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Review of the long-term disability associated with hip fractures
  1. Melanie Bertram,
  2. Rosana Norman,
  3. Linda Kemp,
  4. Theo Vos
  1. The University of Queensland, Centre for Burden of Disease & Cost Effectiveness, School of Population Health, Brisbane, Australia
  1. Correspondence to Rosana Norman, The University of Queensland, Centre for Burden of Disease & Cost Effectiveness, School of Population Health, Herston Road, Herston, Queensland 4006, Australia; r.norman{at}


Objectives To determine the proportion of hip fracture patients who experience long-term disability and to re-estimate the resulting burden of disease associated with hip fractures in Australia in 2003.

Methods A literature review of the functional outcome following a hip fracture (keywords: morbidity, treatment outcome, disability, quality of life, recovery of function, hip fractures, and femoral neck fractures) was carried out using PubMed and Ovid MEDLINE.

Results A range of scales and outcome measures are used to evaluate recovery following a hip fracture. Based on the available evidence on restrictions in activities of daily living, 29% of hip fracture cases in the elderly do not reach their pre-fracture levels 1 year post-fracture. Those who do recover tend to reach their pre-fracture levels of functioning at around 6 months. These new assumptions result in 8251 years lived with disability for hip fractures in Australia in 2003, a 4.5-fold increase compared with the previous calculation based on Global Burden of Disease assumptions that only 5% of hip fractures lead to long-term disability and that the duration of short-term disability is just 51 days.

Conclusions The original assumptions used in burden of disease studies grossly underestimate the long-term disability from hip fractures. The long-term consequences of other injuries may similarly have been underestimated and need to be re-examined. This has important implications for modelling the cost-effectiveness of preventive interventions where disability-adjusted life years are used as a measure of health outcome.

  • Hip fracture
  • burden of disease
  • quality of life
  • disability
  • fracture
  • public health

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.