The hip fracture incidence in the high-risk area Oslo continues to decline.

Oslo in Norway has had the highest incidence of hip fractures in the world. The incidence in Oslo has been thoroughly described every decade since the late 1970s. The incidence in Oslo has previously been higher compared to the rest of Norway but has now decreased to a level below the country average. PURPOSE: The purpose of this study was to report the incidence of hip fractures in Oslo in 2019 and compare it with the incidence rates from the previous four decades. METHODS: Patients residing in Oslo in 2019 with a new hip fracture identified by searching the Oslo hospital's patient administrative systems and protocols from the operating theaters. The diagnosis was verified through medical records and/or radiographs. To compare with previous studies, the direct standardization method was used with the population of Oslo in 2019 as the standard. RESULTS: A total of 758 hip fractures, 70% women, were identified in 2019. The age-standardized incidence rates per 10,000 person-years in 2019 (95% CI) were 45 (41.1-48.8) for women and 30 (25.8-33.8) for men. In women, there has been a continuous decline in age-standardized rates the last three decades and in men the last two decades. The most pronounced decline was seen in the oldest age groups over 70 years. There has been a secular decline in both cervical and trochanteric fractures; however, the decrease in trochanteric fractures was most distinct for males, with more than two times higher risk in 1996/1997 compared to 2019. CONCLUSION: Incidence rates for hip fractures in Oslo in 2019 were the lowest rate reported since 1978. The decrease was significant for both men and women. For the first time, the incidence rates are below the national rates of Norway. However, the rates are still among the highest worldwide.

Vitamin D status and complications, readmissions, and mortality after hip fracture.

Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. INTRODUCTION: We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. METHODS: Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. RESULTS: A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. CONCLUSION: Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT.

Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. INTRODUCTION: Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures. METHODS: This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed. RESULTS: Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (ßper SD = - 0.26, 95% CI: - 0.36,- 0.15), parental hip fracture (ß = - 0.29, 95% CI: - 0.54,- 0.05), and daily alcohol intake (ß = - 0.43, 95% CI - 0.79, - 0.08) were associated with lower TBS. Higher BMD of femoral neck (ßper SD = 0.34, 95% CI 0.25-0.43) and lumbar spine (ßper SD = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (ORper SD = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (ORper SD = 0.75 95% CI 0.60-0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found. CONCLUSION: Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

Biomarkers of muscle damage increased in anterolateral compared to direct lateral approach to the hip in hemiarthroplasty: no correlation with clinical outcome : Short-term analysis of secondary outcomes from a randomized clinical trial in patients with a displaced femoral neck fracture.

In this study, we found elevated levels of serum CK in the anterolateral approach to the hip compared to the direct lateral approach in patients with a displaced femoral neck fracture. No correlation was found between levels of CK and functional outcomes. INTRODUCTION: To compare increase in serum creatine kinase (CK) and its association with functional outcome between the muscle-sparing anterolateral approach and the direct lateral approach to the hip in patients with displaced femoral neck fracture (FNF). METHODS: In this randomized trial, we enrolled eligible patients between 70 and 90 years of age with FNF. Patients were allocated to an uncemented hemiarthroplasty inserted through a direct lateral or an anterolateral approach. The primary endpoints were pain and patient satisfaction assessed by the Visual Analogue Scale (VAS). Among secondary endpoints was increase in CK at 24 and 48 h compared to baseline and its association with surgical parameters, Timed up and Go Test (TUG), Harris Hip Score (HHS), and the presence of a Trendelenburg sign using correlation analysis. This paper reports on increase in serum CK and its association with functional outcome. RESULTS: At 24 h, there was a mean increase from baseline in total CK of 228 U/L (95% CI 187 to 269; P < 0.001). There was a difference between groups at 24 h in CK increase with higher levels in the anterolateral group (mean difference 80 U/L; 95% CI - 0.5 to 162; P = 0.05). Likewise, at 48 h, there was a mean difference of 117 U/L (95% CI 22 to 212; P = 0.01). No correlation was found between CK values and functional assessments. CONCLUSIONS: Compared with the direct lateral approach, the anterolateral approach yielded higher levels of postoperative CK. However, there was no correlation between levels of CK and functional outcome. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02028468.

