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The 23 provinces in China included in the study. The geographical base map data were obtained from the Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences (http://www.resdc.cn/). Black dots indicate the included cities in 23 provinces. https://doi.org/10.1371/journal.pmed.1003180.g001
Source publication
Background
Hip fracture is a public health concern because of its considerable morbidity, excess mortality, great risk of disability, and high societal healthcare costs. China has the largest population of older people in the world and is experiencing rapid population aging and facing great challenges from an increasing number of hip fractures. How...
Context in source publication
Context 1
... all the 480 million residents in 23 provinces in the UEBMI and URBMI databases, a total of 102.56 million participants aged 55 years and older were included in this study (S1 Table), of whom 190,560 were confirmed as having a hip fracture during the study period. The locations of the 23 provinces are shown in Fig 1. Most hip fracture patients were Han Chinese (88.85%), 63.99% were female, and 42.88% of fractures occurred in those aged 75-84 years (Table 1). ...
Citations
... As the aging population gradually increases, the incidence of femoral neck fractures is also on the rise. Statistics show that the incidence of femoral neck fractures accounts for approximately 3.1% of all fractures, and it is projected to reach 3 million cases by the year 2050, with the elderly accounting for about 90% of these fractures [1][2][3]. In China, Chen et al [4] conducted a national retrospective large-data survey on traumatic fractures. ...
Objective
A novel Proximal Femoral Bionic Nail (PFBN) has been developed by a research team for the treatment of femoral neck fractures. This study aims to compare the biomechanical properties of the innovative PFBN with those of the conventional Inverted Triangular Cannulated Screw (ITCS) fixation method through biomechanical testing.
Methods
Sixteen male femoral specimens preserved in formalin were selected, with the donors’ age at death averaging 56.1 ± 6.3 years (range 47–64 years), and a mean age of 51.4 years. The femurs showed no visible damage and were examined by X-rays to exclude diseases affecting bone quality such as tumors, severe osteoporosis, and deformities. The 16 femoral specimens were randomly divided into an experimental group (n = 8) and a control group (n = 8). All femurs were prepared with Pauwels type III femoral neck fractures, fixed with PFBN in the experimental group and ITCS in the control group. Displacement and stress limits of each specimen were measured through cyclic compression tests and failure experiments, and vertical displacement and strain values under a 600 N vertical load were measured in all specimens through vertical compression tests.
Results
In the vertical compression test, the average displacement at the anterior head region of the femur was 0.362 mm for the PFBN group, significantly less than the 0.480 mm for the ITCS group (p < 0.001). At the fracture line area, the average displacement for the PFBN group was also lower than that of the ITCS group (0.196 mm vs. 0.324 mm, p < 0.001). The difference in displacement in the shaft area was smaller, but the average displacement for the PFBN group (0.049 mm) was still significantly less than that for the ITCS group (0.062 mm, p = 0.016). The situation was similar on the posterior side of the femur. The average displacements in the head area, fracture line area, and shaft area for the PFBN group were 0.300 mm, 0.168 mm, and 0.081 mm, respectively, while those for the ITCS group were 0.558 mm, 0.274 mm, and 0.041 mm, with significant differences in all areas (p < 0.001). The average strain in the anterior head area for the PFBN group was 4947 μm/m, significantly less than the 1540 μm/m for the ITCS group (p < 0.001). Likewise, in the fracture line and shaft areas, the average strains for the PFBN group were significantly less than those for the ITCS group (p < 0.05). In the posterior head area, the average strain for the PFBN group was 4861 μm/m, significantly less than the 1442 μm/m for the ITCS group (p < 0.001). The strain conditions in the fracture line and shaft areas also showed the PFBN group was superior to the ITCS group (p < 0.001). In cyclic loading experiments, the PFBN fixation showed smaller maximum displacement (1.269 mm vs. 1.808 mm, p < 0.001), indicating better stability. In the failure experiments, the maximum failure load that the PFBN-fixated fracture block could withstand was significantly higher than that for the ITCS fixation (1817 N vs. 1116 N, p < 0.001).
