Abstract
Summary
The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture. Hip fracture admissions increased over the study period. Men fared worst in terms of higher absolute mortality. Refracture rates and male health outcomes require further attention.
Purpose
The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture in South Australia (SA).
Methods
Analysis of routinely collected, linked hospital separations data, of patients admitted to public and private hospitals in SA with a principal diagnosis of femoral neck fracture between July 2002 and June 2008 was done. Main outcome measures include number and rates of hospital admissions, 30-day in-hospital and 1-year mortality following a first hip fracture and subsequent event rates, by age and sex.
Results
Unadjusted hip fracture admissions increased in SA from 2002 to 2008 by 20 %, age-standardised (adjusted) admission rates increased overall (+5 %, p = 0.215) and significantly amongst males (+26 %, p = 0.001), while there was no change among women (−1 %, p = 0.763). Within 1 year of a hip fracture, 7 % had broken another bone (5 % had refractured a hip). At 1 year post-fracture, unadjusted mortality was consistently and considerably higher amongst men compared to women (33 versus 19 %, p < 0.001). Age-standardised mortality from admission to 1 year fell but not statistically significantly by 15 % in women (p = 0.131) and 8 % in men (p = 0.510). Women had a reduction in age-standardised in-hospital mortality over time (p = 0.048); there was a non-significant decline in men (p = 0.080).
Conclusions
Hip fracture admissions in SA increased over the study period and this appears to be driven by an increase in admissions amongst men. Men fared worst in terms of higher absolute mortality. There is some evidence to suggest refracture rates and male health outcomes require further attention.
Similar content being viewed by others
References
AIHW (2010) The problem of osteoporotic hip fracture in Australia. AIHW, Canberra, Cat. no. AUS121
Madhok R, Melton LJ 3rd, Atkinson EJ et al (1993) Urban vs rural increase in hip fracture incidence: age and sex of 901 cases 1980-89 in Olmsted County. USA Acta Orthop Scand 64:543–548
Schroder HM, Petersen KK, Erlandsen M (1993) Occurrence and incidence of the second hip fracture. Clin Orthop 289:166–199
Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413
Magaziner J, Friedman L, Hawkes W et al (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community dwelling aged. Am J Epidemiol 157:1023–1031
Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250
Randell A, Sambrook P, Nguyen T et al (1995) Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 5(6):427–432
Wark JD (1996) Osteoporosis: the emerging epidemic. Med J Aust 164:327–328
Sanders KM, Nicholson GC, Ugoni AM et al (1999) Health burden of hip and other fractures in Australia beyond 2000 projections based on the Geelong Osteoporosis Study. Med J Aust 170:467–470
Brown DS (2004) Do leaves have to fall in their autumn? A falls prevention strategy in action in the South East of South Australia. Rural Remote Heal 4(231):1–9
ABS online resource 3201.0 Population by Age and Sex, Australian States and Territories, Jun 2010 (2011). http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3201.0Explanatory%20Notes1Jun%202010?OpenDocument. Accessed 1 April 2011
StataCorp (2009) Stata Statistical Software: release 11. StataCorp LP, College Station
Haentjens P, Magaziner J, Colón-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390
Brauer CA, Coca-Perraillon M, Cutler DM et al (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579
Ryg J, Rejnmark L, Overgaard S et al (2009) Hip fracture patients at risk of a second hip fracture: a nationwide population based cohort study of 169,145 cases 1977–2001. J Bone Miner Res 24:1299–1307
ABS online resource 3302.0.55.001—Life Tables, Australia. http://www.abs.gov.au/AUSSTATS/abs@.nsf/second+level+view?ReadForm&prodno=3302.0.55.001&viewtitle=Life%20Tables,%20Australia-2008-2010-Latest-10/11/2011&&tabname=Past%20Future%20Issues&prodno=3302.0.55.001&issue=2008-2010&num=&view=&. Accessed 6 June 2011
Fisher AA, O'Brien ED, Davis MW (2009) Trends in hip fracture epidemiology in Australia: possible impact of bisphosphonates and hormone replacement therapy. Bone 45:246–253
Pasco JA, Brennan SL, Henry MJ et al (2011) Changes in hip fracture rates in Southeastern Australia spanning the period 1994–2007. J Bone Miner Res 26:1648–1654
Cassell E, Clapperton A (2012) A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporos Int. doi:10.1007/s00198-012-1937-6
Leslie WD, O’Donnell SO, Jean S, for the Osteoporosis Surveillance Expert Working Group et al (2009) Trends in hip fracture rates in Canada. JAMA 302(8):883–889
Stevens JA, Rudd RA (2010) Declining hip fracture rates in the United States. Age Ageing 39(4):500–503
Lofthus CM, Osnes EK, Falch JA et al (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418
Rogmark C, Sernbo I, Johnell O et al (1999) Incidence of hip fractures in Malmo, Sweden, 1992–1995. Acta Orthop Scand 70:19–22
Jaglal SB, Weller I, Mamdani M et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905
Kannus P, Niemi S, Parkkari J et al (2006) Nationwide decline in incidence of hip fracture. J Bone Miner Res 21:1836–1838
Nymark T, Lauritsen JM, Ovesen O et al (2006) Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Orthop Scand 77:109–113
Evans JG, Seagroatt V, Goldacre MJ (1997) Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968-86. J Epidemiol Community Health 51:424–429
D’Agostino RB Jr, D’Agostino RB Sr (2007) Estimating treatment effects using observational data. JAMA 297(3):314–316
Acknowledgments
SA Health provided research funds to support the reported analyses via their Strategic Health Research Program.
Conflicts of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gordon, J., Pham, C.T., Karnon, J. et al. Monitoring progress in the management of hip fractures in South Australia, Australia. Arch Osteoporos 7, 267–273 (2012). https://doi.org/10.1007/s11657-012-0107-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11657-012-0107-y