To assess whether the occurrence of a hip fracture is associated with an increased risk of mortality even after taking into account age and prefracture health status and whether this increased risk of mortality persists beyond the first 6 months after the fracture.
A prospective study of risk factors for hip fracture.
Five French areas: Amiens, Lyon, Montpellier, Paris, and Toulouse.
The cohort consisted of 7,512 volunteer ambulatory women aged 75 and older who were recruited from voter registration lists. Women who had a history of hip fracture or bilateral hip replacement were excluded.
The baseline examination included a functional and clinical examination and a questionnaire on life style and treatments. Thereafter, women were followed every 4 months for 4 years to record the occurrence of fractures and deaths. A multivariable proportional hazards model was used to determine the association between hip fracture (treated as a time-dependent variable) and mortality, after adjustment for age and baseline health status.
During a mean+/-standard deviation follow-up of 3.9+/-0.9 years, 338 women had a first hip fracture, and their postfracture mortality rate was 112.4 per 1,000 woman-years, compared with 27.3 per 1,000 woman-years for the 6,115 women who did not have any fracture (P<.001). After adjusting for age and baseline health status, women with hip fracture were more than twice as likely to die (95% confidence interval (CI)=1.6-2.8). This increased risk appeared more pronounced in the first 6 months (relative risk (RR)=3.0, 95% CI=1.9-4.7) than after (RR=1.9, 95% CI=1.6-2.2) (P=.09).
In ambulatory elderly women, the occurrence of a hip fracture is associated with an increased risk of death, even after prefracture health status is taken into account. Although the effect of the fracture is stronger in the first 6 months, it persists for several years thereafter, which suggests that prevention of hip fracture and improved care after the fracture may contribute to increase life expectancy in addition to preserving quality of life.
"During the past decade, the incidence of hip fractures has steadily risen in Taiwan (Hung et al., 2005). Individuals with hip fractures have higher mortality rates than do age-matched cohorts (Empana et al., 2004; Robbins et al., 2006), and residual disability and dependency in their activities of daily life often bother the survivors of hip fractures much more than other types of fractures, despite successful surgical repair (Van Balen et al., 2001; Boonen et al., 2004; Newman et al., 2008). There is much evidence to show that the relationship between physical function and health-related quality of life (HRQOL) is not linear (Jette, 1995; Gray and Hendershot, 2001; Tsauo et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: Researchers measure the significance of hip fracture by the patient's impairment. The patient's quality of life (QOL) is usually also substantially affected. However, there is no specific quality of life (QOL) questionnaire for patients with hip fractures. This study was designed to determine whether adding a new set of specific questions about hip fracture to the World Health Organization Quality of Life Questionnaire would be helpful for patients with hip fractures. Three hundred and fifty-two patients were interviewed over the telephone. Three of the four initial items were chosen for statistical analysis. The Cronbach's alpha of the four domains (physical, psychological, social, and environmental) ranged from 0.84 to 0.92 (P<0.01), and that of the new physical domain (PD) (adding the three new items) was 0.94 (P<0.01). Test-retest correlations of the three new items and all domains exceeded 0.66 (P<0.01). Criteria-related validity of the three new items ranged from 0.52 to 0.65 (P<0.05). The correlations between the new PD and the overall QOL and general health (0.70-0.78) were slightly lower than those (0.72-0.80) between the standard PD and the new items. A four-factor model was confirmed after factor analysis was conducted. In conclusion, adding three new items to the questionnaire led to only limited improvement in reliability and validity. The World Health Organization Quality of Life Questionnaire is sufficient for measuring QOL in patients with hip fractures.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 04/2009; 32(3):245-50. DOI:10.1097/MRR.0b013e32832bb10c · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: La prévalence de l’insuffisance rénale est de 25 % après 70 ans. Les conséquences physiopathologiques défavorables consécutives
à l’insuffisance rénale apparaissent pour un débit de filtration glomérulaire inférieur à 45 ml/min. Les données récentes
de la littérature démontrent qu’une identification précoce de l’insuffisance rénale et de ses conséquences est capitale. Les
événements cardiovasculaires sont plus fréquents chez les patients insuffisants rénaux, ce qui justifie la mise en oeuvre
d’une prévention primaire et secondaire. Chez le patient âgé, l’anémie, dont les conséquences sont significatives (baisse
des capacités fonctionnelles, risque de chutes), est associée dans 17 à 35 % à une insuffisance rénale. Une supplémentation
par érythropoïétine est à discuter en collaboration avec les néphrologues. l’insuffisance rénale est responsable de troubles
du métabolisme osseux avec risque accru de fragilité osseuse justifiant l’initiation d’une supplémentation en vitamine D et
l’indication d’un traitement par un biphosphonate. Une insuffisance rénale implique des adaptations posologiques pour de nombreux
médicaments. Enfin, l’identification de troubles cognitifs doit être systématique parce que, d’une part, ces troubles cognitifs
limitent une bonne prise en charge de l’insuffisance rénale et que, d’autre part, les démences, notamment vasculaires, sont
significativement associées à l’insuffisance rénale. Le médecin gériatre occupe donc une place centrale dans la prise en charge
des patients âgés insuffisants rénaux. Des actions diagnostiques et thérapeutiques simples doivent permettre d’améliorer la
qualité de vie des patients âgés insuffisants rénaux.
