Introduction
Patients and Methods
Statistical Analysis
Results
Baseline Characteristics and Circumstances of the Fall Leading to the Hip Fracture
Women (N = 375) | Men (N = 112) | Total (N = 487) | |
---|---|---|---|
Age, years, mean ± SD | 83.2 (6.6) | 83.1 (7.0) | 83.2 (6.7) |
≥75 years | 339 (90.4) | 100 (89.3) | 439 (90.1) |
Sex, woman | – | – | 375 (77.0) |
Type of centre | |||
Small | 67 (17.9) | 26 (23.2) | 93 (19.1) |
Medium | 101 (26.9) | 37 (33.0) | 138 (28.3) |
Large | 207 (55.2) | 49 (43.8) | 256 (52.6) |
Alcohol intake | 21 (5.6) | 26 (23.2) | 47 (9.6) |
Active smoking | 7 (1.9) | 11 (9.8) | 18 (3.7) |
Body mass index (kg/m2) | |||
<18.5 | 8 (2.1) | 0 (0) | 8 (1.6) |
18.5–<25.0 | 159 (42.4) | 51 (45.5) | 210 (43.1) |
25.0–<30.0 | 112 (29.9) | 39 (34.8) | 151 (31.0) |
≥30.0 | 58 (15.5) | 12 (10.7) | 70 (14.4) |
Missing | 38 (10.1) | 10 (8.9) | 48 (9.9) |
Diagnosis of osteoporosis established by densitometry (T-score ≤−2.5) | 8 (2.1) | 1 (0.9) | 9 (1.8) |
T-score not available | 362 (96.5) | 110 (98.2) | 472 (96.9) |
Secondary osteoporosisa
| 10 (2.7) | 4 (3.6) | 14 (2.9) |
Prior non-hip fracture | 144 (38.4) | 37 (33.3) | 181 (37.2) |
Prior non-hip fracture by low impact trauma | 88 (23.5) | 20 (17.9) | 108 (22.2) |
Time since last fracture, months, median (Q1, Q3)b
| 42.1 (18.7, 109.5) | 75.8 (28.2, 163.7) | 43.0 (20.4, 123.4) |
Location of previous fracturesc
| |||
Wrist | 50 (13.3) | 10 (8.9) | 60 (12.3) |
Shoulder | 24 (6.4) | 4 (3.6) | 28 (5.7) |
Spine | 16 (4.3) | 7 (6.3) | 23 (4.7) |
Upper arm | 17 (4.5) | 2 (1.8) | 19 (3.9) |
Other | 67 (17.9) | 16 (14.3) | 87 (17.9) |
Prior osteoporotic treatment | 70 (18.7) | 6 (5.4) | 76 (15.6) |
Other risk factors for fracture | |||
Parental hip fracture | 21 (5.6) | 9 (8.0) | 30 (6.2) |
Use of glucocorticoids | 22 (5.9) | 5 (4.5) | 27 (5.5) |
Diagnosis of rheumatoid arthritis | 13 (3.5) | 1 (0.9) | 14 (2.9) |
Main comorbidities | |||
Diabetes | 75 (20.0) | 24 (21.4) | 99 (20.3) |
Dementia | 44 (20.5) | 18 (16.1) | 95 (19.5) |
Cerebrovascular disease | 54 (14.4) | 28 (25.0) | 82 (16.8) |
Congestive heart failure | 45 (12.0) | 13 (11.6) | 58 (11.9) |
Peripheral vascular disease | 48 (12.8) | 8 (7.1) | 56 (11.5) |
Chronic pulmonary disease | 22 (5.9) | 26 (23.2) | 48 (9.9) |
Myocardial infarction | 29 (7.7) | 19 (17.0) | 48 (9.9) |
Any tumour | 13 (3.5) | 8 (7.1) | 21 (4.3) |
Moderate or severe renal disease | 13 (3.5) | 8 (7.1) | 21 (4.3) |
Charlson index, mean (SD)d
| 1.8 (1.1) | 2.4 (1.7) | 1.9 (1.3) |
Hip fracture result of a fall | 373 (99.5) | 110 (98.2) | 483 (99.2) |
Living arrangements prior to the fall | |||
Alone in own home | 82 (21.9) | 11 (9.8) | 93 (19.1) |
Partner/family member sharing own home | 219 (58.4) | 79 (70.5) | 298 (61.2) |
