The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture.

BACKGROUND: Sarcopenia, which is a common risk factor for falls and fractures, affects the functional outcome and mortality in geriatric populations. However, the prevalence of sarcopenia among geriatric Taiwanese patients with a hip fracture is unknown, nor is the effect of sarcopenia on the outcome of hip surgery. METHODS: From December 2017 to February 2019, geriatric patients who underwent surgery for a hip fracture were prospectively enrolled. Basic demographic data, responses to questionnaires for dementia screening and quality of life (QoL) and daily living activities (ADL) before the injury were analyzed to identify any association with sarcopenia. The QoL and ADL were monitored at six months after the operation to determine the difference between hip fracture patients with or without sarcopenia. RESULTS: Of 139 hip fracture patients, 70 (50.36%) were diagnosed with sarcopenia. Accounting for all confounding factors in the multivariate logistic regression, lower body mass index (BMI), male gender and a weaker handgrip are the risk factors that are most strongly associated with a diagnosis of sarcopenia in geriatric patients with a hip fracture. Hip fracture patients with sarcopenia also have poor ADL and a lower QoL than patients without sarcopenia before the injury and six months after the operation. CONCLUSION: A high prevalence of sarcopenia among geriatric hip fracture patients is associated with a poor mid-term outcome following hip surgery. Clinicians must recognize the risk of sarcopenia, especially for male hip fracture patients with a lower BMI and a weaker handgrip.

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage.

Kyphoplasty is an important treatment for stabilizing spine fractures due to osteoporosis. However, leakage of polymethyl-methacrylate (PMMA) bone cement during this procedure into the spinal canal has been reported to cause many adverse effects. In this study, we prepared an implantable membrane to serve as a barrier that avoids PMMA cement leakage during kyphoplasty procedures through a hybrid composite made of poly-l-lactic acid (PLLA) and tricalcium silicate (C3S), with the addition of C3S into PLLA matrix, showing enhanced mechanical and anti-degradation properties while keeping good cytocompatibility when compared to PLLA alone and most importantly, when this material design was applied under standardized PMMA cement injection conditions, no posterior wall leakage was observed after the kyphoplasty procedure in pig lumbar vertebral bone models. Testing results assess its effectiveness for clinical practice.

Screw trajectory affects screw cut-out risk after fixation for nondisplaced femoral neck fracture in elderly patients.

BACKGROUND: Incidence of femoral neck fracture has risen with the aging of the population and has critical implications with regard to patient death, functional dependence, and social costs. Screw fixation using triangular configurations and calcar placement are still the preferred treatment for nondisplaced femoral neck fracture, to reduce the risk of loss of reduction and nonunion. However, this method is still controversial in terms of the effects of screw trajectory, including parallel or nonparallel configurations, on fixation of femoral neck fractures. This study aimed to compare the incidence of complications between patients who have undergone fixation with a parallel or a nonparallel screw trajectory. METHODS: We retrospectively analyzed 55 patients who were older than 60 years and diagnosed with nondisplaced femoral neck fracture from March 2014 to March 2016, and who were treated with cannulated screw fixation in our institution. Patient demographics, radiographic parameters including reduction quality, screw trajectory, and complications during the follow-up period were all evaluated. RESULTS: The overall complication rate for screw fixation in elderly patients was 23.6%, and screw cut-out was the most common complication, occurring in 14.5% of all enrolled patients. Also, we found that screw cut-out occurred in more osteoporotic patients, and all screw cut-outs were in groups treated with a nonparallel screw trajectory. However, parallel screw fixation was inclined to back out more after fracture healing and had a lower risk of postoperative screw cut-out. CONCLUSIONS: Our results suggested that fixation with nonparallel screws for nondisplaced femoral neck fracture in elderly and osteoporotic patients might interfere with shortening of the femoral neck along with fracture healing, leaving patients at risk of postoperative screw cut-out from the femoral head.

Worsen depression after viscosupplementation treatment for geriatric people with knee osteoarthritis?

