Original Article

Osteoporosis International

, Volume 24, Issue 9, pp 2387-2396

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

  • B. LeavyAffiliated withDepartment of Surgical Sciences, Orthopedics, Uppsala UniversityUCR/Scheele Email author 
  • , A. C. ÅbergAffiliated withDepartment of Public Health and Caring Sciences, Geriatrics, Uppsala University
  • , H. MelhusAffiliated withDepartment of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University
  • , H. MallminAffiliated withDepartment of Surgical Sciences, Orthopedics, Uppsala University
  • , K. MichaëlssonAffiliated withDepartment of Surgical Sciences, Orthopedics, Uppsala University
  • , L. BybergAffiliated withDepartment of Surgical Sciences, Orthopedics, Uppsala University

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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.


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.


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.


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.


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.


Hip fracture Population based Psychotropic medications Seasonal variation Time of fracture