radius and hip BMD values of >2 SD below the reference value were included in the trial. The participants were randomly assigned to 30 months of impact, balancing, and strengthening exercises or to no intervention. Main outcome measures were body sway length and leg strength at month 30. Secondary endpoints included gait speed, endurance, and grip strength. Outcomes were assessed at 0, 12, 24, and 30 months using blinded operators. Repeated-measures ANOVA was used to determine statistical significance. The analyses were performed on an intention-to-treat basis. RESULTS: Body sway increased more in the control group than in the exercise group over time (time-group interaction, p
Most hip fractures seem to be related to trauma near the hip, so a controlled trial was conducted to investigate the effect of external hip protectors on the prevention of such fractures in residents of a nursing home. 10 of the 28 wards in the nursing home were randomised to receive external hip protectors; thus 167 women and 80 men were given protectors and 277 and 141 men no protectors. A fall register was set up for 2 treatment wards (45 residents) and 2 control wards (76 residents). There were 8 hip and 15 non-hip fractures in the hip-protector group and 31 hip and 27 non-hip fractures in the control group. The relative risk of hip fractures among women and men in the intervention group was 0.44 (95% CI 0.21-0.94). None of the 8 residents in the intervention group who had a hip fracture was wearing the device at the time of the fracture. 154 falls were registered and 20% of these falls produced a direct impact to the hip. In 25 falls direct impact to the hip was sustained at a time when hip protectors were not being worn, and 6 fractures were produced. The study indicates that external hip protectors can prevent hip fractures in nursing-home residents.
Comment In: Lancet. 1997 Aug 23;350(9077):563-49284784
Calibration of the Finnish FRAX model was evaluated using a locally derived population-based cohort of postmenopausal women (n = 13,917). Hip fractures were observed from national register-based data and verified from radiological records. For a subpopulation of 11,182 women, there were enough data to calculate the fracture probabilities using the Finnish FRAX tool (without bone mineral density). A 10-year period prevalence of hip fractures to this subpopulation was 0.66 %. The expected numbers of hip fractures were significantly higher than the self reported ones (O/E ratio 0.46; 95 % CI 0.33-0.63), had a tendency to be greater than the observed ones (O/E ratio 0.83; 95 % CI 0.65-1.04), and calibration in terms of goodness-of-fit of absolute probabilities was questionable (P = 0.015). Strikingly, the 10-year period prevalence of hip fractures to the whole cohort was higher (0.84 %) than for the women with FRAX measurements (0.66 %). This was mainly the result of difference between people who had and who had not responded to postal enquiries (0.71 vs. 1.77 %, P
External hip protectors have been shown to have a good preventive effect against hip fractures in many studies. However, these studies were carried out either entirely or mostly among older persons living in institutions. The aim of this study was to investigate whether health nurses can, after brief training, choose the right persons to use external hip protectors, so that, with a fairly small number of protectors, the number of hip fractures in home-dwelling older persons in a given area could be significantly reduced.
One hundred and fifty pairs of external hip protectors were given to the health nurses of the Central district of Tampere Health Center, to give to those older persons aged more than 75 years who, in their opinion, most needed preventive measures against hip fractures. Older persons living in other districts served as controls. The number of hip fractures in each district for each 6-month period was obtained from the Data Center of Pirkanmaa Health District.
Whereas in control districts the number of hip fractures increased by 14 from 1.1.-30.6.1998 to 1.1.-30.6.2000 (49-63), their number diminished by 4 (43-39) in the Central district, where the protectors were used. The total cost of the external hip protectors was less than that required to treat one hip fracture in the first year.
External hip protectors are most probably effective and economical in preventing hip fractures also among home-dwelling older persons, as has previously been shown among nursing home patients.
Recently, it has been shown that hip fractures can be effectively prevented by use of hip protectors. To determine who would gain most benefit from use of hip protectors, we conducted a study with the aim to clarify factors that contribute to the occurrence of fracture in individuals who fall on their hip. Hip fracture patients were compared with individuals who had fallen on their hip without sustaining a fracture. The study group consisted of 123 consecutive hip fracture patients aged 70 years or over (mean age 82 years, female 82 years and male 80 years). The control group comprised 132 individuals (mean age 81 years, female 81 years and male 80 years) obtained from a prospective study on falls, who had experienced a fall that caused a visible soft tissue injury (bruise or wound) at the hip or gluteal region without sustaining a fracture. Patients were questioned about associated diseases, medications, place of residence, walking ability, need for locomotor aids and some activities in daily living (ADL). Patients who sustained a hip fracture were more likely to be women, living in long-term institutional care, using neuroleptics, dependent in ADL and had more history of previous stroke with hemiparesis, more Parkinsonism and lower body mass indexes (BMI) than those who did not sustain a fracture on fall on the hip. According to a logistical regression model, institutional residence, low BMI and history of stroke with hemiplegic status differed between fracture cases and controls. Institutional residence, low BMI and history of hemiplegic stroke discriminate hip fracture patients from fallers who sustain a soft tissue injury on the hip region. In clinical practice, patients who have these characteristics would be potential candidates to use hip protectors and other preventive measures.