Background/objective: Knee osteoarthritis (OA) in older people may result in psychological impairment, including anxiety and depression. This study investigates the effect of intraarticular hyaluronic acid injection (IAHA) on geriatric patients with OA. Method: A total of 102 geriatric patients with knee OA undergoing IAHA were prospectively enrolled in this study. Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and Visual Analogue Scale (VAS) for pain were recorded. All outcomes were measured at baseline before injection and during two, four, and six month follow-ups. Results: IAHA had a significant short-term effect, relieving pain at the two month follow-up, but the effect was weaker at the four month follow-up. Both IKDC and WOMAC scores were significantly improved at the two month follow-up. Viscosupplementation did not improve STAI. GDS exhibited significant deterioration at the four month follow-up. Conclusions: Although IAHA for the treatment of OA provided short-term efficiency, it had no effects on anxiety and increased depression of geriatric people. Health education should be provided with caution before viscosupplementation treatment to manage expectations of the efficacy of treatment for geriatric OA patients.

Antecedentes/objetivo: La artrosis de rodilla (AR) en personas mayores puede causar ansiedad y depresión. Se investiga el efecto de la inyección intra-articular de ácido hialurónico (IAAH) en pacientes mayores con AR. Método: Ciento dos pacientes mayores tratados con IAAH fueron inscritos de forma prospectiva. Contestaron la Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) y Visual Analogue Scale (VAS). Se evaluó antes de la inyección y durante el seguimiento a dos, cuatro y seis meses. Resultados: La IAAH produjo un efecto significativo a corto plazo, aliviando el dolor a los dos meses de seguimiento, pero el efecto fue más débil a los cuatro meses. Las puntuaciones del IKDC y WOMAC mejoraron significativamente a los dos meses de seguimiento. La visco-suplementación no mejoró la ansiedad. La GDS mostró un deterioro significativo a los cuatro meses de seguimiento. Conclusiones: Aunque la IAAH fue efectiva a corto plazo, no tuvo efectos sobre la ansiedad, y aumentó la depresión. Debe prestarse atención a la educación para la salud antes del tratamiento con viscosuplementación para controlar las expectativas de la eficacia del tratamiento en pacientes mayores con AR.

Worsen depression after viscosupplementation treatment for geriatric people with knee osteoarthritis?

Background/objective: Knee osteoarthritis (OA) in older people may result in psychological impairment, including anxiety and depression. This study investigates the effect of intraarticular hyaluronic acid injection (IAHA) on geriatric patients with OA. Method: A total of 102 geriatric patients with knee OA undergoing IAHA were prospectively enrolled in this study. Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and Visual Analogue Scale (VAS) for pain were recorded. All outcomes were measured at baseline before injection and during two, four, and six month follow-ups. Results: IAHA had a significant short-term effect, relieving pain at the two month follow-up, but the effect was weaker at the four month follow-up. Both IKDC and WOMAC scores were significantly improved at the two month follow-up. Viscosupplementation did not improve STAI. GDS exhibited significant deterioration at the four month follow-up. Conclusions: Although IAHA for the treatment of OA provided short-term efficiency, it had no effects on anxiety and increased depression of geriatric people. Health education should be provided with caution before viscosupplementation treatment to manage expectations of the efficacy of treatment for geriatric OA patients

Antecedentes/objetivo: La artrosis de rodilla (AR) en personas mayores puede causar ansiedad y depresión. Se investiga el efecto de la inyección intra-articular de ácido hialurónico (IAAH) en pacientes mayores con AR. Método: Ciento dos pacientes mayores tratados con IAAH fueron inscritos de forma prospectiva. Contestaron la Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) y Visual Analogue Scale (VAS). Se evaluó antes de la inyección y durante el seguimiento a dos, cuatro y seis meses. Resultados: La IAAH produjo un efecto significativo a corto plazo, aliviando el dolor a los dos meses de seguimiento, pero el efecto fue más débil a los cuatro meses. Las puntuaciones del IKDC y WOMAC mejoraron significativamente a los dos meses de seguimiento. La visco-suplementación no mejoró la ansiedad. La GDS mostró un deterioro significativo a los cuatro meses de seguimiento. Conclusiones: Aunque la IAAH fue efectiva a corto plazo, no tuvo efectos sobre la ansiedad, y aumentó la depresión. Debe prestarse atención a la educación para la salud antes del tratamiento con viscosuplementación para controlar las expectativas de la eficacia del tratamiento en pacientes mayores con AR