Conclusion
The PFBN can meet the biomechanical requirements for internal fixation of femoral neck fractures. PFBN is superior in biomechanical stability compared to ITCS, particularly showing less displacement and higher failure resistance in cyclic load and failure experiments. While there are differences in strain performance in different regions between the two fixation methods, overall, PFBN provides superior stability.
... As reported by National Bureau of Statistics, China had 209 million people aged ≥ 65 years old by the end of 2022, accounting for 14.9% of the total population, and this percentage is predicted to be 14% in 2025 and about 30% by 2050 1,2 . Hip fracture is the second leading fracture type in the older population in China, accompanied with as high as 20-30% of one-year mortality rate 3,4 . Once hip fracture occurs, the hip function and walking ability of patients are severely restricted, leading to a lower quality of life. ...
Objectives
Total hip arthroplasty (THA) is a highly successful and effective surgery for improving hip functions and relieving pain. However, the lower extremities are prone to deep vein thrombosis (DVT) and swelling after surgery, thereby delaying recovery. In this study, we investigated the preventive effects of fondaparinux sodium (FS) and low-molecular-weight heparin (LMWH) on DVT of the lower extremity after THA.
Methods
Firstly, 60 patients who underwent THA at the First Affiliated Hospital of Wannan Medical College from March 2020 to December 2020 were included. Next, the patients were randomly divided into an LMWH group (n = 30) and an FS group (n = 30). Then, the indexes related to DVT were compared between both groups.
Results
Specifically, the differences in baseline data, such as age, gender and body mass index (BMI), between the two groups were not statistically significant. The postoperative weight bearing time of patients in the FS group was much shorter than that in the LMWH group.
Conclusion
Subcutaneous injection of FS not only exhibits superior effects to LMWH in preventing DVT after THA but also has a correlation with reducing the risk of thrombosis and improving patient symptoms.
... With a rapidly aging global population, hip fracture has become a public health concern due to its high morbidity, disability and mortality (1)(2)(3)(4)(5). Globally, hip fracture incidence was estimated to be 14.2 million, and the associated years lived with disability was 2.9 million in 2019 (5). ...
Objective
With a rapidly aging global population, the assessment of mortality risk following hip fracture in older adults has received increasing attention. Recently, the system inflammation response index (SIRI) has been identified as a novel prognostic marker to reflect both systemic inflammation and immune status. However, it is not yet known whether SIRI is a potential predictor of subsequent death in hip fracture patients. Therefore, this study aimed to investigate the association between SIRI and mortality in older patients with hip fracture.
Methods
A total of 1,206 older hip fracture patients undergoing surgery between January 2013 and December 2022 were consecutively derived from our longitudinal database. Patients were divided into three groups according to SIRI tertiles, calculated as neutrophil × monocyte / lymphocyte. Survival status was obtained from medical records or telephone interviews, and the study outcome was all-cause mortality after hip fracture at the longest follow-up. Multivariate Cox proportional hazard model and restricted cubic spline (RCS) regression model were used to evaluate the association between SIRI and mortality. Moreover, a series of sensitivity analyses were conducted to further validate the robustness of the association.
Results
During a median follow-up of 43.85 months, 337 patients (27.94%) died. After full adjustment, each unit increase in SIRI was significantly associated with a 2.2% increase in overall mortality (95% confidence interval [CI]: 1.001–1.042, p = 0.029). Similarly, compared with the first tertile of SIRI, the second and third tertile showed a 1.335-fold (95% CI: 1.011–1.762, p = 0.042) and 1.447-fold (95% CI, 1.093–1.917, p = 0.010) higher risk of death. Sensitivity analyses confirmed the stability of the association. Moreover, RCS analysis revealed a positive non-linear relationship between SIRI and mortality ( P for nonlinearity = 0.021).
Conclusion
High SIRI level at admission was significantly and positively associated with an increased risk of death, suggesting that SIRI may be an independent predictor of mortality in older patients with hip fracture.
... It is projected that by 2050, the incidence of osteoporotic fractures in China will surpass a staggering 5.9 million cases, with medical expenditures soaring above the astounding sum of 20 billion dollars. 1,2 At present, lumbar and hip dual-energy X-ray absorptiometry (DXA) is the most commonly used reference standard for the diagnosis of osteoporosis. [3][4][5] However, over 80% of patients with osteoporotic fractures do not undergo bone mineral density (BMD) testing to reduce the risk. ...