Nursing home | 40 (10.7) | 15 (13.4) | 55 (11.3) |
Relatives home | 33 (8.8) | 7 (6.3) | 40 (8.2) |
Patient alone at the time of a fall | 172 (45.9) | 38 (33.9) | 210 (43.1) |
Where fall happened | |||
Inside | 294 (78.4) | 84 (75.0) | 378 (77.6) |
Outside | 79 (21.1) | 26 (23.2) | 105 (21.6) |
Missing | 2 (0.5) | 2 (1.8) | 4 (0.8) |
If fall happened outside, weather conditions | |||
Dry | 68 (18.1) | 21 (18.8) | 89 (18.3) |
Wet | 10 (2.7) | 4 (3.6) | 14 (2.9) |
Icy | 1 (0.3) | 1 (0.9) | 2 (0.4) |
Season when the fall took place | |||
Winter | 59 (15.7) | 19 (17.0) | 78 (16.0) |
Spring | 74 (19.7) | 28 (25.0) | 102 (20.9) |
Summer | 103 (27.5) | 28 (25.0) | 131 (26.9) |
Autumn | 137 (36.6) | 35 (31.3) | 172 (35.3) |
Missing | 2 (0.5) | 2 (1.7) | 4 (0.8) |
Patient receiving medications that increase the risk of falls | 136 (36.3) | 35 (31.3) | 171 (35.1) |
Health-Related Quality of Life and Patient Autonomy
Baseline (prior to the fracture) | Discharge | 4 months | 12 months | |
---|---|---|---|---|
EQ-5D, health state index, mean (SD)a
| 0.57 (0.39) | 0.04 (0.39)* | 0.47 (0.41)* | 0.53 (0.41)* |
Valid N
| 454 | 446 | 303 | 318 |
Change from baseline, mean (95 % CI) | −0.54 (−0.58 to −0.50) | −0.11 (−0.16 to −0.06) | −0.06 (−0.11 to −0.01) | |
Harris hip score, mean (SD)b
| 74.9 (19.6) | 46.6 (14.6)* | 64.7 (17.9)* | 69.1 (18.9)* |
Valid N
| 353 | 341 | 223 | 244 |
Change from baseline, mean (95 % CI) | −28.3 (−30.4 to −28.3) | −9.9 (−12.6 to −7.2) | −7.1 (−9.7 to −4.5) | |
Modified Barthel index, mean (SD)c
| 77.5 (26.9) | 40.4 (24.3)* | 66.4 (31.4)* | 70.4 (31.1)* |
Valid N
| 441 | 433 | 287 | 306 |
Change from baseline, mean (95 % CI) | −37.3 (−39.5 to −35.1) | −12.2 (−14.9 to −9.5) | −9.8 (−12.5 to −7.1) |
Health Resource Utilization
Women (N = 375) | Men (N = 112) | Total (N = 487) | |
---|---|---|---|
First hospitalization
| |||
Hospital stay, days, mean (SD) | 11.8 (7.9) | 11.9 (8.1) | 11.8 (7.9) |
Median (min–max) | 10.0 (1–69) | 10.0 (2–54) | 10.0 (1–69) |
Geriatric ward, % | 0.5 | 1.7 | 0.8 |
Days, mean (SD) | 5.0 (1.4) | 12.0 (2.8) | 8.5 (4.4) |
Intensive care, % | 26.7 | 22.3 | 25.7 |
Days, mean (SD) | 1.0 (0.2) | 1.5 (2.0) | 1.1 (0.9) |
Orthopaedic ward, % | 99.2 | 98.2 | 99.0 |
Days, mean (SD) | 11.4 (7.7) | 11.4 (8.0) | 11.4 (7.8) |
Other wards, % | 2.1 | 0.8 | 3.7 |
Days, mean (SD) | 2.9 (5.3) | 1.7 (1.6) | 2.2 (3.6) |
Surgical intervention, % | 95.7 | 92.9 | 95.1 |
Intramedullary nail osteosynthesis | 45.3 | 31.3 | 42.1 |
Sliding screw osteosynthesis | 17.6 | 17.9 | 17.7 |
Partial prosthesis | 28.5 | 36.6 | 30.4 |
Total prosthesis | 4.8 | 8.0 | 5.5 |
Imaging | 96.8 | 99.1 | 97.3 |
CT, % | 5.9 | 6.2 | 6.0 |
Num. times used, mean (SD) | 1.2 (0.5) | 1.0 (0) | 1.2 (0.5) |
Ultrasound, % | 4.3 | 4.5 | 4.3 |