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

BACKGROUND: Procedure sedation and analgesia (PSA) is often used to alleviate discomfort and to facilitate fracture reduction for patients with distal radius fracture in emergency departments and clinics, but risks of respiratory distress and needs for different levels of monitoring under PSA are still under concern. Hematoma block (HB) is a simple alternative method of providing rapid pain relief during reduction of distal radius fracture. However, there is still in lack of strong evidence to promote HB over PSA in clinical practice. The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure. METHODS: The PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials.gov were searched for studies comparing HB or PSA in distal radius fracture reduction. The search revealed four randomized controlled trials and one non-randomized trial, which included two studies of pediatric subjects and three studies of adult subjects. Subgroup meta-analysis for adult and pediatric groups were specifically performed according to age difference to avoid potential bias. RESULTS: In the adult group, the effect of HB on post-reduction pain severity was better than that of PSA with significant heterogeneity (Hedges' g - 0.600, 95% confidence interval (CI) - 1.170 to - 0.029, p = 0.039), although there was no difference on the pain severity during reduction between these two groups with significant heterogeneity (Hedges' g 0.356, 95% CI - 1.101 to 1.812, p = 0.632). In the pediatric group, the treatment effect on pain severity was significantly better by HB than that by PSA but without significant heterogeneity (Hedges' g - 0.402, 95% CI - 0.718 to - 0.085, p = 0.013, I 2 < 0.001%). Most of the reported adverse effects (AEs) include nausea, vomiting, and respiratory distress developed in adult patients treated by PSA. The rates of reported AEs did not significantly differ between HB and PSA in the pediatric group. Additionally, final outcomes of reduction failure did not significantly differ between HB and PSA in both adult and pediatric groups. CONCLUSION: Hematoma block is a safe and effective alternative of anesthesia in reduction of distal radius fracture without inferior pain relief compared with PSA among adult and pediatric patients.

Near-infrared bone densitometry: A feasibility study on distal radius measurement.

Osteoporosis, defined as decreased bone mineral density (BMD), poses patients in dangers for fracture risk and has become a major public health problem worldwide because of is associated morbidity, mortality and costs. Without doubt, early detection and timely intervention are important to successfully manage osteoporosis and its associated complications. The dual-energy x-ray absorptiometry (DXA) is the most popular and standard method to measure BMD. However, limitations including radiation exposure and availability restrict its application for osteoporosis screening among general population. In this study, we developed a simple method to detect human distal radius bone density based on near infrared (NIR) image system. Among 10 volunteers (including 5 young and 5 elderly participants) receiving bone density measurement using our NIR image system at the ultradistal part of bilateral distal radius, we demonstrated a strong correlation between the optical attenuation and BMD measured with DXA, which may facilitate predicting bone density status. We hope our potential NIR image system may open a new avenue for development of osteoporosis screening facilities and help in prevention of osteoporosis related fracture and its associated complications in the near future. Pearson's correlations between BMD values from the DXA and light intensity of NIR system.

Application of modified JDP-DGGE-based molecular genotyping method to predict Acanthamoeba genotype and to analyse community diversity in aquatic environments.

Acanthamoeba spp. are ubiquitous, opportunistic potential human pathogens, causing granulomatous amoebic encephalitis and keratitis. They are classified as protozoa, and they include at least 20 different genotypes (T1-T20) based on variation in the 18S rRNA gene. Acanthamoeba spp. are diverse in their production of toxins and in their ability to resist environmental factors. Therefore, it is necessary to develop a rapid genotyping method for Acanthamoeba spp. in aquatic environments. Although the denaturing gradient gel electrophoresis (DGGE) method for analysing microbial genotypes is potentially useful for rapid identification of aquatic environmental species, the technique has been compromised by artificial DGGE profiles in which many DNA fragments of identical sequences are segregated and displayed as different bands. The results indicate that PCR-DGGE genotyping with a GC clamp results in many segregated weaker bands of identical DNA sequences. In contrast, PCR-DGGE genotyping without a GC clamp displays genotype-dependent patterns in the major bands. Thus, DGGE without a GC clamp was performed to compare genotyping efficiency for Acanthamoeba in 21 water samples from rivers and reservoirs in Taiwan. Among them, four samples were found to demonstrate a banding pattern with more than one major band, and these band profiles of major bands were identical to those of positive controls. DNA cloning further confirmed that the sequences of the major bands were identical. In conclusion, more than two genotypes of Acanthamoeba in the four samples were identified by this method, suggesting that PCR-DGGE genotyping without a GC clamp is a useful approach for studying the diversity of Acanthamoeba communities. Graphical abstract.