The gluteal muscles in end-stage osteoarthritis of the hip: intra- and interobserver reliability and agreement of MRI assessments of muscle atrophy and fatty degeneration.

AIM: To assess the intra- and interobserver reliability and agreement of muscular atrophy and fatty degeneration of the gluteal muscles on magnetic resonance imaging (MRI) in patients with end-stage osteoarthritis of the hip. MATERIALS AND METHODS: Thirty-nine patients with end-stage osteoarthritis of the hip, who scheduled for hip replacement surgery, were included in the study. The cross-sectional areas of the gluteus medius and minimus muscles were manually circumscribed and automatically calculated, while intramuscular fatty degeneration was assessed using the semi-quantitative classification system of Goutallier. Two independent observers performed all the evaluations. RESULTS: Good agreement and excellent reliability were found for the cross-sectional areas of the gluteus medius and gluteus minimus (intraclass correlation coefficient [ICC] for intra-observer 0.97 and 0.93, ICC for interobserver 0.98 and 0.95). Fair reliability was found for fatty degeneration of the gluteus muscles (mean kappa 0.23 and mean prevalence-adjusted kappa 0.53). The average proportion of agreement for the raters was 0.71. CONCLUSION: The present study demonstrated substantial agreement and excellent intra- and interobserver reliability for the measurements of the cross-sectional areas of the gluteus medius and gluteus minimus. Assessment of fatty degeneration had fair intra- and interobserver reliability, but acceptable agreement.

Age of menarche is associated with knee joint replacement due to primary osteoarthritis (The HUNT Study and the Norwegian Arthroplasty Register).

OBJECTIVE: To investigate whether parity, age at menarche, menopausal status, age at menopause, use of oral contraceptives (OC) or use of hormone replacement therapy (HRT) were associated with total knee replacement (TKR) or total hip replacement (THR) due to primary osteoarthritis. METHOD: In a prospective cohort study of 30,289 women from the second and third surveys of the Nord-Trøndelag Health Study, data were linked to the Norwegian Arthroplasty Register (NAR) in order to identify TKR or THR due to primary osteoarthritis. Cox proportional hazards models were used to estimate the hazard ratios (HRs). RESULTS: We observed 430 TKRs and 675 THRs during a mean follow-up time of 8.3 years. Increasing age at menarche was inversely associated with the risk of TKR (P-trend < 0.001). Past users and users of systemic HRT were at higher risk of TKR compared to never users (HR 1.42 (95% confidence interval (CI) 1.06-1.90) and HR 1.40 (95% CI 1.03-1.90), respectively). No association was found between parity, age at menarche, menopausal status, age at menopause, oral contraceptive use or HRT use and THR. CONCLUSION: We found that increasing age at menarche reduced the risk of TKR. Past users and users of systemic HRT were at higher risk of TKR compared to never users. Parity did not increase the risk of THR or TKR.

The causal role of smoking on the risk of hip or knee replacement due to primary osteoarthritis: a Mendelian randomisation analysis of the HUNT study.

OBJECTIVE: Smoking has been associated with a reduced risk of hip and knee osteoarthritis (OA) and subsequent joint replacement. The aim of the present study was to assess whether the observed association is likely to be causal. METHOD: 55,745 participants of a population-based cohort were genotyped for the rs1051730 C > T single-nucleotide polymorphism (SNP), a proxy for smoking quantity among smokers. A Mendelian randomization analysis was performed using rs1051730 as an instrument to evaluate the causal role of smoking on the risk of hip or knee replacement (combined as total joint replacement (TJR)). Association between rs1051730 T alleles and TJR was estimated by hazard ratios (HRs) and 95% confidence intervals (CIs). All analyses were adjusted for age and sex. RESULTS: Smoking quantity (no. of cigarettes) was inversely associated with TJR (HR 0.97, 95% CI 0.97-0.98). In the Mendelian randomization analysis, rs1051730 T alleles were associated with reduced risk of TJR among current smokers (HR 0.84, 95% CI 0.76-0.98, per T allele), however we found no evidence of association among former (HR 0.97, 95% CI 0.88-1.07) and never smokers (HR 0.97, 95% CI 0.89-1.06). Neither adjusting for body mass index (BMI), cardiovascular disease (CVD) nor accounting for the competing risk of mortality substantially changed the results. CONCLUSION: This study suggests that smoking may be causally associated with the reduced risk of TJR. Our findings add support to the inverse association found in previous observational studies. More research is needed to further elucidate the underlying mechanisms of this causal association.

