Archives of Osteoporosis

, 14:37 | Cite as

Epidemiological and clinical study of hip fracture in hospitalized elderly patients in Shanghai, China

  • Minmin Chen
  • Yanhua Zhang
  • Yanping Du
  • Wei Hong
  • Wenjing Tang
  • Huilin Li
  • Songbai ZhengEmail author
  • Qun ChengEmail author
Original Article



In this study, we attempted to determine the epidemiology and clinical characteristics of hip fracture in the elderly. We find that elderly people with hip fracture have multiple comorbidities and suffer numerous complications.


We attempted to explore the epidemiology and clinical characteristics of hip fracture in the elderly.


One thousand five hundred thirty-nine patients aged over 65 years were included in the retrospective study. From the medical records, information was gathered about pre-fracture conditions, as well as fracture type, surgical details, laboratory indicators, postoperative complications, length of stay, outcomes, and costs of hospitalization. Binary logistic regression was used to screen for potential risk factors for perioperative complications and postoperative death, and general linear models were used to determine factors that influenced the cost of surgical treatment.


The average age of hip fracture patients in our study was 82.20 ± 6.82 years old, and the male-to-female ratio was 1:2.82. In 1356 patients who underwent hip surgery, the incidence of perioperative complications was 6.71% (91/1356), and the postoperative mortality rate was 1.11% (15/1356). Factors associated with perioperative complications were male sex, heart function class III or higher, serum albumin < 35 g/L, respiratory diseases, and perioperative blood transfusion (P < 0.05). Perioperative blood transfusion was an independent risk factor for postoperative death after hip fracture in the elderly (P < 0.05). The main factors that influenced hospitalization expenses related to elderly hip fracture patients were type of surgery, method of anesthesia, length of stay, perioperative complications, and outcomes (P < 0.05).


Elderly people with hip fracture have multiple comorbidities and suffer numerous complications. Thus, randomized intervention studies should focus on prevention of complications that might be avoidable.


Hip fracture Perioperative complications Risk factors Cause of death Epidemiology 



We thank all participants of the study and the laboratory staff who helped conducted the study.


This study was supported by the National Natural Science Foundation of China (NSFC; no. 81471089), Shanghai Municipal Commission of Health (2013ZYJB0801), and Shanghai Key Laboratory of Clinical Geriatric Medicine (13dz2260700).

