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Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004–2013)

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Abstract

Summary

Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004–2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men.

Introduction

This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004–2013.

Methods

We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC).

Results

From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07–1.17).

Conclusions

Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

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References

  1. Soriguer F, Goday A, Bosch-Comas A, Bordiu E, Calle-Pascual A, Carmena R et al (2012) Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study. Diabetologia 55:88–93

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. de Liefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA (2005) Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 16:1713–1720

    Article  PubMed  Google Scholar 

  3. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a metaanalysis. Osteoporos Int 18:427–444

    Article  CAS  PubMed  Google Scholar 

  4. Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the Nurses’ Health Study. Diabetes Care 29:1573–1578

    Article  PubMed  Google Scholar 

  5. Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL et al (2006) Risk of fracture in women with type 2 diabetes: the Women’s Health Initiative Observational Study. J Clin Endocrinol Metab 91:3404–3410

    Article  CAS  PubMed  Google Scholar 

  6. Melton LJ III, Leibson CL, Achenbach SJ, Therneau TM, Khosla S (2008) Fracture risk in type 2 diabetes: update of a population-based study. J Bone Miner Res 23:1334–1342

    Article  PubMed Central  PubMed  Google Scholar 

  7. Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–1299

    Article  CAS  PubMed  Google Scholar 

  8. Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505

    Article  PubMed  Google Scholar 

  9. Wang H, Lü YW, Lan L, Zhang Q, Chen HL, Zhang GY et al (2013) Impact of diabetes on the prognosis of hip fracture: a cohort study in the Chinese population. Chin Med J (Engl) 126:813–818

    Google Scholar 

  10. Norris R, Parker M (2011) Diabetes mellitus and hip fracture: a study of 5966 cases. Injury 42:1313–1316

    Article  PubMed  Google Scholar 

  11. Miller BJ, Lu X, Cram P (2013) The trends in treatment of femoral neck fractures in the Medicare population from 1991 to 2008. J Bone Joint Surg Am 95:e132

    Article  PubMed Central  PubMed  Google Scholar 

  12. Lai K, Bohm ER, Burnell C, Hedden DR (2007) Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty 22:651–656

    Article  PubMed  Google Scholar 

  13. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP (2009) The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 91:1621–1629

    Article  PubMed  Google Scholar 

  14. Pedersen AB, Mehnert F, Johnsen SP, Sorensen HT (2010) Risk of revision of a total hip replacement in patients with diabetes mellitus: a population-based follow up study. J Bone Joint Surg (Br) 92:929–934

    Article  CAS  Google Scholar 

  15. Instituto Nacional de Gestión Sanitaria, Ministerio de Sanidad, Servicios Sociales e Igualdad: Conjunto Mínimo Básico de Datos, Hospitales del INSALUD. http://www.ingesa.msc.es/estadEstudios/documPublica/CMBD-2001.htm. Accessed 26 April 2015

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  17. Thomsen RW, Nielsen JS, Ulrichsen SP, Pedersen L, Hansen AM, Nilsson T (2012) The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) study: collection of baseline data from the first 580 patients. Clin Epidemiol 4:43–48

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ministerio de Sanidad, Servicios Sociales e Igualdad: Encuesta Nacional de Salud de España. http://www.msssi.gob.es/estadEstudios/estadisticas/encuestaNacional/. Accessed 26 April 2015

  19. Instituto Nacional de Estadística: Population estimates 2010. http://www.ine.es. Accessed 26 April 2015

  20. Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19:335–351

    Article  CAS  PubMed  Google Scholar 

  21. Joinpoint Regression Program (2013) Statistical methodology and applications branch, surveillance research program, National Cancer Institute. Version 4.0.4

  22. Reistetter TA, Graham JE, Deutsch A, Markello SJ, Granger CV, Ottenbacher KJ (2011) Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture. Diabetes Care 34:1375–1377

    Article  PubMed Central  PubMed  Google Scholar 

  23. Adams AL, Shi J, Takayanagi M, Dell RM, Funahashi TT, Jacobsen SJ (2013) Ten-year hip fracture incidence rate trends in a large California population, 1997–2006. Osteoporos Int 24:373–376