High-intensity training following lung cancer surgery: a randomised controlled trial.

BACKGROUND: Many patients with lung cancer are deconditioned with poor physical fitness. Lung resection reduces physical fitness further, impairing the patient's ability to function in daily life. METHODS: We conducted a single-blind randomised controlled trial of high-intensity endurance and strength training (60 min, three times a week, 20 weeks), starting 5-7 weeks after surgery. The control group received standard postoperative care. The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion. Other outcomes included changes in pulmonary function, muscular strength by one-repetition maximum (1RM), total muscle mass measured by dual energy X-ray absorptiometry, daily physical functioning and quality of life (QoL). RESULTS: The intention-to-treat analysis of the 61 randomised patients showed that the exercise group had a greater increase in peak oxygen uptake (3.4 mL/kg/min between-group difference, p=0.002), carbon monoxide transfer factor (Tlco) (5.2% predicted, p=0.007), 1RM leg press (29.5 kg, p<0.001), chair stand (2.1 times p<0.001), stair run (4.3 steps, p=0.002) and total muscle mass (1.36 kg, p=0.012) compared with the controls. The mean±SD QoL (SF-36) physical component summary score was 51.8±5.5 and 43.3±11.3 (p=0.006), and the mental component summary score was 55.5±5.3 and 46.6±14.0 (p=0.015) in the exercise and control groups, respectively. CONCLUSIONS: In patients recently operated for lung cancer, high-intensity endurance and strength training was well tolerated and induced clinically significant improvements in peak oxygen uptake, Tlco, muscular strength, total muscle mass, functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery. TRIAL REGISTRATION NUMBER: NCT01748981.

Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: a randomized, controlled trial of the OsteoACTIVE programme.

BACKGROUND: Exercise programmes have shown to be important for the prevention of fractures in patients with established osteoporosis. However, few studies have evaluated the effect of such programmes for women with low bone mineral density (BMD) (osteoporosis or osteopenia) who have already suffered a fracture. Studies have indicated that exercise programmes concentrating on muscular strength and dynamic balance have a positive effect on significant risk factors for falls such as quadriceps strength and balance. The aim of the present study was to assess the effect of a 6-month exercise programme and a patient education component (OsteoACTIVE) on quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life in postmenopausal women with osteopenia and a previous wrist fracture. METHODS: Eighty postmenopausal women with low BMD and a healed wrist fracture were randomized to OsteoACTIVE (n = 42) (age 65.5, range 51.2-79.2 years) or patient education only (control group) (n = 38) (age 63.9, range 52.7-86.8 years). Follow-up was conducted after 6 months (end of intervention) and 1 year. Outcome measures included quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life. RESULTS: Thirty-five participants (83 %) completed the OsteoACTIVE programme. Mean adherence to OsteoACTIVE was 87 % (range 48-100 %). Twenty-five participants (72 %) met the a priori goal of 80 % adherence to the program. No adverse events were reported. There were no significant differences between the two groups over the 1-year follow-up for any of the outcome measures. CONCLUSION: The OsteoACTIVE rehabilitation programme revealed no significant effect on quadriceps strength, BMD, dynamic balance, walking capacity or self-reported functional outcomes over the 1-year follow-up. TRIAL REGISTRATION: NCT01357278 at ClinicalTrials.gov (date of registration 2010-04-21).

Weight gain and the risk of knee replacement due to primary osteoarthritis: a population based, prospective cohort study of 225,908 individuals.

