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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 95-98

Assessment of epidemiological profile of hip fractures and their risk factors in a Tertiary Care Centre: A case–control study


1 Department of Orthopedics, Shri Jawahir Government Hospital, Jaisalmer, India
2 Department of Orthopedics, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
3 Department of Orthopedics, PD Hinduja Hospital Khar, Mumbai, Mumbai, Maharashtra, India

Date of Submission05-Oct-2020
Date of Decision28-May-2021
Date of Acceptance05-Jul-2021
Date of Web Publication16-Oct-2021

Correspondence Address:
Lokpal Singh Bhati
Department of Orthopedics, Dr. S. N. Medical College, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_116_20

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  Abstract 


Introduction: Hip fractures are common injuries contributing to both morbidity and mortality in the elderly. The present case–control study was conducted to assess the epidemiological profile of hip fractures and their risk factors in a tertiary care centre. Materials and Methods: The present study was a retrospective case–control study carried out in a tertiary care hospital over a period of 1 year. Fifty patients aged 40 years and above who were admitted with radiologically detected fractures of the femur were included as cases. Controls were selected in an equal number of cases. All the physiological parameters were recorded. Other variables were also noted. Data were collected and analyzed using the SPSS software version 21.0. P < 0.05 was considered to be statistically significant. Results: The study population consisted of 50 cases and 50 controls with an equal male-female ratio. Out of 25 cases in males, 68% were extracapsular and 32% were intracapsular fractures. Out of 25 cases in females, 60% were extracapsular and 40% were intracapsular fractures. The extracapsular (24%) and intracapsular (16%) fractures were maximum in the age group of 40–50 years in males. The extracapsular fractures (28%) and intracapsular (16%) were maximum in the age group of 60–70 years in females. Fractures taking place indoors due to loss of balance were higher (38%). Fractures occurring outdoors due to slip higher (22%). The history of weight loss in the past year was more in cases (44%). Cases were more inactive (46%) in the past than controls. Cases were more inactive (34%) in the past than controls. History of chronic diseases such as diabetes was more in cases (14%), and hypertension was more in controls than cases. History of drug uses as some sought of medication was more in cases (52%) than controls, and usage of drugs for hypertension and calcium tablets was more in controls than cases. Addiction to smoking was more in cases, and alcohol was more in controls. Conclusion: Our study concluded that in males, extracapsular fractures were more, and in females, intracapsular fractures were more. The extracapsular and intracapsular fractures were maximum in the age group of 40–50 years in males. The extracapsular fractures and intracapsular were maximum in the age group of 60–70 years in females. Fractures taking place indoors due to loss of balance were higher. Fractures occurring outdoors due to slip was higher.

Keywords: Extracapsular and intracapsular, femur, hip fractures


How to cite this article:
Rathore SS, Rathore JS, Bhati LS, Rathore DS. Assessment of epidemiological profile of hip fractures and their risk factors in a Tertiary Care Centre: A case–control study. Adv Hum Biol 2021;11:95-8

How to cite this URL:
Rathore SS, Rathore JS, Bhati LS, Rathore DS. Assessment of epidemiological profile of hip fractures and their risk factors in a Tertiary Care Centre: A case–control study. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:95-8. Available from: https://www.aihbonline.com/text.asp?2021/11/4/95/328386




  Introduction Top


Osteoporotic hip fractures have become a major cause of morbidity and mortality in the adult and elderly population worldwide. Hip fractures are becoming a matter of concern in Asia, particularly because of a 2–3 times increase in their incidence in almost every country in the continent.[1],[2] The incidence of hip fractures is expected to double to 2.6 million by 2025 and to 6.25 million by 2050. The Asian region would account for over half of hip fractures by the end of 2050.[3] Moreover, with increased life span, hip fractures will appear at accelerated rates leading to increased morbidity, decreased quality of life, potential risk of further falls and subsequent fractures.[4] Due to immense monetary costs involved with these injuries, including the operative, nursing, rehabilitative and disability costs, various preventive strategies against hip fractures have been developed.[5] Hip fractures in the elderly are mainly fragility fractures occurring due to osteoporosis and trivial falls. While in young adults, they usually occur due to high energy trauma such as motor vehicle accidents and falls from height. Various studied risk factors for hip fractures include increasing age, females, ethnicity, smoking, alcohol abuse, osteoporosis, steroid intake, low sunlight exposure and recreational activities.[6],[7] The present case–control study was conducted to assess the epidemiological profile of hip fractures and their risk factors at a tertiary care centre.