The prevalence of renal insufficiency in elderly seniors (> 70 years old) is high, about 25%, and several adverse pathological
consequences appear when the glomerular filtration rate decreases below 45 ml/min. Therefore, what is the place of the geriatric
physician in the care of “an elderly with renal insufficiency”? Recent reports have suggested that an early management of
the renal insufficiency is of major importance in this population. Indeed, some simple reflexes have to be thought of; cardiovascular
complications are frequent in these patients and their presence requires an estimation of the glomerular filtration rate in
order to adapt drug dosages and minimize their toxicity, including their nephrotoxicity. Treatment of hypertension with an
angiotensin inhibitor can be beneficial for the renal insufficiency in presence of proteinuria. Renal insufficiency can led
to anaemia in 17 to 35% of elderly and should be treated (with erythropoietin) in order to prevent the risks of falls, spine
and femoral fracture, and finally the decline of the functional capacities. On the other hand, the osseous metabolism can
be altered in elderly and worsen by the renal insufficiency, further stressing the risks of falls. Therefore, osteoporosis
has to be looked for and treated if necessary with biphosphonates and vitamin D. Finally, screening of cognitive disorders
has to be undertaken not only to assure a good participation of elderly seniors to their treatment, but also to evaluate the
possible association with vascular dementia or of other dementia, increased in elderly with renal insufficiencies. In conclusion,
the geriatric physician has an important rule in the management in elderly senior with renal insufficiency. Simple medical
diagnosis and treatments could improve their quality of live.
Les cahiers de l année gérontologique 12/2009; 1(4):209-222. DOI:10.1007/s12612-009-0025-9
[Show abstract][Hide abstract] ABSTRACT: Several recent reports have described osteonecrosis of the jaws (ONJ) associated with the use of bisphosphonates. Osteonecrosis of the jaws is recognized as a serious complication of bisphosphonate therapy, more commonly with the intravenous form of the drugs. However, there is limited scientific understanding about the association between osteonecrosis of the jaws and bisphosphonates. Primary care physicians treating bone diseases with bisphosphonate need, therefore, to be aware of this potential risk and plan the prophylaxis, early diagnosis and prevention of potential consequences. In this article, I review the literature on this newly described complication, with particular focus on systemic and local predisposing pathologies, preventive measures suggested before and during therapy with oral bisphosphonates, and the frequent clinical presentation of the oral lesions. The expert panel recommendations for the management of care of patients who develop ONJ are summarized also. ONJ has been linked with high-dose intravenous bisphosphonate use in patients with bony cancers and the observation has been extended at a much lower incidence to patients on oral bisphosphonates taken for osteoporosis. The benefit-risk ratio is still heavily weighted towards therapy but primary care physicians need to be aware of this link. The risk is greatest in those with poor oral health who are undergoing dental surgery. If there is doubt, then a review by an experienced oral surgeon is appropriate. Osteoporotic fracture is common, expensive, and associated with increased morbidity and mortality. The incidence of osteoporosis fracture annually is greater than the risk of stroke, breast cancer, and heart attack combined. Bisphosphonates (BPs) have recently been the subject of clinical controversies because of the reported incidence of osteonecrosis of jaw (ONJ). Bisphosphonates as a group of drugs were introduced for the management of various conditions such as osteoporosis, Paget's disease, multiple myeloma, and hypercalcemia of malignancy. This group of drugs has improved the quality of life in many patients with proven efficacy in limiting pain and skeletal-related events. The efficacy of BPs as one method to prevent and treat osteoporosis and avert future fractures, particularly vertebral fractures, is well documented in large clinical trials. However, despite this evidence, many patients at risk for osteoporosis are not screened or treated. The controversy of osteonecrosis of the jaws and bisphosphonates is a recent and growing problem.
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