Kinematic strategies for obstacle-crossing in patients with isolated posterior cruciate ligament deficiency.

The posterior cruciate ligament (PCL) plays an important role in the structural stability and sensory feedback at the knee. Altered structural and proprioceptive function at the PCL-deficient knee may affect the joint motions and the end-point control during functional activities. The current study identified the effects of unilateral PCL deficiency (PCLD) on the end-point control and joint kinematics of the lower limbs during obstacle-crossing. Eighteen patients with unilateral PCLD and eighteen healthy controls were each asked to walk and cross obstacles of heights of 10%, 20% and 30% of their leg lengths, with the affected and the unaffected limb leading, while their kinematic data were measured. Patients with PCLD were found to cross obstacles with significantly increased toe-clearance (p<0.01), increased trailing toe-obstacle distance (p<0.05) and reduced crossing speed (p<0.01) when compared to the controls. Similar end-point control was observed in the PCLD group whether leading with the affected or unaffected limb, which appears to be as a result of bilateral kinematic accommodation to reduce the risk of tripping. To achieve similar toe-clearances, crossing strategies with the unaffected limb leading involved angular changes at more joints than those with the affected limb leading. The PCLD group appeared to adopt a conservative strategy to reduce the risk of tripping over the obstacle during obstacle-crossing, using different joint kinematic changes depending on whether the affected or unaffected limb was leading. It is suggested that monitoring of the kinematic strategies adopted by patients with PCLD during obstacle-crossing may be needed in future rehabilitation programs with the aim of reducing tripping risks during obstacle-crossing.

Arthroscopic extended rotator interval release for treating refractory adhesive capsulitis.

PURPOSE: To present the clinical results of arthroscopic extended rotator interval release with a stretching program for treating refractory adhesive capsulitis. STUDY DESIGN: Case series; level of evidence, 4. METHODS: Arthroscopy-assisted extended rotator interval tissue release including anterior capsular was performed in 26 patients with refractory adhesive capsulitis. All rotator interval tissues, except the medial sling of the biceps, were excised and the excursion of the subscapularis tendon was restored and freely mobilized. The preoperative mean passive forward flexion was 101°, whereas external rotation at the side was 10°. Patients were followed for a minimum of 2 years and their visual analog scale for pain, muscle power, range of motion, Constant score, modified American Shoulder and Elbow Surgeons Shoulder Evaluation Form score, and modified University of California at Los Angeles score were recorded. RESULTS: Visual pain scale and the aforementioned clinical scores improved postoperatively. The patients exhibited a significant postoperative difference in forward flexion, external rotation, and internal rotation. Postoperative mean passive forward flexion was 172°, whereas external rotation at the side was 58°. There was no difference in the muscle power postoperatively including abduction, internal rotation, and external rotation. CONCLUSIONS: Our study revealed satisfactory subjective and objective clinical results after a 2-year follow-up. Arthroscopy-assisted extended rotator interval release with a stretching program could be an alternative treatment for refractory adhesive capsulitis.

Incidence and excess mortality of hip fracture in young adults: a nationwide population-based cohort study.

BACKGROUND: This study assessed the incidence and excess mortality of hip fractures among inpatients aged 20-40 years in a nationwide population database in Taiwan. METHODS: Subjects were selected from Taiwan's National Health Insurance Research Database for the period 2001-2008 and were followed up until the end of 2010. A total of 4,523 subjects were admitted for the first time with primary diagnosis of hip fracture and treated with operation. RESULTS: The overall annual incidence, mortality, and standardized mortality ratio (SMR) decreased from 7.68 to 7.23 per 100,000, from 1.37 % to 0.94 %, and from 9.06 to 6.71, respectively, from 2001 to 2008. The 1-year, 2-year, 3-year, 5-year, and 10-year mortality rates were 1.28 %, 2.44 %, 3.54 %, 5.32 %, and 10.50 %, respectively for the whole cohort. The 1-year, 2-year, 3-year, 5-year, and 10-year SMRs were 8.33, 7.59, 7.28, 6.39, and 5.82, respectively, for the whole cohort. Risk factors for overall death were male gender, trochanteric fracture, hemiarthroplasty, and higher Charlson comorbidity index (CCI) scores. CONCLUSIONS: The high SMRs found in the present study suggest that young adults with former hip fracture should be closely followed up to prevent early mortality.

