Osteoporosis International

, Volume 24, Issue 9, pp 2387–2396

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

  • B. Leavy
  • A. C. Åberg
  • H. Melhus
  • H. Mallmin
  • K. Michaëlsson
  • L. Byberg
Original Article

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.

Keywords

Hip fracture Population based Psychotropic medications Seasonal variation Time of fracture 

Supplementary material

198_2013_2333_MOESM1_ESM.pdf (133 kb)
Online Resource 1Age- and sex-specific incidence of hip fractures admitted to Uppsala University Hospital during the period June 2009–June 2010 (PDF 133 kb)

References

  1. 1.
    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 22:2575–2586PubMedCrossRefGoogle Scholar
  2. 2.
    Youm T, Koval KJ, Kummer FJ, Zuckerman JD (1999) Do all hip fractures result from a fall? Am J Orthop 28:190–194PubMedGoogle Scholar
  3. 3.
    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 324:1326–1331PubMedCrossRefGoogle Scholar
  4. 4.
    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 30:607–616PubMedCrossRefGoogle Scholar
  5. 5.
    Norton R, Campbell AJ, Reid IR, Butler M, Currie R, Robinson E, Gray H (1999) Residential status and risk of hip fracture. Age Ageing 28:135–139PubMedCrossRefGoogle Scholar
  6. 6.
    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 25:381–385PubMedCrossRefGoogle Scholar
  7. 7.
    Aharonoff GB, Dennis MG, Elshinawy A, Zuckerman JD, Koval KJ (1998) Circumstances of falls causing hip fractures in the elderly. Clin Orthop Relat Res 10–14Google Scholar
  8. 8.
    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 14:728–734PubMedCrossRefGoogle Scholar
  9. 9.
    Cumming RG, Klineberg RJ (1994) Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 42:774–778PubMedGoogle Scholar
  10. 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 52:192–198PubMedCrossRefGoogle Scholar
  11. 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 136:733–741PubMedCrossRefGoogle Scholar
  12. 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 53:41–52PubMedGoogle Scholar
  13. 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 46:1294–1298PubMedCrossRefGoogle Scholar
  14. 14.
    Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19:860–867PubMedCrossRefGoogle Scholar
  15. 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 43:1130–1139PubMedCrossRefGoogle Scholar
  16. 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 65:183–187PubMedCrossRefGoogle Scholar
  17. 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 271:128–133PubMedCrossRefGoogle Scholar
  18. 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 24:771–782PubMedCrossRefGoogle Scholar
  19. 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 302:1666–1673PubMedCrossRefGoogle Scholar
  20. 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:e199PubMedCrossRefGoogle Scholar
  21. 21.
    Michaelsson K, Melhus H, Ferm H, Ahlbom A, Pedersen NL (2005) Genetic liability to fractures in the elderly. Arch Intern Med 165:1825–1830PubMedCrossRefGoogle Scholar
  22. 22.
    Cox NJ (2006) Speaking Stata: in praise of trigonometric predictors. Stata J 6:561–579Google Scholar
  23. 23.
    Rothman K (2008) Episheet—spreadsheets for the analysis of epidemiologic data. http://www.drugepi.org/dope-downloads Accessed 4th July 2012
  24. 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. 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 17:1237–1244PubMedCrossRefGoogle Scholar
  26. 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):2239–2256PubMedCrossRefGoogle Scholar
  27. 27.
    Ramnemark A, Nilsson M, Borssen B, Gustafson Y (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577PubMedCrossRefGoogle Scholar
  28. 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 19:1267–1273PubMedCrossRefGoogle Scholar
  29. 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 8:533–537PubMedCrossRefGoogle Scholar
  30. 30.
    Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF (2010) Older hip fracture patients: three groups with different needs. BMC Geriatr 10:65PubMedCrossRefGoogle Scholar
  31. 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 44:156–160PubMedGoogle Scholar
  32. 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 49:80–87PubMedCrossRefGoogle Scholar
  33. 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 63:232–237PubMedCrossRefGoogle Scholar
  34. 34.
    Gillespie WJ, Gillespie LD, Parker MJ (2010) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev CD001255Google Scholar
  35. 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 19:101–111PubMedCrossRefGoogle Scholar
  36. 36.
    Crawford JR, Parker MJ (2003) Seasonal variation of proximal femoral fractures in the United Kingdom. Injury 34:223–225PubMedCrossRefGoogle Scholar
  37. 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 18:1225–1233PubMedCrossRefGoogle Scholar
  38. 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 141:79–83PubMedGoogle Scholar
  39. 39.
    Modarres R, Ouarda TB, Vanasse A, Orzanco MG, Gosselin P (2012) Modeling seasonal variation of hip fracture in Montreal, Canada. Bone 50:909–916PubMedCrossRefGoogle Scholar
  40. 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–S29PubMedCrossRefGoogle Scholar
  41. 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 1:143–146PubMedCrossRefGoogle Scholar
  42. 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 95:2637–2645PubMedCrossRefGoogle Scholar
  43. 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 16:1425–1431PubMedCrossRefGoogle Scholar
  44. 44.
    Ceder L (2005) Predicting the success of rehabilitation following hip fractures. Disabil Rehabil 27:1073–1080PubMedCrossRefGoogle Scholar
  45. 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 78:115–118PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • B. Leavy
    • 1
    • 4
  • A. C. Åberg
    • 2
  • H. Melhus
    • 3
  • H. Mallmin
    • 1
  • K. Michaëlsson
    • 1
  • L. Byberg
    • 1
  1. 1.Department of Surgical Sciences, OrthopedicsUppsala UniversityUppsalaSweden
  2. 2.Department of Public Health and Caring Sciences, GeriatricsUppsala UniversityUppsalaSweden
  3. 3.Department of Medical Sciences, Osteoporosis and Clinical PharmacogeneticsUppsala UniversityUppsalaSweden
  4. 4.UCR/ScheeleUppsalaSweden

Personalised recommendations