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1.
Tunis Med ; 102(2): 107-110, 2024 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-38567477

RESUMO

INTRODUCTION: Proximal femur fractures are one of the most common injuries in older adults representing a serious health condition in developed as well as developing countries. AIM: This study aimed to assess the hospitalization costs of the proximal femur fracture. METHODS: We conducted a prospective descriptive study spread over six months about patients hospitalized and operated on for proximal femur fractures. In order to estimate the cost we referred to the nomenclature of professional acts and the prices set by the Ministry of Public Health and the Ministry of Finance. RESULTS: The study included 100 patients, 55 females and 45 males with an average age of 76 years. The average hospital length of stay was 5 days. The preoperative stay was at a mean of three days. The average total hospitalization cost for these fractures was 2877 Tunisian Dinars depending on the type of fracture and surgical treatment. The main components of the costs were hospital stay costs and human resources costs 40%, cost of the implant 25.9%, cost of consumables 12%, operating cost 10%, cost of additional examinations 9% and cost of medications 2%. CONCLUSION: Proximal femur fractures represent an important cause of health resource consumption. To reduce the cost of hospital care, we recommend limiting the length of hospital stay as much as possible, investing in total hip and hemi-arthroplasties and adapting economical behavior taking into account the cost of consumables.


Assuntos
Fraturas do Quadril , Fraturas Proximais do Fêmur , Masculino , Feminino , Humanos , Idoso , Custos de Cuidados de Saúde , Hospitalização , Tempo de Internação , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Hospitais
2.
Clin Transplant ; 38(4): e15308, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38581296

RESUMO

Kidney transplant recipients are at high risk for fractures, primarily due to post-transplant bone disease. This retrospective cohort study analyzed data from the Korean National Health Insurance Service, including 10 083 kidney transplant recipients examined from 2009 to 2017. We assessed fracture incidence, emphasizing vertebral and hip fractures, and the association of physical activity and traditional risk factors with fracture risk. Kidney transplant recipients were categorized into three groups according to physical activity levels: non-activity, metabolic equivalent of task (MET) 1-499, and MET ≥500. Physical activity was associated with a decreased risk of all types of fractures: any (MET 1-499: adjusted hazard ratio (aHR) .75; 95% confidence interval (CI) .62-.92, MET ≥500: aHR .84; 95% CI .70-1.00), vertebral (MET 1-499: aHR .69; 95% CI .49-.98, MET ≥500: aHR .67; 95% CI .49-.91), and hip (MET 1-499: aHR .43; 95% CI .23-.81) fractures. Additionally, older age, female sex, and diabetes were associated with an increased fracture risk. The assessment of physical activity and traditional risk factors could improve fracture risk prediction. Our findings emphasize the need for further research to establish optimal physical activity recommendations for fracture prevention in kidney transplant recipients.


Assuntos
Fraturas do Quadril , Transplante de Rim , Humanos , Feminino , Estudos de Coortes , Estudos Retrospectivos , Transplante de Rim/efeitos adversos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fatores de Risco , República da Coreia/epidemiologia , Transplantados
3.
Med J Malaysia ; 79(Suppl 1): 117-121, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38555895

RESUMO

INTRODUCTION: Hip fractures, predominantly due to decreased bone density and falls, significantly impact elderly health, disproportionately affecting women and placing a strain on healthcare resources. This study aims to conduct an indepth epidemiological analysis of hip fracture incidence among the elderly in Pahang, Malaysia, to inform better healthcare strategies. MATERIALS AND METHODS: In this retrospective study, medical records of patients admitted with hip fractures between 2019 and 2021 at Hospital Sultan Haji Ahmad Shah (HoSHAS) in Pahang were analyzed. Data on sociodemographic characteristics, nature of trauma, fracture types, and comorbidities were collected and examined using descriptive and inferential statistics. RESULTS: Among 3856 Orthopaedic Department admissions at HoSHAS (2019-2021), 296 hip fracture cases were identified, predominantly in women (71.3%), Malay ethnicity (75.3%), and aged 71-80 (38.5%). Intertrochanteric femur fractures were prevalent (62.8%). Unintentional falls accounted for 94.9% of cases. Logistic regression showed age and gender as significant predictors of femoral neck fractures. Specifically, Chinese seniors were 1.96 times more likely, and women over 65 were 1.95 times more likely to suffer these fractures. Notably, the absence of comorbidities increased the risk by 3.41 times (p < 0.05). CONCLUSION: With increased longevity among Malaysian citizen, the number of hip fracture cases are growing and leading to other health-related problems such as disability, depression, and cardiovascular. Various preventive interventions for osteoporosis and falls should be implemented to reduce the incidence of hip fractures among older adults.