OBJECTIVE: To study the association between weight gain and the risk of knee replacement (KR) due to primary osteoarthritis (OA), and to evaluate whether the association differs by age. DESIGN: 225,908 individuals from national health screenings with repeated measurements of height and weight were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Cox proportional hazard regression was used to calculate sex-specific relative risks (RR) of KR according to change in Body Mass Index (BMI) and weight, corresponding analyses were done for age categories at first screening. RESULTS: During 12 years of follow up, 1591 participants received a KR due to primary OA. Men in the highest quarter of yearly change in BMI had a RR of 1.5 (95% confidence interval (CI) 1.1-1.9) of having a KR compared to those in the lowest quarter. For women the corresponding RR was 2.4 (95% CI 2.1-2.7). Men under the age of 20 at the first screening had a 26% increased risk for KR per 5 kg weight gain, for women the corresponding increase was 43%. At older age the association became weaker, and in the oldest it was lost. CONCLUSIONS: Weight gain increases the risk for later KR both in men and women. The impact of weight gain is strongest in the young, at older age the association is weak or absent. Our study suggests that future OA may be prevented by weight control and that preventive measures should start at an early age.

No strong relationship between body mass index and clinical hand osteoarthritis: results from a population-based case-control study.

OBJECTIVES: The aim of this population-based case-control study was to investigate whether a high body mass index (BMI) is a risk factor for clinical hand osteoarthritis (OA). METHOD: Persons living in Ullensaker municipality in Norway who were aged 20-52 years in 1990 reported height and weight in 1990, 1994, 2004, and 2010 (n = 1276). Cases (clinical hand OA in 2010, n = 59) were compared to controls (participants without self-reported OA or hand pain in 2010, n = 805) with regard to the prospectively measured BMI by means of a generalized estimating equation (GEE) analysis adjusted for age, sex, time, and education. RESULTS: The mean age of hand OA cases was 64 (SD = 7.5) years in 2010 and 78% were women. There was no association between total average BMI over the entire period and later clinical hand OA (p = 0.320). Cases had a higher mean BMI in 1990 [unstandardized B = 0.93, 95% confidence interval (CI) 0.07-1.79] and in 1994 (B = 0.75, 95% CI 0.22-1.28) but there were no differences between the groups in 2004 or 2010. CONCLUSIONS: The study lend support to the hypothesis that having a higher BMI when young or middle-aged might be associated with later hand OA.

A systematic video analysis of 69 injury cases in World Cup alpine skiing.

We have limited insight into how injuries occur in professional ski racing. The aim of this study was to describe the injury situations in World Cup alpine skiing. Injuries reported through the International Ski Federation Injury Surveillance System for three consecutive World Cup seasons (2006-2009) were obtained on video. In total, 69 injuries and 124 runs of matched controls were analysed by five experts to evaluate the skiing situation, skier behavior, as well as piste-related factors. A chi-square test (95% CI, P ≤ 0.05) was used to examine whether there was a difference between course sections regarding where the injury situation occurred. The skier was most frequently turning (n = 55) or landing from a jump (n = 13) at the time of injury. Most of the injuries to the head and upper body (96%) resulted from crashes, while the majority of knee injuries (83%) occurred while the skier was still skiing. Gate contact contributed to 30% of the injuries, while 9% occurred at contact with safety nets/material. Almost half of the injuries (46%) occurred in the final fourth of the course. A particular concern was the high contribution of inappropriate gate contact and the high-energy impacts to the body when crashing.

Injury rate and injury pattern among elite World Cup snowboarders: a 6-year cohort study.

