Technically, hip fractures include pelvic fractures near the hip, acetabular, femoral head, femoral neck, intertrochanteric, and subtrochanteric fractures. More often than not, the term "hip fracture" is used when describing a fracture of the intertrochanteric, femoral neck, or subtrochanteric region in an older patient.
Fractures of the femoral neck have a bimodal distribution with young patients subjected to high energy trauma and older patients sustaining low energy falls. Intertrochanteric fractures occur more often in the elderly. On average the patient with the intertrochanteric fracture is 12 years older than the patient with the femoral neck fracture. Data indicate the trocanteric fractures are more associated with osteoporosis than neck fractures
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. Subtrochanteric fractures also occur in young and old populations. Hip fractures are increasing rapidly due to the rise in the elderly population. Approximately 1.7 million hip fractures occur each year in the world
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, and is estimated to increase to 6.3 million by 2050. The cost for hip fractures worldwide is approximately $34.8 billion US
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. Up to 30% of hip fracture patients die during the first year; it has been estimated that only 25% of deaths following hip fractures are due to the hip fracture itself, and the remaining are due to comorbidities
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. Only 50% regain their prefracture functional status
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. Displaced intracapsular hip fractures in healthy older patients have a 40% reoperation rate
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.
See also: Femoral head fractures Femoral neck fractures Intertrochanteric femur fractures Subtrochanteric femur fractures Acetabular fractures Pelvic fractures
Johnell O, Kanis J, 2005. "Epidemiology of osteoporotic fractures." Osteoporos Int 16 Suppl 2: S3-7 [PubMed]
Abstract:
Several osteoporotic fractures such as hip fractures have a very high morbidity and mortality, and there are similar new findings for vertebral fractures. There have been several definitions of an osteoporotic fracture, and recently updated definitions have specified fractures occurring at a site associated with low BMD and which increase in incidence after the age of 50 years. Other definitions are based on clinical diagnosis. Lifetime risk of any osteoporotic fracture is very high and lies within the range of 40-50% in women and 13-22% for men. Measuring the true burden of osteoporotic fractures involves multiplying the morbidity of hip fractures according to age group: for women aged 50-54 years, the disability caused by osteoporotic fractures is 6.07 times that accounted for by hip fracture alone, and for women aged 80-84 years, the incidence of hip fractures should be multiplied by 1.55; for men aged 50-54 years, the incidence of hip fractures should be multiplied by 4.48, and for those aged 80-84 years by 1.50.
Cooper C, Campion G, Melton LJ, 1992. "Hip fractures in the elderly: a world-wide projection." Osteoporos Int 2 (6): 285-9 [PubMed]
Abstract:
Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.
Johnell O, 1997. "The socioeconomic burden of fractures: today and in the 21st century." Am J Med 103 (2A): 20S-25S; discussion 25S-26S [PubMed]
Abstract:
Hip fractures are a burden to both the individual and the community. Only 50% of patients regain the mobility and independence they enjoyed 12 months before the hip fracture occurred. Direct costs are high: about US$7,000 for the immediate hospital care and $21,000 in total costs for the first year. The numbers of hip fractures worldwide are projected to increase from 1.7 million in 1990 to 6.3 million in 2050 because of the aging of the population; therefore, the total cost of these fractures will also increase. Based on today's currency values and a cost of $21,000 per patient, the total cost of hip fractures in the year 2050 will be $131.5 billion. The costs and morbidity associated with other fractures, such as vertebral fractures, are less well defined. Because hip fractures are associated with the highest and most well-defined costs, morbidity, and mortality of all fragility fractures, models with high sensitivity can now be devised for evaluating the costs and benefits of interventions. These models are constructed using data on incidence, morbidity, mortality, and costs of fractures, along with the efficacy of an intervention, to estimate the impact of that intervention against osteoporosis. According to one model, the cost per hip fracture avoided is $48,600 if a 62-year-old woman with osteoporosis receives treatment with a drug that is administered for 5 years at $830/year and produces a 50% reduction in fracture rate. The cost per life-year saved is $30,600, and the cost per quality-adjusted life-year is $14,900. By comparison, using this model, treatment of a 62-year-old woman with a diastolic pressure of 95 mm Hg using a drug costing $420/year that reduces risk of stroke by 38% results in costs of $144,200 per stroke avoided, $17,800 per life-year saved, and $14,300 per quality-adjusted life-year. Health economic models allow for changes in assumptions, such as extent of compliance, effectiveness of therapy, and risk of side effects. Cost-effectiveness varies according to treatment and is highly sensitive to the estimated efficacy of treatment, patient compliance, age of the patient at the start of treatment, and fracture risk assigned to the patient. Greater cost-effectiveness occurs when treatments are more efficacious and when they are directed at patients with the highest risk of fracture.
Kanis JA, Johnell O, Oden A, Jonsson B, Dawson A, Dere W, 2000. "Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden." Osteoporos Int 11 (2): 120-7 [PubMed]
Abstract:
Bone mineral density measurements are widely used to estimate the relative risk of hip fracture. In addition, many other risk factors have been identified, some of which are known to add to the risk independently of other risk factors, including bone mineral density measurements. In this paper we develop an algorithm that converts relative risks for hip fracture to absolute (15 years and lifetime) risks, modeled on the population of Sweden. Lifetime risks increased as expected with increments in relative risk. Average lifetime risk in women at the age of 50 years was 22.7%, which increased to 64.9% when the relative risk was 6.0. In men the risk increased from 11.1% to 41.3%. The identification of high-risk groups had little effect on the specificity of assessments but increased the sensitivity over a wide range of assumptions. The increment in lifetime risk was relatively stable across all ages, reducing the complexity of computing lifetime risks from relative risk. The derivation of absolute risk from relative risk permits the optimization of selection of individuals or populations either for further risk assessment or for treatment.
Sernbo I, Johnell O, 1993. "Consequences of a hip fracture: a prospective study over 1 year." Osteoporos Int 3 (3): 148-53 [PubMed]
Abstract:
From a population of 230,000 residents, 1429 consecutive hip fracture patients were studied with regard to their social and physical functions both before sustaining the fracture and 1 year later. Changes in the patients' accommodation, need of help and walking aids were described. Using logistic regression we found important factors regarding the ability to return home, mortality within 1 year and length of hospital stay. The cost of a hip fracture over the time a patient is in hospital is, including the cost of an internal fixation, about US $6000. The total cost over 1 year is about US $26,000 per patient, including the operation.
Keating JF, Grant A, Masson M, Scott NW, Forbes JF, 2006. "Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients." J Bone Joint Surg Am 88 (2): 249-60 [PubMed]
Abstract:
BACKGROUND: Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment. METHODS: The study was a multicenter randomized controlled trial. Reduction and fixation was compared with bipolar hemiarthroplasty with cement and total hip replacement with cement. Participating surgeons elected to randomize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar hemiarthroplasty. Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure. Clinical outcomes included mortality and complications. The direct health service costs were compared. Participants were followed up for two years. RESULTS: Two hundred and seven patients were randomized to be treated with one of the three operations, and ninety-one were randomized to be treated with either fixation or bipolar hemiarthroplasty. There were no differences in the mortality rates among the treatment groups. The rate of secondary surgery was highest in the fixation group (39% compared with 5% in the group treated with bipolar hemiarthroplasty and 9% in the group treated with total hip replacement). The fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months. The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups. Although fixation was initially the least costly procedure, this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions. CONCLUSIONS: Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty.