Assuntos
Fraturas do Quadril , Idoso , Humanos , Feminino , Estudos Retrospectivos , Estudos Transversais , Centros de Atenção Terciária , Fatores de Risco , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/complicações
4.
Age Ageing ; 53(3)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38497235

RESUMO

PURPOSE: This study aimed to develop and validate clinical prediction models using machine learning (ML) algorithms for reliable prediction of subsequent hip fractures in older individuals, who had previously sustained a first hip fracture, and facilitate early prevention and diagnosis, therefore effectively managing rapidly rising healthcare costs in China. METHODS: Data were obtained from Grade A Tertiary hospitals for older patients (age ≥ 60 years) diagnosed with hip fractures in southwest China between 1 January 2009 and 1 April 2020. The database was built by collecting clinical and administrative data from outpatients and inpatients nationwide. Data were randomly split into training (80%) and testing datasets (20%), followed by six ML-based prediction models using 19 variables for hip fracture patients within 2 years of the first fracture. RESULTS: A total of 40,237 patients with a median age of 66.0 years, who were admitted to acute-care hospitals for hip fractures, were randomly split into a training dataset (32,189 patients) and a testing dataset (8,048 patients). Our results indicated that three of our ML-based models delivered an excellent prediction of subsequent hip fracture outcomes (the area under the receiver operating characteristics curve: 0.92 (0.91-0.92), 0.92 (0·92-0·93), 0.92 (0·92-0·93)), outperforming previous prediction models based on claims and cohort data. CONCLUSIONS: Our prediction models identify Chinese older people at high risk of subsequent hip fractures with specific baseline clinical and demographic variables such as length of hospital stay. These models might guide future targeted preventative treatments.


Assuntos
Fraturas do Quadril , Idoso , Humanos , Algoritmos , Custos de Cuidados de Saúde , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Aprendizado de Máquina , Fatores de Risco , Pessoa de Meia-Idade
5.
Medicine (Baltimore) ; 103(10): e35773, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38457536

RESUMO

BACKGROUND: This study aimed to comprehensively assess the prevalence and risk factors for Hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis. METHODS: Systematically searched 4 English databases and 4 Chinese databases from inception until October 20, 2022. All studies involving risk factors of HAP in patients with hip fractures will be considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented through Review Manager 5.4 with the pooled odds ratio (OR) and 95% confidence interval. RESULTS: Of 35 articles included in this study, the incidence of HAP was 8.9%. 43 risk factors for HAP were initially included, 23 were eventually involved in the meta-analysis, and 21 risk factors were significant. Among them, the 4 most frequently mentioned risk factors were as follows: Advanced age (OR 1.07, 95% CI 1.05-1.10), chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), time from injury to operation (OR 1.09, 95% CI 1.07-1.12), time from injury to operation ≥ 48 hours (OR 3.59, 95% CI 2.88-4.48), and hypoalbuminemia < 3.5g/dL (OR 2.68, 95% CI 2.15-3.36). DISCUSSION: Hip fracture patients diagnosed with COPD have a 3.44 times higher risk of HAP compared to the general hip fracture patients. The risk of HAP also increases with age, with patients over 70 having a 2.34-fold higher risk and those over 80 having a 2.98-fold higher risk. These findings highlight the need for tailored preventive measures and timely interventions in vulnerable patient populations. Additionally, hip fracture patients who wait more than 48 hours for surgery have a 3.59-fold higher incidence of HAP. This emphasizes the importance of swift surgical intervention to minimize HAP risk. However, there are limitations to consider in this study, such as heterogeneity in selected studies, inclusion of only factors identified through multivariate logistic regression, and the focus on non-randomized controlled trial studies.


