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KMID : 1120320170030000079
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Osteoporosis and Sarcopenia
2017 Volume.3 No. 0 p.79 ~ p.79
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A study of clinical, epidemiological and environmental risk factors associated with fragility hip fracture in elderly Asian Indians, aged ≥60 years
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Varshney S.
Khadgawat R.
Tandon N.
Malhotra R.
Sharma V.
Yadav C.S.
Farooque K.
Trikha V.
Gammangatti S.
Sreenivas V.
Chatterjee P.
Ramot R.
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Abstract
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Introduction: Hip fractures (HF) are the most visible and dramatic consequences of osteoporosis because of poor quality of life, increased mortality and socioeconomic burden. This ongoing hospital based case control study aimed at identifying clinical, epidemiological and environmental risk factors associated with fragility hip fracture.
Materials & methods: Cases were individuals with fragility hip fracture admitted to AIIMS, New Delhi while controls presented to AIIMS for non fracture illnesses. Telephonic follow-ups conducted quarterly among both cases (one month also) and controls. Statistical analysis -STATA-9.
Results: Mean age, Cases (n-326): 72.28±8.68 (M;F-148:178). Controls (n-400): 66.10±5.49 (M:F-218:182). Fall resulted in 99% hip fractures, 56% were intertrochantric fractures, occurred on left side (53%) and sideways fall (65%). Home premises contributed to 68% falls while 32% occurred outside home, at pilgrimages, parks and public transport. Most falls occurred while walking (76%), due to dysbalance (46%), wet floor (24%) and obstruction (15%). Light/visibility in surrounding premises did not contribute to fall since 75% fractures occurred when there was sufficient light. Surgical fracture fixation in 94% cases, 46% operated within one week of fracture and 94% mobilised within one week of surgery. At one year follow-up, 55% cases as against 99% controls walked independently and 35/326 cases against 6/400 controls were dead. Association of hip fracture and continuous variables is shown in Table-1. Univariate analysis showed significant association of hip fracture with advanced age- 3.95(2.76-5.65) for 71-80 years, 16.95 (7.5-38.1) for >80 years, female sex- 1.44 (1.07-1.93), history of fragility fracture 1.44 (1.07-1.93), diabetes-2.08 (1.30-3.33), peripheral neuropathy- 0.65(0.44-0.94), history of neurological disorders- 0.16 (0.019-1.28) for Parkinson, & 12.18 (2.81-52.72), pre fracture walking with support- 4.26 (2.47-7.33), inadequate sun exposure- 1.85 (1.33- 2.59), sedentary/underactive lifestyle- 2.57 (1.02-6.47), abnormal visual acuity- 0.108 (0.68-0.17), cataract surgery- 3.79 (1.60-8.94), pre fracture intake of NSAIDS- 2.76 (0.99- 7.67) & calcium supplements- 2.22 (0.99-4.96) with respective Odds ratios (95% CI).
Discussions and conclusion: Advanced age, past fragility fractures, Diabetes, peripheral neuropathy, hypertension, delirium, inadequate sun exposure, vision impairment, reduced haemoglobin, serum albumin & alkaline phosphatase are risk factors for hip fractures among individual ≥60 years.
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