Objective
To explore the suitable population of CT value for predicting low bone mineral density (low-BMD).
Methods
A total of 1268 patients who underwent chest CT examination and DXA within one-month period retrospectively analyzed. The CT attenuation values of trabecular bone were measured in mid-sagittal plane from thoracic vertebra 7 (T7). Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose low-BMD.
Results
The AUC for diagnosing low BMD was larger in women than in men (0.894 vs 0.744, p < 0.05). The AUC increased gradually with the increase of age but decreased gradually with the increase in height and weight (p < 0.05). In females, when specificity was adjusted to approximately 90%, a threshold of 140.25 HU has a sensitivity of 69.3%, which is higher than the sensitivity of 36.5% in males for distinguishing low-BMD from normal. At the age of 70 or more, when specificity was adjusted to approximately 90%, a threshold of 126.31 HU has a sensitivity of 76.1%, which was higher than that of other age groups.
Conclusion
For patients who had completed chest CTs, the CT values were more effective in predicting low-BMD in female, elderly, lower height, and lower weight patients.
... Hip fractures are a serious and prevalent public health issue [1,2]. The high rates of sickness, mortality, and disability that are associated with ageing populations in particular pose a serious concern [3,4]. ...
... The inclusion criteria for our study were: (1) Age ≥ 50 years; (2) Diagnosis of disease met the criteria for hip fracture; and (3) Patients received surgical treatment in our hospital. Exclusion criteria: (1) No surgical treatment; (2) Hip fracture due to high energy injury; (3) Open fracture; (4) Fracture occurred with excessive blood loss; (5) Associated with bone metabolic or inflammatory diseases; (6) Received medications affecting bone metabolism and inflammatory factors such as glucocorticoids, antibiotics, calcitonin, bisphosphonates, etc. prior to admission to the hospital; (7) Pathological fracture; and (8) Patients with severe liver and kidney disease and malignancy. ...
BACKGROUND
Excellent hip joint function facilitates limb recovery and improves the quality of survival. This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management.
AIM
To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients.
METHODS
The elderly patients who had hip fracture surgery at our hospital between January 1, 2021, and December 31, 2022 were chosen for this retrospective clinical investigation. Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared. Age, gender, fracture site, surgical technique, laboratory indices, and other variables that could have an impact on postoperative joint function were all included in a univariate study. To further identify independent risk factors affecting postoperative joint function in hip fractures, risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis. In addition to this, we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups.
RESULTS
A total of 119 elderly patients with hip fractures were included in this study, of whom 37 were male and 82 were female. The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), and complement C1q (C1q) between the fair and excellent joint function groups (P < 0.05). The results of multiple logistic regression analysis showed that IL-6 > 20 pg/mL [(Odds ratio (OR) 3.070, 95%CI: 1.243-7.579], IL-8 > 21.4 pg/ mL (OR 3.827, 95%CI: 1.498-9.773), CRP > 10 mg/L (OR 2.142, 95%CI: 1.020-4.498) and C1q > 233 mg/L (OR 2.339, 95%CI: 1.094-5.004) were independent risk factors for poor joint function after hip fracture surgery (all P < 0.05).
CONCLUSION
After hip fractures in older patients, inflammatory variables are risk factors for fair joint function; therefore, early intervention to address these markers is essential to enhance joint function and avoid consequences.
... The zoledronic acid (2009) and teriparatide (2012) were introduced to prevent osteoporosis and reduce the risk of hip [22], which, at the same time, increased the use of these drugs. In addition, the increase in the cost of surgery and related medical materials may also lead to an increase in the expense of each patient [23]. Population aging and rising costs in health care are likely to become two substantial challenges facing the next generation of clinicians and health policy makers. ...
Purpose
This study aimed to analyze the epidemiological characteristics of hip fracture in all age groups in Shanghai, and to evaluate the hospitalization cost of patients with hip fracture.
Methods
A total of 1,332 hip fracture patients admitted to a tertiary general hospital between January 2015 and May 2020 in Shanghai were included. Age, sex, diagnosis, cause of injury and site, fracture type, comorbidities, length of stay, treatment, outcomes (at discharge) and hospitalization expenses were recorded. The epidemiological characteristics of hip fracture were analyzed by using SPSS 26.0 software.
