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PURPOSE: Osteoporosis is a pressing public health concern among older adults, contributing to substantial mortality and morbidity rates. Low- to middle-income countries (LMICs) often grapple with limited access to dual-energy X-ray absorptiometry (DXA), the gold standard for early osteoporosis detection. This study aims to assess the performance of the FRAX® score as a population-wide screening tool for predicting osteoporosis risk, rather than fracture, in individuals aged 50 and above within an LMIC context. METHODS: This retrospective cohort study (n=864) assessed the performance of the FRAX® score for predicting osteoporosis risk using comparative c-statistics from Receiver Operating Characteristic (ROC) curves. Hazard ratios (HR) and 95â¯% confidence intervals (CI) were calculated, with p-values <0.05 indicating statistically significant. RESULTS: The 10-year FRAX® probability for hip fracture, calculated without bone mass density (BMD), exhibited significantly superior performance compared to the 10-year FRAX® probability for major fracture in predicting osteoporosis risk (AUROC: 0.71 versus 0.67, p<0.001). Within 2 to 10 years of follow-up, the 10-year FRAX® probability for hip fracture showed both greater predictive performance and net benefit in the decision curve compared to the FRAX® 10-year probability for major fracture. A newly established cutoff of 1.9â¯% yielded a negative predictive value of 92.9â¯% (95â¯%CI: 90.4-94.8â¯%) for the 10-year FRAX® probability for hip fracture. CONCLUSION: The 10-year FRAX® probability for hip fracture estimated without BMD emerges as an effective 10-year screening tool for identifying osteoporosis risk in aged 50 and older, especially when confronted with limited access to DXA scans in LMICs. MINI ABSTRACT: The Fracture Risk Assessment Tool score performance as an osteoporosis screening tool was assessed in areas with limited dual-energy X-ray access. The hip fracture probability showed better performance than major fracture probability within 2 to 10 years. The tool emerges as effective for screening osteoporosis risk in individuals over 50.
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Absorciometria de Fóton , Densidade Óssea , Programas de Rastreamento , Osteoporose , Fraturas por Osteoporose , Humanos , Medição de Risco/métodos , Idoso , Feminino , Masculino , Estudos Retrospectivos , Osteoporose/diagnóstico por imagem , Osteoporose/complicações , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Programas de Rastreamento/métodos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Curva ROC , Países em Desenvolvimento , Idoso de 80 Anos ou mais , Região de Recursos LimitadosRESUMO
This study, characterizing the incidence of hip fractures in Mexico, showed not only that the crude number of fractures has increased, but also there has been a decrease in fracture rates. Nonetheless, as the population ages in the coming decades, the current declines rate of could be expected to reverse. PURPOSE: This study is to examine the incidence, rates, and time trends of hip fractures from 2006 to 2019 in Mexico. Additionally, an analysis of the follow-up of the birth cohorts was carried out. METHODS: Hip fractures registered during the period of the study were obtained through the Mexican Social Security Institute (IMSS) national discharge records. The incidence per 100,000 individuals was calculated from the IMSS population at risk. A time trend analysis was conducted using linear regression, and the identification of breakpoints in linear trends. RESULTS: There was an increase of hip fractures for both sexes ≥ 60 years (43% for women and 41%, for men). However, the rates diminished from 167.8/100,000 in 2006 to 138.5 /100,000 in the population 60 and over (1.9% and 0.9% per year in women and men respectively). When the information was analyzed by age groups, hip fracture rates were similar in both sexes but higher in women. The most significant contribution to the total number of fractures is due to the groups ≥ 70 years; people born before 1937 are accounting for the burden of fractures over the total data. In contrast, the younger generations appear to have lower rates. CONCLUSION: Rates of hip fracture have steadily declined in Mexico since 2006; however, with the population aging in the coming decades, current rates declines could be expected to reverse.
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Fraturas do Quadril , Fraturas por Osteoporose , Humanos , Fraturas do Quadril/epidemiologia , México/epidemiologia , Masculino , Feminino , Incidência , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fraturas por Osteoporose/epidemiologia , Distribuição por Idade , Distribuição por Sexo , AdultoRESUMO
BACKGROUND: Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. METHODS: This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. RESULTS: A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). CONCLUSION: Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.