Assuntos
Pneumonia Associada a Assistência à Saúde , Fraturas do Quadril , Doença Pulmonar Obstrutiva Crônica , Humanos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fatores de Risco , Pneumonia Associada a Assistência à Saúde/epidemiologia , Hospitais
6.
J Orthop Surg Res ; 19(1): 186, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38491543

RESUMO

BACKGROUND: This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. METHODS: This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. RESULTS: The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. CONCLUSION: Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.


Assuntos
Fraturas do Colo Femoral , Fraturas do Quadril , Hiponatremia , Humanos , Idoso , Estudos Retrospectivos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Sódio
7.
Womens Health (Lond) ; 20: 17455057241231387, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38529935

RESUMO

Fracture Risk Assessment Tool is a free, online fracture risk calculator which can be used to predict 10-year fracture risk for women and men over age 50 years. It incorporates seven clinical risk factors and bone density to give a 10-year risk of major osteoporotic fracture and hip fracture. This dynamic tool can be used with patients at the bedside to help guide treatment decisions. There are some limitations to Fracture Risk Assessment Tool, with the most central limitation being the fact that inputs are binary. Much research has been done to try to refine Fracture Risk Assessment Tool to allow for more accurate risk prediction, and this article describes the data for adjusting Fracture Risk Assessment Tool depending on the clinical scenario such as the dose of glucocorticoid use, presence of diabetes and others. Recently, the new FRAXplus tool has been developed to address many of these concerns and will likely replace the old Fracture Risk Assessment Tool in the future. At the current time, it is available in beta form.


Methods for Refining the FRAX® Tool in Patients with Low Bone Density to Help Improve the Accuracy of Osteoporotic Fracture Risk PredictionMany patients who have low bone density develop fragility fractures, even those whose bone density is not yet within the osteoporosis range. Thus, in patients with low bone density, the health care team should estimate the risk of fracture to decide which patients should take medications to prevent fractures. Factors such as age, body mass index, steroid use, family history and other clinical factors can influence the fracture risk, in addition to bone density. There is an online calculator called the Fracture Risk Assessment Tool (FRAX®) which allows patients and doctors to integrate these risk factors with bone density in order to estimate the 10 year risk of osteoporotic fractures. FRAX® asks a series of yes/no questions about the patient's risks for fracture, and also takes into account the patient's country of residence, age, gender, race and bone density at the femur neck. However, there are some important limitations of this calculator. For example, we think that steroid medications increase the risk of fractures, and the higher the dose, the higher the risk of fractures. However, FRAX® only allows a "yes" or "no" input to the steroid use question. This paper aims to descibe methods for refining the FRAX® calculation to make the fracture risk prediction more accurate. For example, it describes a mathematical adjustment to FRAX® to account for the dose of steroids used. It also reviews methods for FRAX® adjustment for diabetes type 1 and 2, and severity of rheumatoid arthritis, among other considerations. Importantly, there is a new FRAX® tool that is currently in beta testing which will also further refine the accuracy of fracture risk prediction.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Medição de Risco , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Densidade Óssea , Fatores de Risco , Fraturas do Quadril/epidemiologia
8.
BMC Med ; 22(1): 118, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481235