Results
The average age of hip fracture was 77.24 ± 12.66 years, and 69.0% of the patients were female. Overall, 886 patients had femoral neck fracture, and 446 patients suffered from intertrochanteric fracture. Most of the fractures caused by falls at the same level and falls from a height occurred in those aged 81–90 years; and traffic accident injuries mostly took place in patients aged 50–60. Among the 1,302 hip fracture patients who underwent surgical treatment, hip replacement was the major choice for femoral neck fracture, accounting for 49.2%. Internal fixation was the main treatment choice for intertrochanteric fracture, making up 97.8%. The median length of hospital stay lasted 8 days and at cost of hospitalization was ¥49,138.18 RMB.
Conclusion
This epidemiological study found that patients with hip fracture had certain distribution characteristics in age, sex, type of fracture, injury season, cause of injury, mode of operation, length of stay, cost, and so on. Proper medical management, social preventive measures, and prevention of falls are needed to reduce the risk of hip fracture and the socioeconomic burden.
... Hip and vertebral fractures are most prevalent and profoundly impact the quality of life of patients and public health services [2]. Thirty years ago, the World Health Organization introduced the use of standard deviation (SD) scores of bone mineral density (BMD) as a diagnostic tool for OP. ...
To elucidate the precise upstream and downstream regulatory mechanisms of inflammatory factors in osteoporosis (OP) progression and to establish a causal relationship between inflammatory factors and OP. We conducted bidirectional Mendelian randomization (MR) analyses using data for 41 cytokines obtained from three independent cohorts comprising 8293 Finnish individuals. Estimated bone mineral density (eBMD) data were derived from 426,824 UK Biobank White British individuals (55% female) and fracture data from 416,795 UK Biobank participants of European ancestry. The inverse variance-weighted method was the primary MR analysis approach. We employed other methods as complementary approaches for mutual corroboration. To test for pleiotropy and heterogeneity, we used the MR-Egger regression, MR-pleiotropy residual sum and outlier global test, and the Cochrane Q test. Macrophage inflammatory protein (MIP)-1α and interleukin (IL)-12p70 expression associated negatively and causally with eBMD (β = −0.017 [MIP-1α], β = −0.011 [IL-12p70]). Conversely, tumor necrosis factor-related apoptosis-inducing ligand was associated with a decreased risk of fractures (Odds Ratio: 0.980). Additionally, OP influenced the expression of multiple inflammatory factors, including growth-regulated oncogene-α, interferon-gamma, IL-6, beta nerve growth factor, and IL-2. Finally, we discovered complex bidirectional causal relationships between IL-8, IL-10, and OP. Specific inflammatory factors may contribute to OP development or may be causally affected by OP. We identified a bidirectional causal relationship between certain inflammatory factors and OP. These findings provide new perspectives for early prediction and targeted treatment of OP. Larger cohort studies are necessary in the future to further validate these findings.
... Hip fractures, encompassing femoral neck fractures and intertrochanteric femur fractures [1,2], are predominantly observed in the elderly population, and surgeon is the main treatment option [3,4]. Among the ongoing demographic aging trends, there is a continual increase in the annual incidence of hip fractures among the elderly population [5,6]. The incidence of perioperative complications in elderly patients with hip fracture is high, some complications are closely related to the prognosis of patients, electrolyte disturbance is one of the most common complications [7][8][9]. ...
Background
This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population.
Methods
This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types.
Results
The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures.
Conclusion
Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.
... Anti-resorption drugs remain the most common drugs used for treating osteoporosis [12][13][14][15]. Bisphosphonates, mainly ibandronate, risedronate, alendronate, and zoledronate, are the first-line drugs for most patients because of factors such as effectiveness, safety, and affordability [16]. ...
... We systematically studied the structure-activity relationship (SAR) of these compounds ( Figure 1B), and found that I-9 ( Figure 1C) may have the best activity of promoting bone formation and anti-osteoporosis [29]. [12][13][14][15]. Bisphosphonates, mainly ibandronate, risedronate, alendronate, and zoledronate, are the first-line drugs for most patients because of factors such as effectiveness, safety, and affordability [16]. ...
