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Outcomes following a hip fracture and length of hospitalization
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Abstracts / Bone 44 (2009) S339–S450
the ADLs in the three groups (normal, osteopenia and osteoporosis) are significantly related only in the presence of vertebral fractures (p = 0.002). Conclusion: Activity restrictions are not related to the condition of osteoporosis itself but to the presence of vertebral fractures. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.304
P393 Outcomes following a hip fracture and length of hospitalization F. de Vriesa,*, A. Gallaghera, R. Arielyb, T. van Staaa a General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK b Global HE&OR, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA Background: Patients experiencing hip fracture are at considerable risk for recurrent osteoporotic fractures and premature death. Objectives: To describe the outcomes of hip fracture cases and their duration of hospitalisation in the UK. Methods: We included patients aged 18 years or older with hip fracture and age/gender-matched controls from the UK GPRD. It was linked for a subset of practices to the registry of hospitalisations (Hospital Episode Statistics). A fracture risk score was estimated [QJM 2005; 98:191-8]. Results: The study population included 19,993 adult hip fracture cases, each matched to one control. The 1-year increased risk of mortality was 16.0% (95% confidence interval [CI] 15.2%–17.7%) in cases vs controls. The 5-year increased risk of mortality was 21.7% (95% CI 20.6%–22.9%) in cases vs controls. The 1-year increased risk of subsequent osteoporotic fracture was 4.1% (95% CI 3.7%–4.5%) in cases vs controls. The 5-year increased risk of subsequent osteoporotic fracture was 10.3% (95% CI 9.4%–11.2%) in cases vs controls. In the year after the hip fracture, 18.9% had initiated osteoporosis medication, increasing to 33.6% 5 years after hip fracture. Strong predictors for mortality after the hip fracture included age (80+ years: HR 4.44 [95% CI 3.87–5.10] vs patients aged 40–59 years) and fracture risk score (HR 2.27 [95% CI 2.14–2.40]. The mean duration of a hospitalization following hip fracture was 25.4 days. It was increased by 6.2 days in patients with a high fracture risk score (vs low score). A body mass index >25, (+3.6 days), and age 80+ years (+ 10.3 days) were important risk factors for longer hospitalization. The risk of being
discharged to a nursing home after the hip fracture was significantly increased among patients with a high fracture risk score, (odds ratio 1.8; 95% CI 1.1–3.0), while a higher socioeconomic status decreased risk of discharge to nursing homes (odds ratio 0.7; 95% CI 0.5–1.0). Conclusions: There was an important heterogeneity in outcomes in hip fracture cases. There is an important increased risk of fracture in the years following a hip fracture, and a low proportion of diagnosed patients are treated with available pharmacotherapies. Conflict of interest: The study was funded by Novartis Pharmaceuticals Corporation. GPRD is owned by the UK Department of Health and operates within the MHRA. GPRD is funded by the MHRA, Medical Research Council, various universities, contract research organisations and pharmaceutical companies. doi:10.1016/j.bone.2009.03.305
P394 Bone mass, size and previous fractures as predictors of prospective fractures in an osteoporotic referral population F. Eklunda,*, A. Nordströmb, U. Björnstigc, P. Nordströmd a Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå, Sweden b Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå, Sweden c Department of Surgical and Perioperative Sciences, Surgery, Umeå, Sweden d Department of Community Medicine and Rehabilitation, Geriatrics, Umeå, Sweden Background: The influence of bone mass, bone size and previous low energy fractures for prospective fractures has not been investigated in a referral osteoporotic population of men and women. Methods: We investigated the association between bone mass, bone size, previous fractures, body constitution, and prospective validated fractures in 5701 women and 1376 men, aged 30 years and older. Bone mass and bone area measurements of the femoral neck were collected at a single study centre in Sweden. Most of the subjects were measured on suspicion of osteoporosis. Data on validated retro- and low energy prospective fractures in the cohort were collected from the corresponding health care district. Results: Bone mineral density (BMD, g/cm2) and estimated volumetric BMD (vBMD, g/cm3) were shown to be good indepen-