  Materials and Methods Top


The present study was a retrospective case–control study carried out at a tertiary care hospital over a period of 1 year. Before the commencement of the study, ethical approval was taken from the institution, and informed consent was obtained from the patients. Fifty patients aged 40 years and above who were admitted with radiologically detected fractures of the femur were included as cases. The patients having femur shaft fractures, pathological fractures and road traffic accident cases with multiple fractures were excluded from the study population. Controls were selected in an equal number of cases. Relatives of patients attending various OPD's of the hospital were selected as controls. All the physiological parameters were recorded, such as height, weight and body mass index (kg/m2) of cases and controls were measured. Other variables were also noted like place and time of fracture, place of the occurrence of the trivial trauma which led to the fracture, timing of the trauma. Mode and cause of fracture were also noted. The history of weight loss was significant enough to loosen their clothes in the last 1 year period before the trauma was also noted. The nature of physical activity such as walking, sitting, standing, squatting, and running/jogging was also noted. The response to each activity was scored according to the time imparted daily toward that activity. Daily walking was graded as none = 0, 1–4 h = 1, 5–8 h = 2, 9–12 h = 3 and >12 hours = 4, whereas sitting was graded as >12 h = 0, 9–12 h = 1, 5–8 h = 2, 1–4 h = 3 and none = 4. Daily standing, squatting and running/jogging were each graded as none = 0, 1–30 min = 1, 30–60 min = 2 and >60 min = 3. Scores for each activity were added. The total scores for the ages were added and named 'total past physical activity score' (TPaPAS). Similarly, scores for each activity in the present were added, and this total was doubled to match TPaPAS, the final value being named 'total present physical activity score' (TPrPAS). Tertiles of respectively the TPaPAS and the TPrPAS of the controls were determined, and according to the tertile values, both cases and controls were grouped into six categories, past inactive, past active, past very active, present inactive, presently active and present very active. History of chronic illness and drug history was also noted. Participants were enquired about their smoking and alcohol intake history in the last 1 year. Data were collected and analysed by using the SPSS software version 21.0 (V22 for windows, IBM, IL, USA). P < 0.05 was taken to be statistically significant.


  Results Top


The study population consisted of 50 cases and 50 controls with an equal male-female ratio. Out of 25 cases in males, 68% were extracapsular and 32% were intracapsular fractures. Out of 25 cases in females, 60% were extracapsular and 40% were intracapsular fractures. The extracapsular (24%) and intracapsular (16%) fractures were maximum in the age group 40–50 years in males. The extracapsular fractures (28%) and intracapsular (16%) were maximum in the age group 60–70 years in females [Table 1]. Fractures taking place indoors due to loss of balance were higher (38%). Fractures occurring outdoors due to slip higher (22%) [Table 2]. The history of weight loss in the past year was more in cases (44%). Cases were more inactive (46%) in the past than controls. Cases were more inactive (34%) in the past than controls. History of chronic diseases such as diabetes was more in cases (14%), and hypertension was more in controls than cases. History of drug uses as some sought of medication was more in cases (44%) than controls, and usage of drugs for hypertension and calcium tablets were more in controls than cases. Addiction for smoking was more in cases, and for alcohol was more in controls [Table 3].
Table 1: Age and sex distribution of cases with respect to types of fractures

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Table 2: Distribution of cases according to place and cause of fracture

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Table 3: Comparison of various variables under the study

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  Discussion Top


In spite of advances in the prevention and treatment of these injuries, hip fractures put on serious problems for both the health care policy-makers and health organizations. Moreover, with increased life span, hip fractures will appear at accelerated rates leading to increased morbidity, decreased quality of life, potential risk of further falls and subsequent fractures.[4]

The study population consisted of 50 cases and 50 controls with an equal male-female ratio. Out of 25 cases in males, 68% were extracapsular, and 32% were intracapsular fractures. Out of 25 cases in females, 60% were extracapsular, and 40% were intracapsular fractures. The extracapsular (24%) and intracapsular (16%) fractures were maximum in the age group 40–50 years in males. The extracapsular fractures (28%) and intracapsular (16%) were maximum in the age group 60–70 years in females. In a study done by Nordin, it was found that the maximum prevalence of hip fractures among Indian men was in the age group of 30–39 years (25%) and 50–70 years (25%) in contrast to 56% of hip fractures occurring in 70–90 years in Finnish men which probably indicates the earlier onset of osteoporosis in Indian men.[8]