RESUMO

BACKGROUND: Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morbidity measured by the medication-based Rx-Risk Comorbidity Index (Rx-Risk) and the risk of first hip fracture. METHODS: Individual-level data on medications dispensed from pharmacies (2005-2016) was retrieved from the Norwegian Prescription Database and used to calculate Rx-Risk for each calendar year. Information on first hip fractures (2006-2017) was obtained from a nationwide hip fracture database. Individuals ≥ 51 years who filled at least one prescription during the study period comprised the population at risk. Using Rx-Risk as a time-varying exposure variable, relative risk estimates were obtained by a negative binomial model. RESULTS: During 2006-2017, 94,104 individuals sustained a first hip fracture. A higher Rx-Risk was associated with increased risk of hip fracture within all categories of age and sex. Women with the highest Rx-Risk (> 25) had a relative risk of 6.1 (95% confidence interval (CI): 5.4, 6.8) compared to women with Rx-Risk ≤ 0, whereas the corresponding relative risk in women with Rx-Risk 1-5 was 1.4 (95% CI: 1.3, 1.4). Similar results were found in men. Women > 80 years with Rx-Risk 21-25 had the highest incidence rate (514 (95% CI: 462, 566) per 10, 000 person years). The relative increase in hip fracture risk with higher Rx-Risk was most pronounced in the youngest patients aged 51-65 years. CONCLUSIONS: Rx-Risk is a strong predictor of hip fracture in the general outpatient population and may be useful to identify individuals at risk in a clinical setting and in future studies.


Assuntos
Fraturas do Quadril , Masculino , Humanos , Feminino , Estudos de Coortes , Comorbidade , Fraturas do Quadril/epidemiologia , Risco , Incidência , Fatores de Risco
9.
Injury ; 55(4): 111461, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38457999

RESUMO

OBJECTIVE: This study aimed to provide population based trends in incidence rate, hospital length of stay (HLOS), trauma mechanism, and costs for healthcare and lost productivity of subtrochanteric femur fractures in the Netherlands. METHODS: Data on patients with subtrochanteric femur fractures sustained between January 1, 2000 and December 31, 2019 were extracted from the National Medical Registration of the Dutch Hospital Database. Incidence rates, HLOS, health care and productivity costs were calculated in sex- and age-specific groups. RESULTS: A total of 14,399 patients sustained a subtrochanteric fracture in the 20-year study period. Incidence rates in the entire population dropped by 15.5 % from 4.5 to 3.8 per 100,000 person years (py). This decline was larger in women (6.4 to 5.2 per 100,000 py, -19.8 %) than in men (2.6 to 2.5 per 100,000 py, -4.0 %). HLOS declined by 62.5 % from a mean of 21.6 days in 2000-2004 to 8.1 days in 2015-2019. Subtrochanteric fractures were associated with total annual costs of €15.5 M, of which 91 % (€14.1 M) were health care costs and €1.3 M were costs due to lost productivity. Mean healthcare costs per case were lower in men (€16,394) than in women (€23,154). CONCLUSION: The incidence rates and HLOS of subtrochanteric fractures in the Netherlands have decreased in the 2000-2019 study period and subtrochanteric fractures are associated with a relatively small total annual cost of €15.5 M. Increasing incidence rates and a bimodal age distribution, described in previous studies from other European countries, were not found in the Dutch population.


Assuntos
Fraturas do Quadril , Masculino , Humanos , Feminino , Incidência , Países Baixos/epidemiologia , Fraturas do Quadril/epidemiologia , Fêmur , Custos de Cuidados de Saúde
10.
Arch Osteoporos ; 19(1): 18, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38503995