Num. times used, mean (SD) | 1.1 (0.3) | 1.4 (0.9) | 1.1 (0.5) |
X-ray, % | 96.8 | 99.1 | 97.3 |
Num. times used, mean (SD) | 4.0 (1.8) | 4.2 (1.7) | 4.0 (1.8) |
Other proceduresa, % | 0.5 | 58.9 | 49.9 |
Num. times used, mean (SD) | 5.8 (3.5) | 6.4 (5.0) | 5.9 (3.9) |
Emergency room visit prior to hospitalization, % | 86.9 | 84.8 | 86.4 |
12-month follow-up
| |||
Re-hospitalizations, % | 6.4 | 3.6 | 5.7 |
Hospital stay, days, mean (SD) | 16.2 (13.9) | 5.8 (4.5) | 14.7 (13.4) |
Median (min–max) | 12.5 (2–56) | 4.5 (2–12) | 10.5 (2–56) |
Imaging, % | 5.9 | 3.6 | 5.3 |
Surgical intervention, % | 0.8 | 0 | 0.6 |
Intramedullary nail osteosynthesis | 0.5 | 0 | 0.4 |
Partial prosthesis | 0.3 | 0 | 0.2 |
Other proceduresa, % | 4.3 | 3.6 | 4.1 |
Ambulatory care | |||
Outpatient visits, % | 81.3 | 67.0 | 78.0 |
Number of visits, mean (SD) | 9.1 (9.5) | 9.4 (10.9) | 9.2 (9.7) |
Median (min–max) | 6.0 (1–75) | 6 (1–58) | 6 (1–75) |
Nurse at health centre visits, % | 31.7 | 31.2 | 31.6 |
Number of visits, mean (SD) | 3.2 (4.9) | 1.9 (1.4) | 2.9 (4.4) |
Nurse’s home visits, % | 39.5 | 33.0 | 38.0 |
Number of visits, mean (SD) | 5.8 (7.1) | 7.1 (8.5) | 6.0 (7.4) |
Physician at health centre visits, % | 38.7 | 38.4 | 38.6 |
Number of visits, mean (SD) | 3.0 (2.4) | 2.8 (2.3) | 3.0 (2.4) |
Specialist, % | 61.9 | 57.1 | 60.8 |
Number of visits, mean (SD) | 3.1 (2.5) | 2.8 (3.0) | 3.0 (2.6) |
Physician’s home visits, % | 29.1 | 15.2 | 25.9 |
Number of visits, mean (SD) | 3.4 (3.8) | 4.6 (4.3) | 3.6 (3.9) |
Rehabilitation facility, % | 36.3 | 33.0 | 35.5 |
Number of sessions, mean (SD) | 28.5 (43.2) | 29.6 (33.5) | 28.7 (41.2) |
Median (min–max) | 16 (1–320) | 14 (1–128) | 15 (1–320) |
Health centre, % | 14.7 | 11.6 | 14.0 |
Number of sessions, mean (SD) | 27.4 (25.3) | 36.8 (38.5) | 29.2 (28.2) |
Home, % | 24.5 | 25.9 | 24.8 |
Number of sessions, mean (SD) | 25.7 (41.1) | 21.3 (23.9) | 24.7 (37.6) |
Imaging, % | 4.0 | 1.8 | 3.5 |
Num. times used, mean (SD) | 6.5 (4.7) | 6.0 (5.7) | 6.4 (4.6) |
Other proceduresa, % | 2.4 | 1.8 | 2.3 |
Num. times used, mean (SD) | 2.0 (1.7) | 2.5 (2.1) | 2.1 (1.6) |
Ambulance use, % | 53.3 | 37.5 | 49.7 |
Num. times used, mean (SD) | 5.0 (10.6) | 4.0 (4.4) | 4.8 (9.8) |
Visits to emergency room, % | 16.0 | 14.3 | 15.6 |
Num. times used, mean (SD) | 1.9 (2.2) | 1.4 (0.7) | 1.8 (2.0) |
Walking aids, % | 60.3 | 53.6 | 58.7 |
Walker | 49.9 | 44.6 | 48.7 |
Wheelchair | 16.5 | 14.3 | 16.0 |
Home care | |||
Formal, % | 23.7 | 17.0 | 22.2 |
Days, mean (SD) | 47.1 (66.7) | 61.6 (95.1) | 49.6 (72.2) |
Median (min–max) | 26.5 (1–411) | 47.0 (1–618) | 25.1 (1–411) |
Care from social workers, % | 4.5 | 5.4 | 4.7 |
Days, mean (SD) | 6.6 (8.2) | 5.8 (2.8) | 6.4 (7.2) |
Nursing home, % | 8.8 | 4.5 | 7.8 |