As the global population ages, the number of patients with osteoporosis is rapidly rising. The existing first-line clinical drugs are bone resorption inhibitors that have difficulty restoring the bone mass of elderly patients to the safe range. The range and period of use of existing peptides and monoclonal antibodies are limited, and small-molecule bone formation–promoting drugs are urgently required. We established an I-9 synthesis route with high yield, simple operation, and low cost that was suitable for future large-scale production. I-9 administration promoted bone formation and increased bone mass in mice with low bone mass in an aged C57 mouse model. Our findings revealed a hitherto undescribed pathway involving the BMP2–ERK–ATF4 axis that promotes osteoblast differentiation; I-9 has favorable biosafety in mice. This study systematically investigated the efficacy, safety, and mechanism of I-9 for treating osteoporosis and positions this drug for preclinical research in the future. Thus, this study has promoted the development of small-molecule bone-promoting drugs.
... 3 Studies indicate a high 1-year mortality rate post-hip fracture, reaching up to 30%, with 50% of survivors experiencing a loss of functional independence and one-third becoming fully dependent. [4][5][6] Globally, hip fractures are among the top 10 causes of disability, with Asia projected to contribute significantly due to its three-quarters share of the world population. 3 By 2050, more than 50% of hip fractures are anticipated to occur in Asia, 3 especially in China. ...
... A retrospective cohort study involving 480 million residents in China from 2012 to 2016 revealed that the overall hip fracture incidence varied from 130.11 to 164.17 per 100,000 person-years. 6 The incidence demonstrated an agedependent increase in China, with rates ranging from 36. 15 to 48.35 in the 55-64 age group, 131.50 to 115.16 in the 65-74 age group, 342.80 to 314.99 in the 75-84 age group, and 523.96 to 633.03 in the ≥ 85 age group. ...
... 15 to 48.35 in the 55-64 age group, 131.50 to 115.16 in the 65-74 age group, 342.80 to 314.99 in the 75-84 age group, and 523.96 to 633.03 in the ≥ 85 age group. 6 Handgrip strength (HGS) is widely recognized as an indicator of overall muscle strength and functional status, providing a valuable tool for assessing musculoskeletal health and predicting adverse health outcomes. Our previous research indicated a significant correlation between low HGS and an increased risk of all-cause mortality and cardiovascular mortality in the American population. ...
Objective
Hip fracture and falls are significant health concerns. Handgrip strength (HGS) is closely associated with overall muscle strength and physical health. However, the longitudinal relationship between HGS and the risk of hip fractures and falls remains unclear, particularly regarding gender differences. This longitudinal study aimed to investigate the association between HGS and the risk of hip fracture and falls in individuals aged 45 years and above, considering gender‐specific differences over a 4‐year period.
Methods
This study included 10,092 participants (4471 men and 5621 women) aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS). Incidents of hip fractures and falls were recorded during a 4‐year follow‐up, along with various demographic and clinical factors. Participants were categorized into five groups based on their HGS quintiles. Logistic regression models were employed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between HGS and hip fracture/fall risk.
Results
During the 4‐year follow‐up period, 223 cases of hip fracture (2.2%) and 1831 cases of falls (18.1%) were documented. Notably, higher HGS demonstrated a strong inverse association with the risk of hip fracture in both males and females ( p < 0.05). In comparison to the lowest HGS quintile, the adjusted odds ratios (ORs) for hip fracture were 0.46 (0.27–0.78) for the total population, 0.4 (0.19–0.81) for males and 0.48 (0.23–0.98) for females in the highest HGS quintile. Furthermore, a profound and statistically significant negative correlation between HGS and falls was detected ( p < 0.05). The adjusted ORs for falls in the highest HGS quintile, compared to the lowest quintile, were 0.62 (0.51–0.76) in the overall population, 0.59 (0.44–0.78) in males, and 0.78 (0.62–0.99) in females.
Conclusion
Our findings highlight the significant inverse association between HGS and the risk of hip fracture and falls in both males and females aged 45 years and above. Assessing handgrip strength may serve as a valuable tool for predicting fracture and fall risk.