RESUMO

Fracture risk stratification is crucial in countries with limited access to bone density measurement. 24.8% women were in the high-risk category while 30.4% were in the low-risk category. In the intermediate risk group, after recalculation of fracture risk with bone density, 38.3% required treatment. In more than half, treatment decisions can be made without bone density. PURPOSE: We aimed to examine the role of age-dependent intervention thresholds (ITs) applied to the Fracture Risk Assessment (FRAX) tool in therapeutic decision making for osteoporosis in the Malaysian population. METHODS: Data were collated from 1380 treatment-naïve postmenopausal women aged 40-85 years who underwent bone mineral density (BMD) measurements for clinical reasons. Age-dependent ITs, for both major osteoporotic fracture (MOF) and hip fracture (HF), were calculated considering a woman with a BMI of 25 kg/m2, aged between 40 and 85years, with a prior fragility fracture, sans other clinical risk factors. Those with fracture probabilities equal to or above upper assessment thresholds (UATs) were considered to have high fracture risk. Those below the lower assessment thresholds (LATs) were considered to have low fracture risk. RESULTS: The ITs of MOF and HF ranged from 0.7 to 18% and 0.2 to 8%, between 40 and 85years. The LATs of MOF ranged from 0.3 to 11%, while those of HF ranged from 0.1 to 5.2%. The UATs of MOF and HF were 0.8 to 21.6% and 0.2 to 9.6%, respectively. In this study, 24.8% women were in the high-risk category while 30.4% were in the low-risk category. Of the 44.8% (n=618) in the intermediate risk group, after recalculation of fracture risk with BMD input, 38.3% (237/618) were above the ITs while the rest (n=381, 61.7%) were below the ITs. Judged by the Youden Index, 11.5% MOF probability which was associated with a sensitivity of 0.62 and specificity of 0.83 and 4.0% HF probability associated with a sensitivity of 0.63 and a specificity 0.82 were found to be the most appropriate fixed ITs in this analysis. CONCLUSION: Less than half of the study population (44.8%) required BMD for osteoporosis management when age-specific assessment thresholds were applied. Therefore, in more than half, therapeutic decisions can be made without BMD based on these assessment thresholds.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Medição de Risco , Osteoporose/epidemiologia , Osteoporose/terapia , Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/complicações , Densidade Óssea , Fatores de Risco , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Fraturas do Quadril/complicações , Tomada de Decisões
11.
BMC Geriatr ; 24(1): 296, 2024 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-38549043

RESUMO

BACKGROUND: Hip fractures are a serious health concern among the elderly, particularly in patients with hypertension, where the incidence of acute heart failure preoperatively is high, significantly affecting surgical outcomes and prognosis. This study aims to assess the risk of preoperative acute heart failure in elderly patients with hypertension and hip fractures by constructing a predictive model using machine learning on potential risk factors. METHODS: A retrospective study design was employed, collecting preoperative data from January 2018 to December 2019 of elderly hypertensive patients with hip fractures at the Third Hospital of Hebei Medical University. Using SPSS 24.0 and R software, predictive models were established through LASSO regression and multivariable logistic regression analysis. The models' predictive performance was evaluated using metrics such as the concordance index (C-index), receiver operating characteristic curve (ROC curve), and decision curve analysis (DCA), providing insights into the nomogram's predictive accuracy and clinical utility. RESULTS: Out of 1038 patients screened, factors such as gender, age, history of stroke, arrhythmias, anemia, and complications were identified as independent risk factors for preoperative acute heart failure in the study population. Notable predictors included Sex (OR 0.463, 95% CI 0.299-0.7184, P = 0.001), Age (OR 1.737, 95% CI 1.213-2.488, P = 0.003), Stroke (OR 1.627, 95% CI 1.137-2.327, P = 0.008), Arrhythmia (OR 2.727, 95% CI 1.490-4.990, P = 0.001), Complications (OR 2.733, 95% CI 1.850-4.036, P < 0.001), and Anemia (OR 3.258, 95% CI 2.180-4.867, P < 0.001). The prediction model of acute heart failure was Logit(P) = -2.091-0.770 × Sex + 0.552 × Age + 0.487 × Stroke + 1.003 × Arrhythmia + 1.005 × Complications + 1.181 × Anemia, and the prediction model nomogram was established. The model's AUC was 0.785 (95% CI, 0.754-0.815), Decision curve analysis (DCA) further validated the nomogram's excellent performance, identifying an optimal cutoff value probability range of 3% to 58% for predicting preoperative acute heart failure in elderly patients with hypertension and hip fractures. CONCLUSION: The predictive model developed in this study is highly accurate and serves as a powerful tool for the clinical assessment of the risk of preoperative acute heart failure in elderly hypertensive patients with hip fractures, aiding in the optimization of preoperative risk assessment and patient management.