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Singer A, Exuzides A, Spangler L, O'Malley C, Colby C, Johnston K, Agodoa I, Baker J, Kagan R (2015) Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 90:53–62CrossRefGoogle Scholar
  2. 2.
    Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795CrossRefGoogle Scholar
  3. 3.
    Sernbo I, Johnell O (1993) Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 3:148–153CrossRefGoogle Scholar
  4. 4.
    Shen SH, Huang KC, Tsai YH, Yang TY, Lee MS, Ueng SW, Hsu RW (2014) Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc 15:725–731CrossRefGoogle Scholar
  5. 5.
    Leslie WD, Lix LM, Finlayson GS, Metge CJ, Morin SN, Majumdar SR (2013) Direct healthcare costs for 5 years post-fracture in Canada: a long-term population-based assessment. Osteoporos Int 24:1697–1705CrossRefGoogle Scholar
  6. 6.
    Ahlborg HG, Rosengren BE, Jarvinen TL, Rogmark C, Nilsson JA, Sernbo I, Karlsson MK (2010) Prevalence of osteoporosis and incidence of hip fracture in women—secular trends over 30 years. BMC Musculoskelet Disord 11:48CrossRefGoogle Scholar
  7. 7.
    Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC (2016) Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status. Bone 87:19–26CrossRefGoogle Scholar
  8. 8.
    Dhanwal DK, Cooper C, Dennison EM (2010) Geographic variation in osteoporotic hip fracture incidence: the growing importance of Asian influences in coming decades. J Osteoporos 2010:757102CrossRefGoogle Scholar
  9. 9.
    Povoroznyuk VV, Grygorieva NV, Kanis JA, McCloskey EV, Johansson H, Strafun SS, Korzh MO, Vaida VM, Klymovytsky FV, Forosenko VS, Vlasenko RO Epidemiology of hip fractures in two regions of Ukraine. J Osteoporos 2018, 2018:7182873Google Scholar
  10. 10.
    Lv H, Yin P, Long A, Gao Y, Zhao Z, Li J, Zhang L, Zhang L, Tang P (2016) Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study. Osteoporos Int 27:3001–3009CrossRefGoogle Scholar
  11. 11.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650CrossRefGoogle Scholar
  12. 12.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413CrossRefGoogle Scholar
  13. 13.
    Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288CrossRefGoogle Scholar
  14. 14.
    Cummings SR, Xu L, Chen X, Zhao X, Yu W, Ge Q (1994) Bone mass, rates of osteoporotic fractures, and prevention of fractures: are there differences between China and Western countries? Chin Med Sci J 9:197–200PubMedGoogle Scholar
  15. 15.
    Lin X, Xiong D, Peng YQ, Sheng ZF, Wu XY, Wu XP, Wu F, Yuan LQ, Liao EY (2015) Epidemiology and management of osteoporosis in the People’s Republic of China: current perspectives. Clin Interv Aging 10:1017–1033PubMedPubMedCentralGoogle Scholar
  16. 16.
    Emaus N, Olsen LR, Ahmed LA, Balteskard L, Jacobsen BK, Magnus T, Ytterstad B (2011) Hip fractures in a city in northern Norway over 15 years: time trends, seasonal variation and mortality : the Harstad Injury Prevention Study. Osteoporos Int 22:2603–2610CrossRefGoogle Scholar
  17. 17.
    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 23:2239–2256CrossRefGoogle Scholar
  18. 18.
    Pfeilschifter J (2015) Diagnosing osteoporosis: what is new in the 2014 DVO guideline? Dtsch Med Wochenschr 140:1667–1671CrossRefGoogle Scholar
  19. 19.
    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):i37–i41CrossRefGoogle Scholar
  20. 20.
    Henderson CY, Ryan JP (2015) Predicting mortality following hip fracture: an analysis of comorbidities and complications. Ir J Med Sci 184:667–671CrossRefGoogle Scholar
  21. 21.
    Oh ES, Sieber FE, Leoutsakos JM, Inouye SK, Lee HB (2016) Sex differences in hip fracture surgery: preoperative risk factors for delirium and postoperative outcomes. J Am Geriatr Soc 64:1616–1621CrossRefGoogle Scholar
  22. 22.
    Khan SK, Rushton SP, Shields DW, Corsar KG, Refaie R, Gray AC, Deehan DJ (2015) The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture surgery. INJURY 46:358–362CrossRefGoogle Scholar
  23. 23.
    Meals C, Roy S, Medvedev G, Wallace M, Neviaser RJ, O'Brien J (2016) Identifying the risk of swallowing-related pulmonary complications in older patients with hip fracture. ORTHOPEDICS 39:e93–e97CrossRefGoogle Scholar
  24. 24.
    Brown CA, Boling J, Manson M, Owens T, Zura R (2012) Relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture. South Med J 105:306–310CrossRefGoogle Scholar
  25. 25.
    Oh ES, Li M, Fafowora TM, Inouye SK, Chen CH, Rosman LM, Lyketsos CG, Sieber FE, Puhan MA (2015) Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry 30:900–910CrossRefGoogle Scholar
  26. 26.
    Poh KS, Lingaraj K (2013) Complications and their risk factors following hip fracture surgery. J Orthop Surg (Hong Kong) 21:154–157CrossRefGoogle Scholar
  27. 27.
    Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ (2015) Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J 97-B:246–251CrossRefGoogle Scholar
  28. 28.
    Eschbach DA, Oberkircher L, Bliemel C, Mohr J, Ruchholtz S, Buecking B (2013) Increased age is not associated with higher incidence of complications, longer stay in acute care hospital and in hospital mortality in geriatric hip fracture patients. Maturitas 74:185–189CrossRefGoogle Scholar
  29. 29.
    Merchant RA, Lui KL, Ismail NH, Wong HP, Sitoh YY (2005) The relationship between postoperative complications and outcomes after hip fracture surgery. Ann Acad Med Singap 34:163–168PubMedGoogle Scholar
  30. 30.
    Ferguson JF, Patel PN, Shah RY, Mulvey CK, Gadi R, Nijjar PS, Usman HM, Mehta NN, Shah R, Master SR, Propert KJ, Reilly MP (2013) Race and gender variation in response to evoked inflammation. J Transl Med 11:63CrossRefGoogle Scholar
  31. 31.
    Dong X, Mendes DLC, Artz A, Tang Y, Shah R, Evans D (2008) A population-based study of hemoglobin, race, and mortality in elderly persons. J Gerontol A Biol Sci Med Sci 63:873–878CrossRefGoogle Scholar
  32. 32.
    Rohrig G (2016) Anemia in the frail, elderly patient. Clin Interv Aging 11:319–326CrossRefGoogle Scholar
  33. 33.
    Shokoohi A, Stanworth S, Mistry D, Lamb S, Staves J, Murphy MF (2012) The risks of red cell transfusion for hip fracture surgery in the elderly. Vox Sang 103:223–230CrossRefGoogle Scholar
  34. 34.
    van der Zanden V, Beishuizen SJ, Scholtens RM, de Jonghe A, de Rooij SE, van Munster BC (2016) The effects of blood transfusion on delirium incidence. J Am Med Dir Assoc 17:748–753CrossRefGoogle Scholar
  35. 35.
    Qu B, Ma Y, Yan M, Wu HH, Fan L, Liao DF, Pan XM, Hong Z (2014) The economic burden of fracture patients with osteoporosis in western China. Osteoporos Int 25:1853–1860CrossRefGoogle Scholar
  36. 36.
    Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Minmin Chen
    • 1
    • 2
  • Yanhua Zhang
    • 3
  • Yanping Du
    • 1
    • 2
  • Wei Hong
    • 1
    • 2
  • Wenjing Tang
    • 1
    • 2
  • Huilin Li
    • 1
    • 2
  • Songbai Zheng
    • 2
    Email author
  • Qun Cheng
    • 1
    • 2
    Email author
  1. 1.Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Department of Osteoporosis and Bone DiseaseHuadong Hospital affiliated to Fudan UniversityShanghaiChina
  2. 2.Research Center on Aging and MedicineFudan UniversityShanghaiChina
  3. 3.Department of General MedicineSanmenxia Central Hospital of Henan ProvinceSanmenxiaChina

Personalised recommendations