Abstracts / Bone 44 (2009) S339–S450
the ADLs in the three groups (normal, osteopenia and osteoporosis) are significantly related only in the presence of vertebral fractures (p = 0.002). Conclusion: Activity restrictions are not related to the condition of osteoporosis itself but to the presence of vertebral fractures. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.304
P393 Outcomes following a hip fracture and length of hospitalization F. de Vriesa,*, A. Gallaghera, R. Arielyb, T. van Staaa a General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK b Global HE&OR, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA Background: Patients experiencing hip fracture are at considerable risk for recurrent osteoporotic fractures and premature death. Objectives: To describe the outcomes of hip fracture cases and their duration of hospitalisation in the UK. Methods: We included patients aged 18 years or older with hip fracture and age/gender-matched controls from the UK GPRD. It was linked for a subset of practices to the registry of hospitalisations (Hospital Episode Statistics). A fracture risk score was estimated [QJM 2005; 98:191-8]. Results: The study population included 19,993 adult hip fracture cases, each matched to one control. The 1-year increased risk of mortality was 16.0% (95% confidence interval [CI] 15.2%–17.7%) in cases vs controls. The 5-year increased risk of mortality was 21.7% (95% CI 20.6%–22.9%) in cases vs controls. The 1-year increased risk of subsequent osteoporotic fracture was 4.1% (95% CI 3.7%–4.5%) in cases vs controls. The 5-year increased risk of subsequent osteoporotic fracture was 10.3% (95% CI 9.4%–11.2%) in cases vs controls. In the year after the hip fracture, 18.9% had initiated osteoporosis medication, increasing to 33.6% 5 years after hip fracture. Strong predictors for mortality after the hip fracture included age (80+ years: HR 4.44 [95% CI 3.87–5.10] vs patients aged 40–59 years) and fracture risk score (HR 2.27 [95% CI 2.14–2.40]. The mean duration of a hospitalization following hip fracture was 25.4 days. It was increased by 6.2 days in patients with a high fracture risk score (vs low score). A body mass index >25, (+3.6 days), and age 80+ years (+ 10.3 days) were important risk factors for longer hospitalization. The risk of being
discharged to a nursing home after the hip fracture was significantly increased among patients with a high fracture risk score, (odds ratio 1.8; 95% CI 1.1–3.0), while a higher socioeconomic status decreased risk of discharge to nursing homes (odds ratio 0.7; 95% CI 0.5–1.0). Conclusions: There was an important heterogeneity in outcomes in hip fracture cases. There is an important increased risk of fracture in the years following a hip fracture, and a low proportion of diagnosed patients are treated with available pharmacotherapies. Conflict of interest: The study was funded by Novartis Pharmaceuticals Corporation. GPRD is owned by the UK Department of Health and operates within the MHRA. GPRD is funded by the MHRA, Medical Research Council, various universities, contract research organisations and pharmaceutical companies. doi:10.1016/j.bone.2009.03.305
P394 Bone mass, size and previous fractures as predictors of prospective fractures in an osteoporotic referral population F. Eklunda,*, A. Nordströmb, U. Björnstigc, P. Nordströmd a Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå, Sweden b Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå, Sweden c Department of Surgical and Perioperative Sciences, Surgery, Umeå, Sweden d Department of Community Medicine and Rehabilitation, Geriatrics, Umeå, Sweden Background: The influence of bone mass, bone size and previous low energy fractures for prospective fractures has not been investigated in a referral osteoporotic population of men and women. Methods: We investigated the association between bone mass, bone size, previous fractures, body constitution, and prospective validated fractures in 5701 women and 1376 men, aged 30 years and older. Bone mass and bone area measurements of the femoral neck were collected at a single study centre in Sweden. Most of the subjects were measured on suspicion of osteoporosis. Data on validated retro- and low energy prospective fractures in the cohort were collected from the corresponding health care district. Results: Bone mineral density (BMD, g/cm2) and estimated volumetric BMD (vBMD, g/cm3) were shown to be good indepen-