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Fraturas do Quadril , Fraturas por Osteoporose , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Masculino , Vida Independente , Estudos Retrospectivos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fatores de RiscoRESUMO
INTRODUCTION: as the population pyramid gets inverted, more active and longer lives are lived, geriatric patients with high energy trauma (HET) become more frequent; requiring more resources, getting worse results with more perioperative complications, coupled with a fragile state of health and osteopenia, make these fractures difficult to manage. With the hypothesis that the incidence of pelvic and acetabular fractures in the elderly due to HET is higher than that reported in the world literature, the research question was generated: What is the incidence of pelvic and acetabular fractures in the elderly due to HET, in a 5-year period? MATERIAL AND METHODS: with the authorization of the Ethics Committee, an observational study of a retrospective cohort was carried out, using medical records, identifying the incidence of these fractures, surgically treated in our institution Clínica Las Vegas, Medellin, Colombia, a level III hospital, from July 1, 2016 to June 30, 2021. RESULTS: a cumulative incidence of 1.95 new cases per 100,000 person-years was calculated, a prevalence of 13.8%; resulting in a higher incidence and prevalence, confirming our hypothesis. CONCLUSION: treatment should be aimed at improving quality of life with stable fixation, identification and treatment of associated injuries, minimizing the risk of mechanical complications and prioritizing the reinforcement of preventive measures, also in the improvement of male role behavior, whom, as it seems, will keep carrying out risky activities despite their age.
INTRODUCCIÓN: a medida que se invierte la pirámide poblacional, se viven vidas más largas y activas, se vuelven más frecuentes los pacientes geriátricos con trauma de alta energía; requiriendo más recursos, obteniéndose peores resultados, con más complicaciones perioperatorias, hacen a estas fracturas difíciles de manejar. Establecida la hipótesis de que la incidencia de las fracturas de pelvis y acetábulo, en el adulto mayor por trauma de alta energía, es superior a la reportada en la literatura mundial, se generó la pregunta de investigación: ¿Cuál es la incidencia de fracturas de pelvis y acetábulo por trauma de alta energía en el adulto mayor en un período de cinco años? MATERIAL Y MÉTODOS: una vez obtenida la autorización del Comité de Ética, se realizó un estudio observacional de una cohorte retrospectiva, utilizando registros médicos, identificando la incidencia de estas fracturas, tratadas quirúrgicamente en nuestro hospital de III nivel, Clínica Las Vegas, Medellín, Colombia, del 1 de Julio de 2016 a 30 de Junio de 2021. RESULTADOS: se calculó una incidencia acumulada de 1.95 nuevos casos por cada 100,000 personas-año, una prevalencia de 13.8%; resultando en una mayor incidencia y prevalencia, confirmándose nuestra hipótesis. CONCLUSIÓN: el tratamiento debe orientarse a mejorar la calidad de vida con una fijación estable, identificación y tratamiento de lesiones asociadas, minimizando el riesgo de complicaciones mecánicas y priorizar el reforzamiento de medidas preventivas y a la mejora del comportamiento del rol masculino, que aparentemente, seguirán realizando actividades de riesgo a pesar de su edad.
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Fraturas Ósseas , Fraturas do Quadril , Ossos Pélvicos , Fraturas da Coluna Vertebral , Idoso , Humanos , Masculino , Acetábulo/lesões , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fraturas do Quadril/complicações , Incidência , Ossos Pélvicos/lesões , Qualidade de Vida , Estudos Retrospectivos , FemininoRESUMO
Background: The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. Patients who tested positive for COVID-19 experienced a higher overall rate of post-surgical complications and hospital mortality. Objective: To compare the asociation of post-surgical complications presented in post-surgical hip patients with and without history of COVID-19 infection. Material and methods: Prospective cohort study. The inclusion criteria were: post-hip surgery adults with and without a history of COVID-19 infection who attended their post-surgical follow-up consultation. The association of post-surgical complications in both groups was studied. The association of complications was analyzed with the chi-squared statistical test, and the effect size with Cramer's V test. Results: The association of complications and a history of COVID-19 infection was moderate, with a chi-squared of 2.55, V Cramer of 0.23. The most frequent complication was aseptic loosening of prosthetic components. The pre-surgical diagnosis and its association with both groups had a chi-squared of 10.07, and a V Cramer of 0.45, at the expense of hip fracture. Conclusions: A history of COVID-19 infection may be associated with the presence of post-surgical complications. Aseptic loosening of prosthetic components was the most frequent complication in both groups of patients, and hip fracture was the main pre-surgical diagnosis.