Assuntos
Anemia , Insuficiência Cardíaca , Fraturas do Quadril , Hipertensão , Acidente Vascular Cerebral , Idoso , Humanos , Estudos Retrospectivos , Fraturas do Quadril/complicações , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Aprendizado de Máquina , Arritmias Cardíacas , Fatores de Risco
12.
Lakartidningen ; 1212024 01 30.
Artigo em Sueco | MEDLINE | ID: mdl-38343318

RESUMO

In Sweden, secondary prevention of fragility fractures through osteoporosis medication is directed by national guidelines. According to these, postmenopausal women and men who have suffered a fragility fracture should be assessed and pharmaceutical treatment of osteoporosis should always be considered. For the most serious fractures (hip and vertebral fractures), treatment can be initiated immediately. Despite this, previous studies have shown that the level of pharmaceutical treatment is low. In Sweden, osteoporosis drugs are predominantly administered by prescription, but about one-third of drugs are nowadays administered on-site in the health care system, which is not recorded in national registers. We have estimated the total amount of osteoporosis drugs through aggregated sales statistics. Our results show that medical treatment with osteoporosis drugs is still at low levels, covering approximately 5 percent of the population aged 70 or older, with clear differences between regions.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Masculino , Feminino , Humanos , Prevenção Secundária/métodos , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Fraturas Ósseas/complicações , Prescrições , Preparações Farmacêuticas , Fraturas por Osteoporose/prevenção & controle , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle
13.
Bone ; 182: 117051, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38382701

RESUMO

Areal bone mineral density (aBMD) currently represents the clinical gold standard for hip fracture risk assessment. Nevertheless, it is characterised by a limited prediction accuracy, as about half of the people experiencing a fracture are not classified as at being at risk by aBMD. In the context of a progressively ageing population, the identification of accurate predictive tools would be pivotal to implement preventive actions. In this study, DXA-based statistical models of the proximal femur shape, intensity (i.e., density) and their combination were developed and employed to predict hip fracture on a retrospective cohort of post-menopausal women. Proximal femur shape and pixel-by-pixel aBMD values were extracted from DXA images and partial least square (PLS) algorithm adopted to extract corresponding modes and components. Subsequently, logistic regression models were built employing the first three shape, intensity and shape-intensity PLS components, and their ability to predict hip fracture tested according to a 10-fold cross-validation procedure. The area under the ROC curves (AUC) for the shape, intensity, and shape-intensity-based predictive models were 0.59 (95%CI 0.47-0.69), 0.80 (95%CI 0.70-0.90) and 0.83 (95%CI 0.73-0.90), with the first being significantly lower than the latter two. aBMD yielded an AUC of 0.72 (95%CI 0.59-0.82), found to be significantly lower than the shape-intensity-based predictive model. In conclusion, a methodology to assess hip fracture risk uniquely based on the clinically available imaging technique, DXA, is proposed. Our study results show that hip fracture risk prediction could be enhanced by taking advantage of the full set of information DXA contains.


Assuntos
Densidade Óssea , Fraturas do Quadril , Humanos , Feminino , Estudos Retrospectivos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Fêmur , Modelos Estatísticos , Absorciometria de Fóton/métodos
14.
Eur Geriatr Med ; 15(2): 305-332, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38418713

RESUMO

PURPOSE: To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. METHODS: A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. RESULTS: We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. CONCLUSION: These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.


Assuntos
Acidentes por Quedas , Fraturas do Quadril , Humanos , Idoso , Acidentes por Quedas/prevenção & controle , Fraturas do Quadril/epidemiologia , Atividades Cotidianas , Comorbidade , Processos Mentais
15.
Injury ; 55(3): 111377, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38324951

RESUMO

Recent data from the UK's National Hip Fracture Database (NHFD) demonstrate an upward trajectory in the incidence of hip fractures, a trend which is expected to persist. In 2023 alone, the NHFD reported 72,160 cases, underscoring the prevalence of these injuries. These fractures are associated with significant morbidity, mortality, and economic costs. National guidelines for the surgical management of these fractures are established, although the implementation of total hip arthroplasty (THA) as a primary treatment modality varies. This review offers a narrative synthesis of contemporary literature on hip fractures, focusing on epidemiology, classification systems, and treatment options, with a particular emphasis on the outcomes of THA.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Hemiartroplastia , Fraturas do Quadril , Humanos , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fixação Interna de Fraturas
16.
Calcif Tissue Int ; 114(4): 315-325, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38300303