BACKGROUND: There is limited knowledge on the injury rate and injury pattern in the different disciplines among elite snowboarders. OBJECTIVE: The aim of this study was to describe and compare the injury rate and injury pattern among the different International Ski Federation (Fédération Internationale de Ski, FIS) World Cup (WC) snowboard disciplines. METHODS: We conducted retrospective interviews with FIS WC snowboard athletes at the end of each season in the period 2007-2012, to register all acute injuries sustained during training or competition during the competitive season requiring attention by medical personnel. To calculate the exposure, we obtained information from result lists from the FIS competition database for all WC competitions for each of the interviewed athletes. RESULTS: We registered a total of 574 injuries among 1432 athletes, accounting for an overall injury rate of 40.1 injuries/100 athlete/season. A total of 171 injuries occurred during the FIS WC competitions, corresponding to 6.4 injuries/1000 runs. During competition, injury risk was highest in snowboard cross with 11.9/1000 runs, followed by 6.3 in halfpipe, 3.6 in big air and 2.8 in parallel giant slalom/parallel slalom (PGS/PSL). Snowboard cross also had the highest risk of severe injuries (>28 days absence). No differences in injury risk were detected between male and female snowboarders. The most commonly injured body part was the knee (17.8%), followed by the shoulder/clavicle (13.4%) and head/face (13.2%). The risk of knee injury (the most common injury type) and head injury was significantly higher in snowboard cross and halfpipe compared to PGS/PSL. CONCLUSIONS: The risk of injuries was higher in snowboard cross than in halfpipe, big air and PGS/PSL. The most commonly injured body part was the knee. Prevention of snowboard injuries among elite snowboarders should focus on knee injuries, severe injuries and snowboard cross athletes.

Decrease in incidence of distal radius fractures in Oslo, Norway.

This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high compared to other regions in Norway and some of the other Nordic countries. PURPOSE: We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999. METHODS: Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated. RESULTS: The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71-0.84) and 0.77 (95% CI 0.66-0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71-0.86) and 0.78 (95% CI 0.63-0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40-0.80) for women and 0.77 (95% CI 0.44-1.37) for men. CONCLUSIONS: The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.

Radiostereometric analysis of hemiarthroplasties of the hip--a highly precise method for measurements of cartilage wear.

OBJECTIVE: Cartilage wear is a feature of osteoarthritis and rheumatoid arthritis. Precise measurements of wear have been difficult. Cartilage wear caused by an artificial articulating joint surface is a well-known feature of hemiarthroplasties. The aim of this study was to demonstrate that radiostereometric analysis (RSA) may be used for three-dimensional measurements of cartilage wear in hemiarthroplasties of the hip. METHOD: We performed a phantom model study to assess the feasibility of a subsequent clinical trial. We showed that the motion of the prosthetic head relative to the pelvis was not influenced by the orientation of the prosthetic head. Twenty-two patients were randomised to treatment with a cemented or an uncemented hemiarthroplasty for an acute femoral neck fracture. Migration of the prosthetic head into the acetabulum was measured using RSA. RESULTS: A mean migration of the prosthetic head into the acetabulum of 0.62 mm was found at 3 months [95% confidence interval (CI): 0.27-0.97] and a further migration of -0.07 mm at 12 months (95% CI: -0.16-0.32). There were no differences between the groups in prosthetic migration or functional outcome. Between three and 12 months, there was no detectable cartilage wear during the first postoperative year. CONCLUSION: Whether the migration during the first 3 months represents a period of bedding in due to a harder opposite surface remains to be shown. RSA may be used for measurement of cartilage wear in hemiarthroplasties of the hip. This study demonstrates a highly precise method for measurements of cartilage wear.

The rate of hip osteoarthritis in patients with proximal femoral fractures versus hip contusion.