Control of body's center of mass motion relative to center of pressure during uphill walking in the elderly.

Uphill walking places more challenges on the locomotor system than level walking does when the two limbs work together to ensure the stability and continuous progression of the body over the base of support. With age-related degeneration older people may have more difficulty in maintaining balance during uphill walking, and may thus experience an increased risk of falling. The current study aimed to investigate using gait analysis techniques to determine the effects of age and slope angles on the control of the COM relative to the COP in terms of their inclination angles (IA) and the rate of change of IA (RCIA) during uphill walking. The elderly were found to show IAs similar to those of the young, but with reduced self-selected walking speed and RCIAs (P<0.05). After adjusting for walking speed differences, the elderly showed significantly greater excursions of IA in the sagittal plane (P<0.05) and increased RCIA at heel-strike and during single limb support (SLS) and double limb support (DLS) in the sagittal plane (P<0.05), and increased RCIA at heel-strike in the frontal plane (P<0.05). The RCIAs were significantly reduced with increasing slope angles (P<0.05). The current results show that the elderly adopted a control strategy different from the young during uphill walking, and that the IA and RCIA during walking provide a sensitive measure to differentiate individuals with different balance control abilities. The current results and findings may serve as baseline data for future clinical and ergonomic applications.

Mortality and complications of hip fracture in young adults: a nationwide population-based cohort study.

BACKGROUND: This study assessed the mortality and complications of hip fractures using in-patients aged 20-40 years from a nationwide population database in Taiwan. METHODS: Subjects were selected from Taiwan's National Health Insurance Research Database for the period 2000-2008, and these subjects were followed up until the end of 2010. A total of 5,079 (3,879 male and 1,200 female) subjects were admitted for the first time with primary diagnosis of hip fracture and treated with operation. We calculated the long-term overall survival rate and complication-free rate. We also assessed the risk factors for mortality and complications. RESULTS: The 1-month, 3-month, 6-month, 1-year, 2-year, 5-year, and 10-year complication-free rates were 98.3%, 96.2%, 94.5%, 86.8%, 80.4%, 75.3%, and 73.5% for the entire cohort, respectively. The 10-year survival rates were 93.3%, 91.8%, and 94.5% for total cases, trochanteric fracture, and cervical fracture, respectively. The 10-year complication-free rates were 73.5%, 80.5%, and 67.3% for total cases, trochanteric fracture, and cervical fracture, respectively. The risk factors for overall death were male, older age, and greater number of Charlson comorbidity index (CCI) comorbidities. The risk factors for complication were cervical fracture, and greater number of CCI comorbidities. Complications resulted in 42.83% of patients receiving internal fixation implants or prothesis removal and 2.01% underwent conversion to revision arthroplasty during follow-up. CONCLUSIONS: The overall 10-year survival rate in hip fracture patients aged 20-40 years in Taiwan was over 90%. The 10-year complication-free rates were around 70%. Preventing the occurrence of severe complications after hip fracture among young adults is an important public health issue that warrants greater attention.

Redistribution of intra- and inter-limb support moments during downhill walking on different slopes.

Downhill walking presents a greater risk of falling as a result of slipping or loss of balance in comparison with level walking. The current study aimed to investigate the effects of inclination angles on the intra-limb (inter-joint) and inter-limb sharing of the body support during downhill walking for a better understanding of the associated control strategy. Fifteen young male adults (age: 32.6±5.2 years, height: 168.9±5.5cm, mass: 68.4±8.7kg) performed level and downhill walking while their kinematic and kinetic data were measured for calculating joint moments and total support moments of the lower limbs using inverse dynamics analysis. The peak total support moments of both the leading and trailing limbs increased with increasing inclination angles (p<0.05) with different sharing patterns among individual joints. Being the major contributor to the peak total support moment during early single-limb support, the contribution of the knee remained unaltered (p>0.05), but the contributions of the hip increased with reduced contributions from the ankle (p<0.05). For the increased peak total support moment during late single-limb support, the intra-limb sharing changed from a major ankle contribution to a major knee contribution strategy. The hip contribution was also increased (p<0.05) but the hip flexor moment remained unaltered (p>0.05). During double-limb support, the main contributor to the whole body support changed from the trailing limb to the leading limb with increasing inclination angles (p<0.05).