Another study done by Wong from Singapore reviewed hip fracture prevalence among different races and found the average age in Indians to be 58 years as compared to 63 years in Chinese people.[9]

Fractures taking place indoors due to loss of balance were higher (38%). Fractures occurring outdoors due to slip higher (22%). Ahuja et al., in a retrospective study of risk factors and epidemiological profile of hip fractures in 41 patients, concluded that simple measures such as high friction bathroom tiles, bedside and wall side railings, trochanteric hip pads, adequate lighting play a significant role in reducing hip fractures.[9]

The history of weight loss in the past year was more in cases (44%). Cases were more inactive (46%) in the past than controls. A meta-analysis included eight prospective studies and suggested that weight loss may be a risk factor for hip fracture and that weight gain may be a protective factor for hip fracture.[10],[11]

Cases were more inactive (34%) in the past than controls. Present and past physical activities have an impact on hip fractures. History of chronic diseases like diabetes was more in cases (14%), and hypertension was more in controls than cases. History of drug uses as some sought of medication was more in cases (44%) than controls, and usage of drugs for hypertension and calcium tablets were more in controls than cases. Addiction to smoking was more in cases, and alcohol was more in controls. It has also been seen that moderate physical activity reduce the risk of fractures, but both extreme activity and inactivity seem to increase the risk of fractures by increasing the chances of falls. Physical activity increases muscle mass, thereby reducing the rate of falls.[12]

Bishnoi et al.[13] found that the mean age of patients was 56.8 years. In elderly patients, a low energy simple fall accounted for >85% of fractures with the presence of significant osteoporosis (Singh's index grade 3). The in-hospital mortality was 2.1%. Hip fracture characteristics included intertrochanteric 57.81%, femoral neck 30.26% and subtrochanteric 11.93%. Smoking and medical comorbidities were present in a significant number of patients.


  Conclusion Top


Our study concluded that in males, extracapsular fractures were more, and in females intracapsular fractures were more. The extracapsular and intracapsular fractures were maximum in the age group 40–50 years in males. The extracapsular fractures and intracapsular were maximum in the age group 60–70 years in females. Fractures taking place indoors due to loss of balance were higher. Fractures occurring outdoors due to slip higher were.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patel MC, Chandra M, Lo JC. Mortality following hip fracture in Chinese, Japanese, and Filipina women. Am J Manag Care 2016;22:e358-9.  Back to cited text no. 1
    
2.
Lau EM. The epidemiology of osteoporosis in Asia. IBMS Bonekey 2009;6:190-3.  Back to cited text no. 2
    
3.
Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: A world-wide projection. Osteoporos Int 1992;2:285-9.  Back to cited text no. 3
    
4.
Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: Quality of life and functional status in older adults living in the community. Aust N Z J Med 2000;30:327-32.  Back to cited text no. 4
    
5.
Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: Trends and geographical variations over the last 40 years. Injury 2008;39:1157-63.  Back to cited text no. 5
    
6.
Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, et al. Risk factors for hip fracture in men from southern Europe: The MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1999;9:45-54.  Back to cited text no. 6
    
7.
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767-73.  Back to cited text no. 7
    
8.
Wong PC. Femoral neck fractures among the major racial groups in Singapore. Incidence patterns compared with non-asian communities. II. Singapore Med J 1964;4:150-7.  Back to cited text no. 8
    
9.
Ahuja K, Sen S, Dhanwal D. Risk factors and epidemiological profile of hip fractures in Indian population: A case-control study. Osteoporos Sarcopenia 2017;3:138-48.  Back to cited text no. 9
    
10.
Nordin BE. International patterns of osteoporosis. Clin Orthop Relat Res 1966;45:17-30.  Back to cited text no. 10
    
11.
Lv QB, Fu X, Jin HM, Xu HC, Huang ZY, Xu HZ, et al. The relationship between weight change and risk of hip fracture: Meta-analysis of prospective studies. Sci Rep 2015;5:16030.  Back to cited text no. 11
    
12.
Karlsson M. Exercise increases muscle strength and probably prevents hip fractures. Lakartidningen 2002;99:3408-13.  Back to cited text no. 12
    
13.
Bishnoi M, Kirmani TT, Huda N, Chahal G, Bishnoi S. Epidemiological analysis of hip fractures at a tertiary care center: A retrospective study. Int J Res Orthop 2018;4:568-71.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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