Introducción: la Organización Mundial de la Salud (OMS) declaró la COVID-19 como pandemia el 11 de marzo de 2020. Los pacientes con COVID-19 tuvieron una tasa mayor de complicaciones postquirúrgicas en cirugía de cadera. Objetivo: comparar la presencia de complicaciones posquirúrgicas en pacientes postoperados de cadera con y sin antecedente de infección por COVID-19. Material y métodos: estudio de cohorte prospectiva. Los criterios de inclusión fueron: adultos postoperados de cirugía de cadera con y sin antecedente de infección por COVID-19 que acudieron a su consulta postquirúrgica de control. Se estudió la asociación de las complicaciones postquirúrgicas en ambos grupos y se analizó con la prueba estadística chi cuadrada y el tamaño del efecto con la prueba V de Cramer. Resultados: la asociación de complicaciones y el antecedente de infección por COVID-19 fue moderada, chi cuadrada de 2.55, V de Cramer de 0.23. La complicación más frecuente fue el aflojamiento aséptico de componentes protésicos. El diagnóstico prequirúrgico y su asociación con ambos grupos tuvieron una chi cuadrada de 10.07, V de Cramer de 0.45, a expensas de la fractura de cadera. Conclusiones: el antecedente de infección por COVID-19 puede asociarse con la presencia de complicaciones postquirúgicas. El aflojamiento aséptico de componentes protésicos fue la complicación más frecuente en ambos grupos de pacientes y la fractura de cadera el diagnóstico prequirúrgico principal.
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COVID-19 , Fraturas do Quadril , Adulto , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Estudos RetrospectivosRESUMO
Fracture probabilities derived from the original FRAX model for Brazil were compared to those from an updated model based on more recent regional estimates of the incidence of hip fracture. Fracture probabilities were consistently lower in the updated FRAX model. Despite large differences between models, differences in the rank order of fracture probabilities were minimal. OBJECTIVE: Recent epidemiological data indicate that the risk of hip fracture in Brazil is lower than that used to create the original FRAX model. This paper describes the epidemiology of hip fracture in Brazil and the synthesis of an updated FRAX model with the aim of comparing this new model with the original model. METHODS: Hip fracture rates from three cities in three regions were combined, weighted by the population of each region. For other major fractures, incidence rates for Brazil were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Mortality estimates were taken from the UN. RESULTS: Compared to the original FRAX model, the updated model gave lower 10-year fracture probabilities in men and women at all ages. Notwithstanding, there was a very close correlation in fracture probabilities between the original and updated models (r > 0.99) so that the revisions had little impact on the rank order of risk. CONCLUSION: The disparities between the original and updated FRAX models indicate the importance of updating country-specific FRAX models with the advent of significant changes in fracture epidemiology.
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Fraturas do Quadril , Fraturas da Coluna Vertebral , Masculino , Humanos , Feminino , Brasil/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Cidades , AntebraçoRESUMO
BACKGROUND: The prevalence of intertrochanteric hip fractures is approximately 30%. The usual management of hip fractures is performed by dynamic hip screw (DHS) or central medullary nailing (CMN). The COVID-19 pandemic has changed medical treatment guidelines in all specialties around the world. OBJECTIVE: To recognize the prevalence and management of unstable trochanteric hip fractures during the COVID-19 pandemic. METHOD: An observational study was conducted in a third-level care hospital in patients with fractures of type AOOTA 31A2.1 and A2.2 managed with CMN or DHS. The management trends by orthopedic surgeons were analyzed. RESULTS: The prevalence during 2019 was 38%, in 2020 it was 21.3% and in 2021 it was 32.6%. The male-to-female ratio found was 1:1.7. The age was 66.48 ± 21.6 years (range: 17-92). Of orthopedic surgeons surveyed, 80.4% preferred CMN. CONCLUSIONS: The prevalence decreased during 2020. The treatment trend during the pandemic was higher for the DHS system; the use of CMN decreased by 86%. The treatment of intertrochanteric hip fractures was influenced due to the COVID-19 pandemic towards a cheaper method.
ANTECEDENTES: La prevalencia de las fracturas transtrocantéricas se sitúa alrededor del 30%. El tratamiento se realiza mediante sistema de tornillo deslizante (STD) o clavo centromedular (CCM). La pandemia de COVID-19 ha modificado las pautas de tratamiento médico en todas las especialidades en todo el mundo. OBJETIVO: Reconocer la prevalencia y el manejo de las fracturas transtrocantéricas inestables durante la pandemia de COVID-19. MÉTODO: Se realizó un estudio observacional en un hospital de tercer nivel de atención en pacientes con fracturas de tipo AOOTA 31A2.1 y A2.2 manejados con CCM o STD, y se analizaron las tendencias de manejo por parte de los cirujanos ortopedistas. RESULTADOS: La prevalencia durante el año 2019 fue del 38%, en 2020 fue del 21.3% y en 2021 fue del 32.6%. La proporción encontrada hombre-mujer fue de 1:1.7. La edad fue de 66.48 ± 21.6 años (rango: 17-92). De los cirujanos ortopedistas encuestados, el 80.4% prefieren el CCM. CONCLUSIONES: La prevalencia disminuyó durante el año 2020. La tendencia de tratamiento durante la pandemia fue superior para el sistema STD y el uso de CCM disminuyó un 86%. El tratamiento de estas fracturas fue influenciado por la pandemia de COVID-19 hacia un método más económico.