RESUMO

Osteosarcopenia is the coexistence of low bone mass and sarcopenia. In older women, its prevalence is not well described, and it is unknown if sarcopenia is additive to low bone mass for fracture and mortality risk. The study investigated prevalence of osteosarcopenia and if osteosarcopenia is associated with higher fracture and mortality risk than low bone mass alone in older community-dwelling women. The longitudinal, population-based OPRA Cohort (n = 1044), all aged 75 at inclusion, followed for 10 years. Using WHO and EWGSOP2 definitions for low bone mass (T-score < -1.0 femoral neck) and sarcopenia (knee strength; appendicular lean muscle mass) women were categorized (1) Normal, (2) Low bone mass (LBM), and 3) Osteosarcopenia (probable; confirmed). Risk of hip, major osteoporotic fracture, and mortality were estimated. Osteosarcopeniaconfirmed prevalence increased from age 75 to 80 and 85 from 3.0% (29/970) to 4.9% (32/656) to 9.2% (33/358) but prevalence is potentially 2-4 times higher (11.8%, 13.4%, 20.3%) based on osteosarcopeniaprobable. Having osteosarcopeniaprobable significantly increased 10-year risk of hip fracture (HRadj 2.67 [1.34-5.32]), major osteoporotic fracture (HRadj 2.04 [1.27-3.27]), and mortality (HRadj 1.91 [1.21-3.04]). In contrast, LBM increased osteoporotic fracture risk (HRadj 2.08 [1.46-2.97], but not hip fracture (HRadj 1.62 [0.92-2.85]) or mortality (HRadj 0.94 [0.64-1.38]). Median time-to-hip fracture was 7.6 years (normal), 6.0 years (LBM), and 5.7 years (osteosarcopeniaprobable). Prevalence of confirmed osteosarcopenia is almost 10% at age 85. Probable osteosarcopenia significantly increased risk of hip and major osteoporotic fractures and mortality more so than low bone mass alone.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Sarcopenia , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Osteoporose/complicações , Osteoporose/epidemiologia , Sarcopenia/complicações , Sarcopenia/epidemiologia , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Prevalência , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia
17.
Calcif Tissue Int ; 114(4): 326-339, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38340169

RESUMO

To describe the secular trend and seasonality of the incidence of hip fracture (HF) and its relationship with climatic variables during the period 2010-2019 in Catalonia in people aged ≥ 65 years. The results were analyzed by sex, age groups (65-74, 75-84, and ≥ 85), and types of fracture (extracapsular and intracapsular). Data on sex, age, type of fracture, year, and month of hospitalization of patients admitted with a diagnosis of HF between January 1, 2010 and December 31, 2019 were collected. Crude and standardized HF incidence (HFi) rates were obtained. Data on the monthly mean of climatological variables (temperature, insolation, icy days, rain, relative humidity, atmospheric pressure, and wind force) were obtained from the network of meteorological stations in Catalonia. Time series analytical statistics were used to identify trends and seasonality. Linear regression and a seasonal autoregressive integrated moving average (ARIMA) were used to analyze the relationship of each climatic parameter with fracture rates. In addition, generalized additive models were used to ascertain the best predictive model. The total number of HF episodes was 90,149 (74.1% in women and 25.9% in men). The total number of HFs increased by 6.4% between 2010 and 2019. The median age (SD) was 84.5 (7.14) and 54% of patients were ≥ 85 years of age. Extracapsular fractures were the most common (55%). The standardized incidence rates decreased from 728.1/100,000 (95% CI 738.6-769.3) to 624.5/100,000 (95% CI 648.7-677.0), which represents a decrease of 14.2% (p < 0.05). The decline was greater at older ages. There were seasonal variations, with higher incidences in autumn (27.2%) and winter (25.7%) and lower rates in summer (23.5%) and spring (23.6%). Seasonality was more pronounced in elderly people and men. In the bivariate regression analysis, high temperatures and greater insolation were negatively associated with the HF rate, while the number of icy days, rainy days, and high relative humidity were associated with a higher incidence of fractures in all age groups and sexes. In the regression analysis using the seasonal ARIMA model, only insolation had a consistently significant association with overall HFi, after adjusting by trend and other climatic parameters. While the global number of HFs grew in Catalonia due to increases in the elderly population, the standardized HF rate decreased during the years 2010-2019. There was a seasonal trend, with predominance in the cold months and correlations with climatic parameters, especially with insolation.