UNLABELLED: We found no difference in the rate of radiological hip osteoarthritis in the injured hip when comparing 349 patients with proximal femoral fractures and 112 patients with hip contusion. There was, however, a tendency for more osteoarthritis in patients with trochanteric fractures than in patients with femoral neck fractures. INTRODUCTION: Osteoarthritis (OA) and osteoporotic fractures are two age-related disorders associated with considerable morbidity. There is a clinical impression of an inverse relation between osteoarthritis and osteoporosis, and a protective effect of OA against osteoporotic fractures has been proposed. METHODS: We performed a case-control study in 461 subjects. Cases (n = 349) were patients aged 50 years or above who sustained a proximal femoral fracture from November 2003 to October 2004, registered prospectively in the department's fracture register. Controls (n = 112) were patients aged 50 years or above with the diagnosis of hip contusion, recruited from the hospital's discharge register. Radiographic OA was scored according to Kellgren and Lawrence (K&L), and minimal joint space (MJS) was measured in both hips when possible. A K&L grade II or higher or an MJS less than 2.5 mm was defined as OA. RESULTS: Both in the hip fracture group and in the contusion group mean, the MJS was 3.5 mm on the injured side (p = 0.79). In the fracture group, 31/250 (12%) had MJS <2.5 mm and 16/112 (14%) in the contusion group (p = 0.18). In the fracture group, 40/250 (16%) had a K&L OA grade II or higher, and in the contusion group 20/112 (18%) persons had a K&L OA grade II or higher (p = 0.66). There was a tendency for a higher incidence of OA in patients with trochanteric fractures compared with patients with cervical fractures. CONCLUSIONS: We found no differences on the injured side in the rate of hip OA between hip fracture patients and hip contusion patients.

Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial.

UNLABELLED: We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective. INTRODUCTION: Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly. METHODS: A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients' quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios. RESULTS: Over the 2-year period, patients treated with hemiarthroplasty gained 0.15-0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings. CONCLUSION: Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway.

UNLABELLED: This study reports a significant decrease in age-adjusted incidence rates of hip fracture for women in Oslo, Norway, even compared with data from 1978/1979. Use of bisphosphonate may explain up to one third of the decline in the incidence. INTRODUCTION: The aims of the present study were to report the current incidence of hip fractures in Oslo and to estimate the influence of bisphosphonates on the current incidence. METHODS: Using the electronic diagnosis registers and lists from the operating theaters of the hospitals of Oslo, all patients with ICD-10 codes S72.0 and S72.1 (hip fracture) in 2007 were identified. Medical records of all identified patients were reviewed to verify the diagnosis. Age- and gender-specific annual incidence rates were calculated using the population of Oslo on January 1, 2007 as the population at risk. Data on the use of bisphosphonates were obtained from official registers. RESULTS: A total number of 1,005 hip fractures, 712 (71%) in women, were included. The age-adjusted fracture rates per 10,000 for the age group >50 years were 82.0 for women and 39.1 for men in 2007, compared with 110.8 and 41.4 in 1996/1997, 116.5 and 42.9 in 1988/1989, and 97.5 and 34.5 in 1978/1979, respectively. It was estimated that the use of bisphosphonates may explain up to 13% of the decline in incidence in women aged 60-69 years and up to 34% in women aged 70-79 years. CONCLUSIONS: The incidence of hip fractures in women in Oslo has decreased significantly during the last decade and is now at a lower level than in 1978/1979. This reduction was not evident in men. The incidence of hip fractures in Oslo is, however, still the highest in the world.

Injuries among World Cup ski and snowboard athletes.

There is little information available on injuries to World Cup skiers and snowboarders. The aim of this study was to describe and compare the injury risk to World Cup athletes in alpine skiing, freestyle skiing, snowboarding, ski jumping, Nordic combined and cross country skiing. We performed retrospective interviews with the International Ski Federation (FIS) World Cup athletes from selected nations during the 2006-2007 and 2007-2008 winter seasons and recorded all acute injuries occurring during the seasons. We interviewed 2121 athletes and recorded 705 injuries. There were 520 (72%) time-loss injuries and 196 (28%) severe injuries (absence >28 days). In freestyle skiing, alpine skiing and snowboarding, there were 27.6, 29.8 and 37.8 time-loss and 14.4, 11.3 and 13.8 severe injuries per 100 athletes per season, respectively. In Nordic combined, ski jumping and cross country skiing, there were 15.8, 13.6 and 6.3 time-loss and 3.3, 5.6 and 0.7 severe injuries per 100 athletes per season, respectively. In conclusion about 1/3 of the World Cup alpine, freestyle and snowboard athletes sustain a time-loss injury each season, while the risk is low in the Nordic disciplines. A particular concern was the high proportion of severe injuries observed among alpine, freestyle and snowboard athletes, which is in contrast to most other sports.