Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age

Thoors, Oscar; Mellner, Carl; Hedström, Margareta

doi:10.1080/17453674.2021.1876996

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…One could argue that there are few very young patients in our cohort, 91% of the patients are aged 40 to 59 years, but this is coherent with a Danish register study where 90% of hip fractures in patients under 65 years of age are found in patients aged 40 to 65 [4]. In a Swedish register study on patients with hip fractures younger than 50 years, the median age was 42 [47]. When excluding patients aged 50-59, our cohort show a corresponding median age of 44; hence, we consider our sample sufficiently representative.…”

Section: Limitationssupporting

confidence: 85%

Frailty and osteoporosis in patients with hip fractures under the age of 60—a prospective cohort of 218 individuals

et al. 2022

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Research on younger patients with hip fractures is limited. This study adds knowledge on patient and injury characteristics, and DXA was investigated at the time of the fracture. Risk factors for osteoporosis and fractures were numerous among young patients, and osteoporosis was markedly more prevalent than in the general population. Introduction Knowledge on younger patients with hip fractures is limited. Common preconceptions are that they suffer fractures due to high-energy trauma, alcohol or substance use disorder but not associated to osteoporosis. We aimed to descriptively analyze the characteristics of young and middle-aged patients with hip fractures and examine bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) at the time of the fracture. Methods A prospective multicenter cohort study on adult patients with hip fractures below age 60 collected detailed information on patient characteristics regarding demographics, trauma mechanism, previous fractures, comorbidity and medication, and lifestyle factors. DXA results were compared to population-based reference data. ResultsThe cohort contains 91 women and 127 men, median age 53 (IQR 47-57). Most fractures, 83%, occurred in patients aged 45-59. Two-thirds of all fractures resulted from low-energy trauma. Half of the patients had prior fractures after age 20. Thirty-four percent were healthy, 31% had one previous disease, and 35% had multiple comorbidities. Use of medication associated with increased fracture risk was 32%. Smoking was prevalent in 42%, harmful alcohol use reported by 29%, and signs of drug-related problems by 8%. Osteoporosis according to WHO criteria was found in 31%, osteopenia in 57%, and normal BMD in 12%. ConclusionIn patients with hip fractures below age 60, risk factors for osteoporosis and fractures were numerous. Moreover, the prevalence of osteoporosis was markedly higher than in the general population. We suggest that young and middle-aged patients with hip fractures undergo a thorough health investigation including DXA, regardless of trauma mechanism.

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Section: Limitationssupporting

confidence: 85%

Frailty and osteoporosis in patients with hip fractures under the age of 60—a prospective cohort of 218 individuals

et al. 2022

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“…Other studies have showed that among all patients with hip fractures, approximately 2-11% of them are younger than 50 years old [34]. The latest research shows that the proportion of patients with hip fractures under the age of 50 with femoral neck fractures is 58% [35].…”

Section: Discussionmentioning

confidence: 98%

Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women

Li,

Shen,

Tan

et al. 2024

BMC Musculoskelet Disord

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Background Although it is generally believed that the femoral neck fracture is related to the femoral neck geometric parameters (FNGPs), the association between the risk of osteoporotic fracture of the femoral neck and FNGPs in native Chinese women is still unclear. Methods A total of 374 female patients (mean age 70.2 ± 9.32 years) with osteoporotic fracture of the femoral neck, and 374 non-fracture control groups were completely matched with the case group according to the age ratio of 1:1. Using DXA bone densitometer to measured eight FNGPs: the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compressive strength index (CSI) at the narrowest point of the femoral neck. Results Compared with the control group, the average values of OD (2.9%), ED (4.5%), and BR (26.1%) in the patient group significantly increased (p = 0.015 to < 0.001), while CSA (‒15.3%), CT (‒18.2%), SM (‒10.3%), CSMI (‒6.4%), and CSI (‒10.8%) significantly decreased (all p < 0.001). The prevalence of osteoporosis in the lumbar spine, femoral neck, and total hip was, respectively, 82%, 81%, and 65% in fracture patients. Cox proportional hazard model analysis showed that in the age adjusted model, the fracture hazard ratio (HR) of CSA, CT, BR, SM, and CSI significantly increased (HRs = 1.60‒8.33; 95% CI = 1.08‒16.6; all p < 0.001). In the model adjusted for age and femoral neck BMD, HRs of CT (HRs = 3.90‒8.03; 95% CI = 2.45‒15.1; all p < 0.001) and BR (HRs = 1.62‒2.60; 95% CI = 1.20‒5.44; all p < 0.001) were still significantly increased. Conclusion These results suggest that the majority of osteoporotic fractures of the femoral neck of native Chinese women occur in patients with osteoporosis. CT thinning or BR increase of FNGPs may be independent predictors of fragility fracture of femoral neck in native Chinese women unrelated to BMD.

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“…The database consisted of 1465 patients over 60 years of age that had suffered a hip fracture. Patients below the age of 60 years were excluded as mortality rates in younger patients that suffer hip fractures are drastically lower and we wanted to focus on potentially frail patients with health issues related to aging [ 20 , 21 ]. Patients with ASA 5 or 6 ( n = 1) were excluded.…”

Section: Methodsmentioning

confidence: 99%

Development and Internal Validation of a Multivariable Prediction Model for Mortality After Hip Fracture with Machine Learning Techniques

Mosfeldt,

Jørgensen,

Lauritzen

et al. 2024

Calcif Tissue Int

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In order to estimate the likelihood of 1, 3, 6 and 12 month mortality in patients with hip fractures, we applied a variety of machine learning methods using readily available, preoperative data. We used prospectively collected data from a single university hospital in Copenhagen, Denmark for consecutive patients with hip fractures, aged 60 years and older, treated between September 2008 to September 2010 (n = 1186). Preoperative biochemical and anamnestic data were used as predictors and outcome was survival at 1, 3, 6 and 12 months after the fracture. After feature selection for each timepoint a stratified split was done (70/30) before training and validating Random Forest models, extreme gradient boosting (XGB) and Generalized Linear Models. We evaluated and compared each model using receiver operator characteristic (ROC), calibration slope and intercept, Spiegelhalter’s z- test and Decision Curve Analysis. Using combinations of between 10 and 13 anamnestic and biochemical parameters we were able to successfully estimate the likelihood of mortality with an area under the curve on ROC curves of 0.79, 0.80, 0.79 and 0.81 for 1, 3, 6 and 12 month, respectively. The XGB was the overall best calibrated and most promising model. The XGB model most successfully estimated the likelihood of mortality postoperatively. An easy-to-use model could be helpful in perioperative decisions concerning level of care, focused research and information to patients. External validation is necessary before widespread use and is currently underway, an online tool has been developed for educational/experimental purposes (https://hipfx.shinyapps.io/hipfx/).

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Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age

Abstract: Hedström (2021): Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age, Acta Orthopaedica,

Cited by 5 publications

References 19 publications

Frailty and osteoporosis in patients with hip fractures under the age of 60—a prospective cohort of 218 individuals

Frailty and osteoporosis in patients with hip fractures under the age of 60—a prospective cohort of 218 individuals

Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women

Development and Internal Validation of a Multivariable Prediction Model for Mortality After Hip Fracture with Machine Learning Techniques

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