Osteoporosis International

, Volume 28, Issue 1, pp 269–277 | Cite as

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment

  • E. C. Folbert
  • J. H. Hegeman
  • M. Vermeer
  • E. M. Regtuijt
  • D. van der Velde
  • H. J. ten Duis
  • J. P. Slaets
Original Article



To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care.


The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors.


This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008.


The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4–5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1–2 OR 1.46, CCI 3–4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96).


After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.


Hip fracture Orthogeriatric models of care Mortality Risk factors 


Compliance with ethical standards

Conflicts of interest

Ellis Folbert states that there has been funding from the Nurse Practitioners Association Research Foundation (OWVS Foundation) for language editing of this manuscript. Ellis Folbert, Han Hegeman, Marloes Vermeer, Marlies Regtuijt, Detlef van der Velde, Henk Jan ten Duis, and Joris Slaets declare that they have no conflict of interest.

Ethical approval

The Medical Ethical Committee of Medisch Spectrum Twente (MST) at Enschede, the Netherlands, declares that this study does not meet the criteria necessary for an assessment by a medical ethical committee according to Dutch law (K15-54).


  1. 1.
    Klop C, Welsing PMJ, Leufkens HGM, Elders PJM, Overbeek JA et al (2015) The epidemiology of hip and major osteoporotic fractures in a Dutch population of community-dwelling elderly: implications for the Dutch FRAX® algorithm. PLoS One 10(12), e0143800. doi:10.1371/journal.pone.0143800, eCollection 2015CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733, Epub 2006/09/20CrossRefPubMedGoogle Scholar
  3. 3.
    Friedman SM, Mendelson DA (2014) Epidemiology of fragility fractures. Clin Geriatr Med 30(2):175–181, Epub 2014/04/12CrossRefPubMedGoogle Scholar
  4. 4.
    Hartholt KA, Oudshoorn C, Zielinski SM et al (2011) The epidemic of hip fractures: are we on the right track? PLoS One 6(7), e22227, Epub 2011/07/30CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20(10):1633–1650, Epub 2009/05/08CrossRefPubMedGoogle Scholar
  6. 6.
    Bertram M, Norman R, Kemp L, Vos T (2011) Review of the long-term disability associated with hip fractures. Inj Prev 17(6):365–370, Epub 2011/04/14CrossRefPubMedGoogle Scholar
  7. 7.
    Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K et al (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet (London, England) 385(9978):1623–1633, Epub 2015/02/11CrossRefGoogle Scholar
  8. 8.
    Sabharwal S, Wilson H (2015) Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteoporos Int 26(10):2387–2399CrossRefPubMedGoogle Scholar
  9. 9.
    Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U et al (2010) Ortho-geriatric service–a literature review comparing different models. Osteoporosis Int 21(Suppl 4):S637–S646, Epub 2010/11/26CrossRefGoogle Scholar
  10. 10.
    Grigoryan KV, Javedan HMS, Rudolph JLD (2014) Ortho-geriatric care models and outcomes in Hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28(3):e49–e55. doi:10.1097/BOT.0b013e3182a5a045 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M et al (2013) Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury 44(11):1403–1412, Epub 2013/07/25CrossRefPubMedGoogle Scholar
  12. 12.
    https://www.nice.org.uk/guidance/cg124. Hip fracture management in adults. Publication date 2011. Accessed 2016, April 09
  13. 13.
    https://www.vmszorg.nl/themas/kwetsbare-ouderen. Safety Management program Frail elderly scoring system. [webpage] The Hague, 2009. Accessed 2015, December 31
  14. 14.
    Fitz-Henry J (2011) The ASA, classification and peri-operative risk. Ann R Coll Surg Engl 93(3):185–187, Epub 2011/04/12CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Maryland State Med J 14:61–65Google Scholar
  16. 16.
    Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br Volume 75(5):797–798, Epub 1993/09/01Google Scholar
  17. 17.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383, Epub 1987/01/01CrossRefPubMedGoogle Scholar
  18. 18.
    Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482, Epub 2005/09/03sGoogle Scholar
  19. 19.
    Friedman SM, Mendelson DA, Kates SL, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 56(7):1349–1356, Epub 2008/05/28CrossRefPubMedGoogle Scholar
  20. 20.
    Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF Sr (2005) Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv 4(1):27–31, Epub 2005/03/16Google Scholar
  21. 21.
    Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW et al (2010) Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. J Am Geriatr Soc 58(6):1081–1089, Epub 2010/08/21CrossRefPubMedGoogle Scholar
  22. 22.
    Auais M, Morin S, Nadeau L, Finch L, Mayo N (2013) Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporosis Int 24(10):2713–2724, Epub 2013/06/08CrossRefGoogle Scholar
  23. 23.
    Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A (2014) Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 43(1):122–126, Epub 2013/07/09CrossRefPubMedGoogle Scholar
  24. 24.
    Chen X, Mao G, Leng S (2014) Frailty syndrome: an overview. Clin Interv Aging 9:433–441. doi:10.2147/CIA.S45300 PubMedPubMedCentralGoogle Scholar
  25. 25.
    Joseph B, Pandit V, Zangbar P, Kulvatunyou N, Hashmi A, Green DJ et al (2014) Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg 149(8):766–772. doi:10.1001/jamasurg.2014.296 CrossRefPubMedGoogle Scholar
  26. 26.
    Milte R, Crotty M (2014) Musculoskeletal health, frailty and functional decline. Best Pract Res Clin Rheumatol 28(3):395–410. doi:10.1016/j.berh.2014.07.005, Epub 2014 Aug 16CrossRefPubMedGoogle Scholar
  27. 27.
    Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43(4):464–471, Epub 2014/06/05CrossRefPubMedGoogle Scholar
  28. 28.
    Partridge JS, Harari D, Dhesi JK (2012) Frailty in the older surgical patient: a review. Age Ageing 41(2):142–147, Epub 2012/02/22CrossRefPubMedGoogle Scholar
  29. 29.
    Ireland AW, Kelly PJ, Cumming RG (2015) Risk factor profiles for early and delayed mortality after hip fracture: analyses of linked Australian Department of Veterans’ Affairs databases. Injury 46(6):1028–1035, Epub 2015/03/31CrossRefPubMedGoogle Scholar
  30. 30.
    Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, et al. Malnutrition according to mini nutritional assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc. 2015. Epub 2015/04/13Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • E. C. Folbert
    • 1
  • J. H. Hegeman
    • 1
  • M. Vermeer
    • 2
  • E. M. Regtuijt
    • 3
  • D. van der Velde
    • 1
  • H. J. ten Duis
    • 4
  • J. P. Slaets
    • 5
  1. 1.Department of Trauma SurgeryZiekenhuisgroep TwenteAlmelo/HengeloThe Netherlands
  2. 2.ZGT AcademyZiekenhuisgroep TwenteAlmelo/HengeloThe Netherlands
  3. 3.Department of Geriatric MedicineZiekenhuisgroep TwenteAlmelo/HengeloThe Netherlands
  4. 4.Department of SurgeryUniversity of Groningen (RUG)GroningenThe Netherlands
  5. 5.Department of Geriatric Medicine, Groningen and Leyden Academy on Vitality and AgeingUniversity Medical Centre GroningenLeidenThe Netherlands

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