Outcome of hip fracture in older Irish women: a 2-year follow-up of subjects in a case–control study
Introduction
Hip fractures are a major public health problem in older people. They are associated with increased mortality [1], [2], [3], [4], [5], [6], [7], [8] and many survivors experience a decline in function [9], [10], [11], [12], [13], [14], [15]. There are increasing numbers of older people in our population and it has been predicted that by the year 2025 the number in western Europe over 50 years of age will have increased by 45% from the 1990 figure, with a consequent increase in the number of hip fractures [16]. This has major implications for planning of health-care delivery and services for older age groups. It is therefore important to consider the impact of hip fracture on older people and their subsequent health.
The aim of this study was to assess outcome at 2 years in hip fracture cases and controls who had been entered into a case–control study [17].
Section snippets
Methods
A case–control study examining the role of radiologically assessed bone mineral density in hip fracture was carried out in Dublin [17]. The cases comprised of 106 consecutive female patients over 50 years of age who sustained a hip fracture following a fall, who were admitted directly to St. Vincent’s University Hospital in Dublin and who lived in the hospital catchment area. Patients referred from other hospitals or those with a fracture due to malignancy or road traffic accidents were
Results
One-hundred and six cases and 89 controls were included in this study. At baseline, cases and controls were similar with regard to age, place of residence, social class and marital status (Table 1).
Mortality was significantly higher in cases at 1 and 2 years; 25 (23.6%) cases and nine (10.1%) controls died during the 2-year period (RR=2.3; 95% CI, 1.15–4.73; P=0.014); the mortality rate at 1 year was 16.0% for cases and 4.5% for controls (RR=3.6; 95% CI, 1.25–10.22; P=0.010). The remainder of
Discussion
Although there have been many studies on the outcome of hip fractures in older individuals, most have focused on mortality with less emphasis on other aspects of outcome. Furthermore, many studies have not included controls and have followed patients for relatively short periods of time after injury. Previous studies in Ireland provided only limited data on outcomes and did not include controls [4], [21]. This study examined the impact of hip fracture at 2 years on older Irish women in terms of
Acknowledgements
We thank the women who participated in the study and the research nurses, Veronica O’Neill and Bernadette Lynch. We also thank Dr. Elizabeth Dinn, Iris Van Rooij, Professor Geoffrey Bourke, Professor James Masterson and the staff of the Department of Radiology, St. Vincent’s University Hospital. The original case–control study was funded by the Health Research Board and Novartis Ireland. The Health Research Board funded the follow-up study.
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