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COVID-19 , Fraturas do Quadril , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pandemias , COVID-19/epidemiologia , Hospitais , Parafusos Ósseos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Estudos RetrospectivosRESUMO
PURPOSE: The study aims to identify, describe, and organize the currently available evidence regarding hip fracture (HF) registries in low- and middle-income countries (LMICs). METHODS: We conducted a scoping review adhering to PRISMA-ScR guidelines. We searched MEDLINE (PubMed), Google Scholar, Global Index Medicus, websites related to HF, and study references for eligible studies. Two reviewers independently performed the study selection and data extraction, including studies describing the use of individual patient records with the aim to improve the quality of care in older people with HF in LMICs. RESULTS: A total of 222 abstracts were screened, 59 full-text articles were reviewed, and 10 studies regarding 3 registries were included in the analysis. Malaysia and Mexico implemented a HF registry in public hospitals whereas Argentina implemented a registry in the private setting. The Mexican registry, the most recent one, is the only one that publishes annual reports. There was significant variability in data fields between registries, particularly in functional evaluation and follow-up. The Ministry of Health finances the Malaysian registry, while Argentinian and Mexican registries founding was unclear. CONCLUSION: The adoption of HF registries in LMICs is scarce. The few experiences show promising results but higher support is required to develop more registries. Long-term sustainability remains a challenge.
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Países em Desenvolvimento , Fraturas do Quadril , Humanos , Idoso , Fraturas do Quadril/epidemiologia , Sistema de Registros , Argentina , Malásia/epidemiologiaRESUMO
Introducción: La fractura de cadera (FC) es una solución de continuidad en el extremo proximal del fémur, con consecuencias significativas para quien la padece. Este estudio busca comparar descriptivamente la tasa de mortalidad por FC en el periodo 2017-2022, en Chile. Metodología: Estudio descriptivo observacional sobre defunciones por FC entre 2017 y 2022, en Chile (n= 3.190), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calcularon tasas de mortalidad por FC por variable, índice de sobremortalidad e índice de Swaroop, utilizando datos del Censo 2017. No requirió comité de ética. Resultados: La mayor tasa de mortalidad por FC se observó en el año 2018 (3,23), en el grupo de 100 años y más (2.264,15), la región de Valparaíso (28,31) y el sexo femenino (4,32) reflejandose en su índice de sobremortalidad (2,589). La menor tasa de mortalidad por FC ocurrió en el año 2021 (2,76), en el grupo de entre 0 y 19 años (0,04) y en la región de Atacama (12,58). El índice de Swaroop fue 100% en la mayoría de las regiones. Discusión: La tendencia a la baja desde el año 2019 podría explicarse por el confinamiento por COVID-19 que limitó la movilidad de las personas mayores. Los cambios postmenopausicos y un mayor riesgo de caídas podrían explicar una mayor tasa de mortalidad por FC en mujeres y pacientes de edad avanzada, respectivamente. El análisis por región podría relacionarse con la proporción demográfica de personas mayores.
Introduction: The hip fracture (HF) is a discontinuity in the proximal end of the femur, with significant consequences for those who suffer from it. This study aims to descriptively compare the HF mortality rate in the period 2017-2022 in Chile. Methodology: This is an observational descriptive study on deaths due to HF between 2017 and 2022 in Chile (n=3,190), according to data from the Department of Statistics and Health Information of Chile. HF mortality was calculated by variable, excess mortality rate, and Swaroop index, using data from the 2017 Census. No ethics committee was required. Results: The highest HF mortality rate was in 2018 (3,23), in the age group of 100 years and older (2.264,15), the Valparaíso region (28,31) and the female sex (4,32) reflected in its excess mortality rate (2,589). The lowest HF mortality rate occurred in 2021 (2,76), in the group between 0 and 19 years (0,04) and in the Atacama region (12,58). The Swaroop index was 100% in most regions. Discussion: The downward trend since 2019 could be explained by the COVID-19 lockdown that limited the mobility of elderly adults. Postmenopausal changes and a higher risk of falls could explain higher HF mortality rate in women and old people patients, respectively. The regional analysis could be related to the demographic proportion of elder people.