Hip fracture epidemiology and treatment

Introduction Life changes after a hip fracture. Although much effort is spent to optimize treatment, still 25 % of the patients are deceased within a year, and more than half of the patients previously living independent, are institutionalized after a hip fracture. Hip fractures are common in the Norwegian population, with a total number of approximately 10 000 fractures per year [1]. The incidence is increasing exponentially with age [2]. Optimal treatment is important to improve outcome after a fracture, and preventive measures will save lives, pain and resources. The most common reason for hip fracture is osteoporosis and hip fracture incidence is thus a marker of osteoporosis. Development of hip fracture incidence over time can thus be the basis for hypothesis about risk factors and treatment for osteoporosis in a community. Materials and Methods Paper I and II were based on identification of hip fracture patients in Oslo, Norway in 2007. Electronic discharge registers and operation theatre protocols were used to identify patients, and charts were reviewed to verify the presence of a new hip fracture. Paper III studied treatment of patients with intracapsular hip fractures prospectively randomized to receive treatment with either internal fixation (IF) with two parallel screws or hemiarthroplasty (HA). The patients were examined after median 6 years using questionnaires to establish hip function (HHS), ADL function (Barthel Index) and Quality of Life (EQ-5D). Results A total number of 1,005 hip fractures in 985 patients were verified in Oslo, Norway in 2007. These fractures were regarded as the gold standard for hip fractures in Oslo in 2007, and the data registers were validated against this. Sensitivity of the hospital diagnosis registers, e.g. if the register contains all fractures, varied between 95 % and 99 %. Norwegian Patient Registry overestimated the number of fractures by 5 % when using the diagnose codes alone. Only 69 % of the fractures were registered in the Norwegian Hip Fracture Register compared with the gold standard. Sensitivity of this register was 69 % in total, varying between 29 % and 89 % between the individual hospitals. The incidence of hip fractures in Oslo decreased significantly between 1996/97 and 2007. It was estimated that the use of bisphosphonates may explain up to 13% of the decline in incidence in women aged 60-69 years and up to 34 % in women aged 70-79 years. Only 30 % of the patients in the randomized study were alive after 6 years and there were no difference between the two groups in mortality. No difference in hip function, ADL function or Quality of life was found. However, only 12 of 31 patients in the group of IF still had their native joint as a result of more than 60 % reoperations in the group. Conclusion The incidence of hip fractures in women in Oslo has decreased significantly during the last decade, and is now at a lower level than in 1978/79. Incidence data on hip fracture in Oslo, Norway, have been collected in a standardized way every decade since 1978/79 to reduce risk of wrong conclusion due to poor data register quality. Although hip fracture is a straightforward diagnosis, electronic diagnosis registers are inaccurate for this diagnosis. The unpredictable degree of both over- and underestimation makes it difficult to apply correction algorithms to improve data quality. Hence, when using data from registers additional processing and information are required to improve validity. Hip fracture patients have high mortality. Hemiarthroplasty is the treatment of choice after femoral neck fractures compared with internal fixation due to superior short time results with comparable long term results