Days, mean (SD) | 56.7 (63.5) | 110.0 (96.9) | 63.7 (69.6) |
Rehabilitation facility, % | 15.5 | 10.7 | 14.4 |
Days, mean (SD) | 38.1 (38.0) | 48.7 (45.3) | 39.9 (39.2) |
Informal, % | 56.5 | 42.9 | 53.4 |
Hours, mean (SD) | 78.0 (103.7) | 73.1 (89.3) | 77.1 (101.0) |
Median (min–max) | 35 (1–672) | 38 (2–336) | 35 (1–672) |
Cared by relatives, % | 49.3 | 39.3 | 47.0 |
Hours, mean (SD) | 64.7 (81.7) | 61.8 (79.4) | 64.1 (81.1) |
Paid worker, % | 24.5 | 16.1 | 22.6 |
Hours, mean (SD) | 49.6 (69.9) | 44.0 (67.3) | 48.7 (69.2) |
Mean € (95 % CI) | Women (N = 375) | Men (N = 112) |
---|---|---|
Total direct cost | 9690 (9184, 10,197) | 9019 (8079, 9958) |
First hospitalization
| ||
First hospitalization | 7067 (6733, 7401) | 7196 (6522, 7870) |
Hospital stay | 4796 (4469, 5122) | 4856 (4240, 5472) |
Geriatric ward | 11 (0, 26) | 88 (0, 211) |
Intensive care | 154 (127, 181) | 184 (66, 301) |
Orthopaedic ward | 4631 (4311, 4950) | 4584 (3964, 5205) |
Surgical intervention | 2064 (1997, 2131) | 2128 (1969, 2288) |
Intramedullary nail osteosynthesis | 795 (706, 884) | 545 (393, 697) |
Sliding screw osteosynthesis | 401 (312, 490) | 401 (239, 562) |
Partial prosthesis | 691 (580, 803) | 887 (667, 1106) |
Total prosthesis | 177 (97, 257) | 296 (108, 484) |
Imaging | 89 (83, 94) | 96 (87, 106) |
Computed tomography | 6 (3, 8) | 5 (1, 9) |
Ultrasound | 4 (2, 5) | 5 (0, 10) |
X-ray | 80 (76, 84) | 87 (80, 94) |
Emergency room visit prior to hosp. | 118 (114, 123) | 115 (106, 125) |
12-month follow-up
| ||
Re-hospitalizationb
| 395 (173, 617) | 59 (0, 120) |
Ambulatory care | 1323 (1119, 1528) | 997 (753, 1241) |
Outpatient visits | 329 (291, 367) | 281 (204, 359) |
Nurse at health centre visits | 16 (11, 21) | 10 (6, 13) |
Nurse’s home visits | 73 (56, 91) | 75 (40, 110) |
Physician at health centre visits | 56 (46, 66) | 50 (33, 68) |
Specialist | 122 (106, 138) | 104 (72, 135) |
Physician’s home visits | 62 (46, 78) | 43 (16, 70) |
Rehabilitation facility | 284 (191, 376) | 258 (142, 373) |
Health centre | 48 (32, 65) | 52 (12, 91) |
Home | 235 (148, 323) | 206 (100, 313) |
Imaging | 6 (2, 10) | 3 (0, 8) |
Ambulance use | 486 (336, 635) | 269 (157, 382) |
Visits to emergency room | 42 (26, 57) | 29 (14, 44) |
Walking aids | 177 (148, 207) | 157 (104, 210) |
Walker | 55 (49, 62) | 49 (37, 60) |
Wheelchair | 122 (92, 152) | 109 (55, 162) |
Home care, mean use | 905 (690, 1121) | 767 (285, 1250) |
Formal | 603 (397, 810) | 563 (116, 1009) |
Care from social workers | 18 (5, 31) | 18 (3, 35) |
Nursing home | 258 (129, 387) | 254 (−30, 538) |
Rehabilitation facility | 327 (213, 441) | 290 (74, 506) |
Informal | 302 (236, 368) | 205 (114, 296) |
Cared by relatives | 162 (128, 196) | 123 (68, 178) |
Paid worker | 140 (93, 188) | 81 (15, 148) |