Influence of inclination angles on intra- and inter-limb load-sharing during uphill walking.

Uphill walking is an inevitable part of daily living, placing more challenges on the locomotor system with greater risk of falls than level walking does. The current study aimed to investigate the effects of inclination angles on the inter-joint and inter-limb load-sharing during uphill walking in terms of total support moment and contributions of individual joint moments to the total support moment. Fifteen young adults walked up walkways with 0°, 5°, 10° and 15° of slope while kinematic and kinetic data were collected and analyzed. With increasing inclination angles, the first peak of the total support moment was increased with unaltered individual joint contributions, suggesting an unaltered inter-joint control pattern in the leading limb to meet the increased demands. The second peak of the total support moment remained unchanged with increasing inclination angles primarily through a compensatory redistribution of the hip and knee moments. During DLS, the leading limb shared the majority of the whole body support moments. The current results reveal basic intra- and inter-limb load-sharing patterns of uphill walking, which will be helpful for a better understanding of the control strategies adopted and for subsequent clinical applications.

One-stage arthroscopic repair of rotator cuff tears with shoulder stiffness.

PURPOSE: The purpose of this study is to describe a 1-stage treatment with concomitant arthroscopic capsular release and rotator cuff repair and present clinical outcomes with a minimum follow-up of 2 years. METHODS: Arthroscopic rotator cuff repair was performed in 211 consecutive patients. Forty-three patients had severe concomitant shoulder stiffness at the time of the repair. In the stiffness group, 1-stage arthroscopic capsular release and rotator cuff repair were performed. Preoperative mean passive forward flexion was 124°, whereas external rotation at the side was 309°. All patients were evaluated at a minimum 2-year follow-up, which included a visual analog scale score for pain, tests of muscle power and range of motion, the Constant score, and the modified American Shoulder and Elbow Surgeons shoulder evaluation form and modified University of California, Los Angeles scores. RESULTS: The mean visual analog scale score during motion at the last follow-up was 1.5 in the stiffness group and 1.3 in the non-stiffness group. In the stiffness group, forward flexion was 175° whereas external rotation at the side was 60° postoperatively; shoulder motion improved (P < .001) and was comparable with that of the contralateral side. Other functional outcome instruments showed no statistical difference between the 2 groups. CONCLUSIONS: In this study, 1-stage treatment of patients with rotator cuff tears and shoulder stiffness was performed by arthroscopic capsular release and cuff repair, and overall satisfactory results were achieved in selected patients. The results of the stiffness group in this study were statistically the same as those in the non-stiffness group. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study.

Osteoporotic hip fractures cause high mortality in the elderly population. However, few population studies reported the long-term mortality of hip fracture among the elderly in Asian population. This study assessed the incidence, excess mortality, and risk factors after osteoporotic hip fractures through inpatients aged 60 years or older. A total of 143,595 patients with hip fracture were selected from Taiwan National Health Insurance database in the years 1999 to 2009 and followed up until the end of 2010. Annual incidence, mortality and SMR, and mortality and SMR at different periods after fracture were measured. From 1999 to 2005, hip fracture incidence gradually increased and then fluctuated after 2006. From 1999 to 2009, the male-to-female ratio of annual incidence increased from 0.60 to 0.66, annual mortality for hip fracture decreased from 18.10% to 13.98%, male-to-female ratio of annual mortality increased from 1.38 to 1.64, and annual SMR decreased from 13.80 to 2.98. Follow-up SMR at one, two, five, and ten years post-fracture was 9.67, 5.28, 3.31, and 2.89, respectively. Females had higher follow-up SMR in the younger age groups (60-69 yr of age) but lower follow-up SMR in the older age groups (over 80 yr of age) compared with males. Among the studied patients, incidence is gradually decreasing along with annual mortality and SMR. Hip fracture affects short-term but not long-term mortality.