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Hip fracture mortality and morbidity--can we do better?
C W Davidson1, M J Merrilees, T J Wilkinson
1Christchurch School of Medicine, Princess Margaret Hosital.
Insights
Hip fractures result in high mortality, particularly in men, and significant morbidity, including pain and reduced mobility. Osteoporosis management is often inadequate, with frequent vitamin D deficiency noted in patients.
Area of Science:
- Orthopedics
- Gerontology
- Public Health
Background:
- Hip fractures represent a significant cause of mortality and morbidity in the elderly.
- Effective management and prevention strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To assess mortality and morbidity associated with neck of femur fractures.
- To evaluate the investigation and treatment of osteoporosis in hip fracture patients.
Main Methods:
- Retrospective review of 331 hip fractures (May 1998-April 1999) at Christchurch Hospitals.
- Radiographic classification, mortality data collection, and 12-24 month functional outcome assessment via patient contact.
- Recording of bone density scans, osteoporosis treatment, and vitamin D levels.
Main Results:
- Twelve-month mortality was 26%, with higher rates in men, independent of age.
- Among survivors, 27% reported persistent pain and 60% experienced worsened mobility.
- Vitamin D levels were measured in 15% of patients, with 69% found to be deficient.
Conclusions:
- High mortality and morbidity underscore the need for improved hip fracture prevention.
- Current osteoporosis management is suboptimal, with limited use of therapies beyond calcium.
- Vitamin D deficiency is prevalent and under-recognized in this patient population.
Aims:
To determine the mortality and morbidity from fractures of the neck of femur in Christchurch Hospital and to determine the extent that hip fracture patients are investigated and treated for osteoporosis.
Methods:
All patients treated for a fractured hip at Christchurch Hospitals between May 1998 and April 1999 were identified. Their radiographs were reviewed and each fracture was classified. Dates of death were recorded where applicable. Surviving patients were contacted at least twelve months after their fracture and asked questions relating to functional outcome following surgery. The numbers of patients who had ever had a bone density scan, treatment for osteoporosis and/or a measurement of vitamin D were recorded.
Results:
There were 331 fractures among 329 patients (242 women, 87 men), mean age of 79.7 (standard deviation 10.5) years. Twelve-month mortality was 26%. Men had a higher mortality rate than women for all fracture types that was independent of age. Follow up of the 231 surviving patients 12-24 months later revealed 27% still had pain and 60% had worsened mobility that they attributed to the fracture. Worsened mobility affected people living at home more than people living in institutional care. 32 people (15%) had had a vitamin D concentration measured and in 22 of these (69%) levels were below the reference range.
Conclusions:
The mortality and morbidity after hip fracture is high, especially in men. There were few significant correlates with greater morbidity except for fixation by hemi arthroplasty. More attention to hip fracture prevention is needed. Few subjects were on any therapy for osteoporosis other than calcium supplements. Vitamin D deficiency is an important but under-recognised condition.
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