Assuntos
Fraturas do Quadril , Masculino , Humanos , Idoso , Feminino , Idoso de 80 Anos ou mais , Espanha/epidemiologia , Estações do Ano , Fraturas do Quadril/epidemiologia , Análise de Regressão , Temperatura Baixa , Incidência
18.
Bone ; 181: 117032, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38307177

RESUMO

OBJECTIVE: The adverse impacts of meteorological factors on human health have attracted great attention. However, no studies have investigated the nonlinear effects of humidex on hip fractures (HF), particularly in middle-aged and older adults. This study aimed to quantify the impacts of humidex, a comprehensive index of temperature and relative humidity, on HF admissions. METHODS: Daily HF admissions, meteorological variables and air pollutants in the subtropical coastal city of Shantou, China, from 2015 to 2020 were collected. A generalized linear regression model combined with a distributed lag nonlinear model was applied to explore the exposure-lag-response relationship between humidex and HF admissions. Subgroup analyses were also conducted by gender, age and season. Attributable fractions (AF) and attributable numbers (AN) were used to represent the burden of disease. RESULTS: A total of 6200 HF admissions were identified during the study period. Taking the median humidex (31.9) as a reference, the single-day lag effects of low humidex (13, 2.5th percentile) were significant at lag 0 [relative risk (RR) = 1.145, 95 % confidence interval (CI): 1.041-1.259] to lag 2 (RR = 1.049, 95 % CI: 1.010-1.089). The cumulative lag effects of low humidex were significant at lag 0-0 (RR = 1.145, 95 % CI: 1.041-1.259) to lag 0-6 (RR = 1.258, 95 % CI: 1.010-1.567) and reached a maximum at lag 0-3 (RR = 1.330, 95 % CI: 1.113-1.590). High humidex (44, 97.5th percentile) was not associated with the risk of HF. Females and people over the age of 75 appeared to be more susceptible to low humidex. In addition, the adverse effects of low humidex were more pronounced in the cold season. The AF and AN of low humidex on HF admissions were 24.8 % (95 % CI: 10.2-37.1 %) and 1538, respectively. CONCLUSION: Low humidex was associated with an increased risk of HF admissions. The government should take timely measures to prevent people from being exposed to low humidex to effectively reduce HF admissions.


Assuntos
Fraturas do Quadril , Hospitalização , Feminino , Pessoa de Meia-Idade , Humanos , Idoso , Temperatura , Estações do Ano , Temperatura Baixa , China/epidemiologia , Fraturas do Quadril/epidemiologia
19.
BMC Musculoskelet Disord ; 25(1): 143, 2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38355490

RESUMO

BACKGROUND: Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF. METHODS: A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis. RESULTS: We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection. CONCLUSION: Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.


Assuntos
Doença das Coronárias , Insuficiência Cardíaca , Fraturas do Quadril , Humanos , Idoso , Estudos Retrospectivos , Estudos de Coortes , Prognóstico , Estudos de Casos e Controles , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fatores de Risco , Insuficiência Cardíaca/epidemiologia , Hemoglobinas/análise , Albuminas
20.
JAMA Netw Open ; 7(2): e241107, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38421643

RESUMO

Importance: Previous research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods. Objective: To examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses' Health Study. Design, Setting, and Participants: This cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses' Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023. Main outcomes and Measures: Hip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture. Results: In total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend). Conclusions and Relevance: Findings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.


Assuntos
Fraturas do Quadril , Animais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos de Coortes , Pós-Menopausa , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Dieta , Verduras
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