    Article  CAS  PubMed  Google Scholar 

  24. Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21:373–380

    Article  CAS  PubMed  Google Scholar 

  25. Nilson F, Moniruzzaman S, Gustavsson J, Andersson R (2013) Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxf) 35:125–131

    Article  Google Scholar 

  26. Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–1145

    Article  CAS  PubMed  Google Scholar 

  27. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289

    Article  CAS  PubMed  Google Scholar 

  28. Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, Díez-Pérez A, Dennison EM (2014) Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int 25:1267–1274

    Article  CAS  PubMed  Google Scholar 

  29. Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES et al (2008) Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care 31:391–396

    Article  PubMed Central  PubMed  Google Scholar 

  30. Martinez-Laguna D, Tebe C, Javaid MK, Nogues X, Arden NK, Cooper C et al (2015) Incident type 2 diabetes and hip fracture risk: a population-based matched cohort study. Osteoporos Int 26:827–833

    Article  CAS  PubMed  Google Scholar 

  31. Hothersall EJ, Livingstone SJ, Looker HC, Ahmed SF, Cleland S, Leese GP et al (2014) Contemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from Scotland. J Bone Miner Res 29:1054–1060

    Article  PubMed Central  PubMed  Google Scholar 

  32. Thakore RV, Foxx AM, Lang MF, Sathiyakumar V, Obremskey WT, Boyce RH, Ehrenfeld JM, Sethi MK (2015) Operative intervention for geriatric hip fracture: does type of surgery affect hospital length of stay? Am J Orthop 44:228–232

    PubMed  Google Scholar 

  33. Gulcelik NE, Bayraktar M, Caglar O, Alpaslan M, Karakaya J (2011) Mortality after hip fracture in diabetic patients. Exp Clin Endocrinol Diabetes 119:414–418

    Article  CAS  PubMed  Google Scholar 

  34. Golinvaux NS, Bohl DD, Basques BA, Baumgaertner MR, Grauer JN (2015) Diabetes confers little to no increased risk of postoperative complications after hip fracture surgery in geriatric patients. Clin Orthop Relat Res 473:1043–1051

    Article  PubMed  Google Scholar 

  35. Westberg-Rasmussen S, Starup-Linde J, Gregersen S, Vestergaard P (2015) Predictors of mortality subsequent to a fracture in diabetes mellitus patients. Front Endocrinol 6:46

    Article  Google Scholar 

  36. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209

    Article  PubMed  Google Scholar 

  37. Wu TY, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A (2011) Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health 33:284–91

    Article  Google Scholar 

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Acknowledgments

This study forms part of research funded by the Fondo de Investigaciones Sanitarias (FIS—Health Research Fund, grant no. PI13/00118, Instituto de Salud Carlos III) and by the Grupo de Excelencia Investigadora URJC-Banco Santander No. 30VCPIGI03: Investigación traslacional en el proceso de salud-enfermedad (ITPSE).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain

    A. Lopez-de-Andrés, R. Jiménez-García, I. Jiménez-Trujillo, V. Hernández-Barrera & P. Carrasco-Garrido

  2. Medicine Department, Hospital Gregorio Marañon, Madrid, Comunidad de Madrid, Spain

    J. M. de Miguel-Yanes

  3. Medicine Department, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain

    M. Méndez-Bailón

  4. Health Security Agency, Ministry of Health, Madrid, Comunidad de Madrid, Spain

    N. Perez-Farinos

  5. Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain

    J. de Miguel-Diez

  6. Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain

    M. Á. Salinero-Fort

Authors
  1. A. Lopez-de-Andrés
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  2. R. Jiménez-García
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  3. I. Jiménez-Trujillo
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  4. V. Hernández-Barrera
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  5. J. M. de Miguel-Yanes
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  6. M. Méndez-Bailón
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  7. N. Perez-Farinos
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  8. J. de Miguel-Diez
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  10. P. Carrasco-Garrido
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Corresponding author

Correspondence to A. Lopez-de-Andrés.

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Lopez-de-Andrés, A., Jiménez-García, R., Jiménez-Trujillo, I. et al. Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004–2013). Osteoporos Int 27, 605–616 (2016). https://doi.org/10.1007/s00198-015-3305-9

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  • DOI: https://doi.org/10.1007/s00198-015-3305-9

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