Top

Osteoporosis International

Published in:

01-09-2013 | Original Article

When and where do hip fractures occur? A population-based study

Authors: B. Leavy, A. C. Åberg, H. Melhus, H. Mallmin, K. Michaëlsson, L. Byberg

Published in: Osteoporosis International | Issue 9/2013

Abstract

Summary

We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects’ psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days.

Introduction

This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground.

Methods

We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews.

Results

The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95 % confidence interval (CI), 1.12–4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95 % CI, 1.40–6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95 % CI, 1.02–1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors.

Conclusions

Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.

Available only for authorised users

Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B (2011) Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int 22:2575–2586PubMedCrossRef

Youm T, Koval KJ, Kummer FJ, Zuckerman JD (1999) Do all hip fractures result from a fall? Am J Orthop 28:190–194PubMed

Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med 324:1326–1331PubMedCrossRef

Allander E, Gullberg B, Johnell O, Kanis JA, Ranstam J, Elffors L (1998) Circumstances around the fall in a multinational hip fracture risk study: a diverse pattern for prevention. MEDOS Study Group. Mediterranean Osteoporosis Study. Accid Anal Prev 30:607–616PubMedCrossRef

Norton R, Campbell AJ, Reid IR, Butler M, Currie R, Robinson E, Gray H (1999) Residential status and risk of hip fracture. Age Ageing 28:135–139PubMedCrossRef

Butler M, Norton R, Lee-Joe T, Cheng A, Campbell AJ (1996) The risks of hip fracture in older people from private homes and institutions. Age Ageing 25:381–385PubMedCrossRef

Aharonoff GB, Dennis MG, Elshinawy A, Zuckerman JD, Koval KJ (1998) Circumstances of falls causing hip fractures in the elderly. Clin Orthop Relat Res 10–14

Allander E (1998) How well do investigators estimate results in advance? A methodological study from a multinational epidemiological survey on hip fracture risks. Int J Technol Assess Health Care 14:728–734PubMedCrossRef

Cumming RG, Klineberg RJ (1994) Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 42:774–778PubMed

10.

Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52:192–198PubMedCrossRef

11.

Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y (2002) Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 136:733–741PubMedCrossRef

12.

Kallin K, Jensen J, Olsson LL, Nyberg L, Gustafson Y (2004) Why the elderly fall in residential care facilities, and suggested remedies. J Fam Pract 53:41–52PubMed

13.

Gronskag AB, Forsmo S, Romundstad P, Langhammer A, Schei B (2010) Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT Study. Bone 46:1294–1298PubMedCrossRef

14.

Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19:860–867PubMedCrossRef

15.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139PubMedCrossRef

16.

Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187PubMedCrossRef

17.

Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271:128–133PubMedCrossRef

18.

Michaelsson K, Holmberg L, Mallmin H, Sorensen S, Wolk A, Bergstrom R, Ljunghall S (1995) Diet and hip fracture risk: a case–control study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment. Int J Epidemiol 24:771–782PubMedCrossRef

19.

Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673PubMedCrossRef

20.

Michaelsson K, Olofsson H, Jensevik K, Larsson S, Mallmin H, Berglund L, Vessby B, Melhus H (2007) Leisure physical activity and the risk of fracture in men. PLoS Med 4:e199PubMedCrossRef

21.

Michaelsson K, Melhus H, Ferm H, Ahlbom A, Pedersen NL (2005) Genetic liability to fractures in the elderly. Arch Intern Med 165:1825–1830PubMedCrossRef

22.

Cox NJ (2006) Speaking Stata: in praise of trigonometric predictors. Stata J 6:561–579

23.

Rothman K (2008) Episheet—spreadsheets for the analysis of epidemiologic data. http://www.drugepi.org/dope-downloads Accessed 4th July 2012

24.

Statistics Sweden (2009) Population figures for Uppsala County by age and sex, Dec 31st 2009. http://www.scb.se/Pages/SSD/SSD_TablePresentation____340508.aspx?rxid=fdbcc7af-492e-458b-ade2-8b3821e4120d Accessed 12th May 2012

25.

Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244PubMedCrossRef

26.

Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256PubMedCrossRef

27.

Ramnemark A, Nilsson M, Borssen B, Gustafson Y (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577PubMedCrossRef

28.

Bergstrom U, Bjornstig U, Stenlund H, Jonsson H, Svensson O (2008) Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umea, Sweden. Osteoporos Int 19:1267–1273PubMedCrossRef

29.

Formiga F, Lopez-Soto A, Duaso E, Ruiz D, Chivite D, Perez-Castejon JM, Navarro M, Pujol R (2007) Differences in the characteristics of elderly patients suffering from hip fracture due to falls according to place of residence. J Am Med Dir Assoc 8:533–537PubMedCrossRef

30.

Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF (2010) Older hip fracture patients: three groups with different needs. BMC Geriatr 10:65PubMedCrossRef

31.

Nyberg L, Gustafson Y, Berggren D, Brannstrom B, Bucht G (1996) Falls leading to femoral neck fractures in lucid older people. J Am Geriatr Soc 44:156–160PubMed

32.

Eriksson S, Strandberg S, Gustafson Y, Lundin-Olsson L (2009) Circumstances surrounding falls in patients with dementia in a psychogeriatric ward. Arch Gerontol Geriatr 49:80–87PubMedCrossRef

33.

van der Velde N, Stricker BH, Pols HA, van der Cammen TJ (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 63:232–237PubMedCrossRef

34.

Gillespie WJ, Gillespie LD, Parker MJ (2010) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev CD001255

35.

Bentzen H, Forsen L, Becker C, Bergland A (2008) Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial. Osteoporos Int 19:101–111PubMedCrossRef

36.

Crawford JR, Parker MJ (2003) Seasonal variation of proximal femoral fractures in the United Kingdom. Injury 34:223–225PubMedCrossRef

37.

Bischoff-Ferrari HA, Orav JE, Barrett JA, Baron JA (2007) Effect of seasonality and weather on fracture risk in individuals 65 years and older. Osteoporos Int 18:1225–1233PubMedCrossRef

38.

Jacobsen SJ, Sargent DJ, Atkinson EJ, O'Fallon WM, Melton LJ 3rd (1995) Population-based study of the contribution of weather to hip fracture seasonality. Am J Epidemiol 141:79–83PubMed

39.

Modarres R, Ouarda TB, Vanasse A, Orzanco MG, Gosselin P (2012) Modeling seasonal variation of hip fracture in Montreal, Canada. Bone 50:909–916PubMedCrossRef

40.

Gullberg B, Duppe H, Nilsson B, Redlund-Johnell I, Sernbo I, Obrant K, Johnell O (1993) Incidence of hip fractures in Malmo, Sweden (1950–1991). Bone 14(Suppl 1):S23–S29PubMedCrossRef

41.

Bastow MD, Rawlings J, Allison SP (1983) Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1:143–146PubMedCrossRef

42.

Melhus H, Snellman G, Gedeborg R et al (2010) Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab 95:2637–2645PubMedCrossRef

43.

Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K (2005) Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 16:1425–1431PubMedCrossRef

44.

Ceder L (2005) Predicting the success of rehabilitation following hip fractures. Disabil Rehabil 27:1073–1080PubMedCrossRef

45.

Svensson O, Stromberg L, Ohlen G, Lindgren U (1996) Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 78:115–118PubMed

Title: When and where do hip fractures occur? A population-based study
Authors: B. Leavy
A. C. Åberg
H. Melhus
H. Mallmin
K. Michaëlsson
L. Byberg
Publication date: 01-09-2013
Publisher: Springer London
Published in: Osteoporosis International / Issue 9/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-013-2333-6

At a glance: The STEP trials

Springer Medicine

When and where do hip fractures occur? A population-based study

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2013

Missense polymorphisms of the WNT16 gene are associated with bone mass, hip geometry and fractures

Bone mineral loss at the proximal femur in acute spinal cord injury

Does frailty predict increased risk of falls and fractures? A prospective population-based study

Associations between adverse social position and bone mineral density in women aged 50 years or older: data from the Manitoba Bone Density Program

Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study

Primary non-adherence to bisphosphonates in an integrated healthcare setting