Epidemiological Characteristics Of Intertrochanteric Fractures And The Effect Of Anti-Osteoporosis Treatment After Intertrochanteric Fracture Surgery In The Elderly

Hip fracture is a common worldwide health problem with approximately 1.7 million patients around the world every year.About half of hip fracture patients are intertrochanteric fracture,and the relative proportion of intertrochanteric hip fracture was found to increase with age.The mobility and quality of life in patients after osteoporotic hip fractures are often declined,which is a considerable burden on individual,family,health service system and on the whole society.Most of the elderly patients with intertrochanteric fractures are accompanied with bone loss,some even with osteoporosis.The efficiency of anti-osteoporosis treatment on osteoporotic patients has been demonstrated.However,the role of anti-osteoporosis mediation as a predictor of clinical and functional outcome after intertrochanteric hip fracture surgery is not clearly documented.The objective of this study was to investigate epidemiological characteristics of intertrochanteric fractures and the impact of anti-osteoporosis mediation on postoperative functional recovery,re-fracture rate,complications and mortality using outcomes of geriatric patients with intertrochanteric fractures.Part 1: Epidemiological characteristics of intertrochanteric fractures in the elderlyPurpose: To investigate the epidemiological characteristics of intertrochanteric fractures in the elderly.Method: Records of 396 patients over 65 years old with intertrochanteric fracture between January 2013 and December 2014 were retrieved from databases of orthopedic department of our hospital.Data collected for our study included patients’ general information,hospital stay,preoperative examination,information of fracture(reason,trauma energy,side and type),history of medical disease,history of drugs taken and preoperative functional evaluation.All cases were divided into three groups according to the age: 65-75 years old(group A),76-85 years old(group B)and over 86 years of old(group C).Epidemiological characteristics were compared among the groups.Result: In this study,396 patients were included with 356 cases receiving surgical treatment and 40 cases receiving conservative treatment.The Harris score and Parker score of group A and group B were significantly higher than that of group C(P<0.05).The history of hip fracture of three groups(1%,4.7% and 9.1%)tended to increase with aging.Overall,the proportion of patients without any comorbidity was 29.3%(108/369),and with more than one kind of comorbidity reached to 70.7%(261/369).In all patients,male patients accounted for 35.1% and female accounted for 64.9%,and the ratio of male and female was 1:2.The ratio of male/female of group A(1:1)had significantly difference compared with group B(1:3)and group C(1:2)(P<0.05).With age,the proportion of smoking in three groups was decreasing,6.8%,1.2% and 0,respectively.With age,the proportion of drinking in three groups was decreasing,7.9%,3.5% and 1.8%,respectively.In all patients,85.3% were lower energy fractures and 14.7% were high energy fractures.The proportion low energy fracture of group A,B,C were 69.7%,90.2% and 95.2%,respectively.And patients with low energy fracture of group A was significant lower than that of group B and group C(P<0.05).In all patients,type IIb(38%)and type III(31%)were the most.Overall,30.1% fractures were stable,and 69.9% were unstable fractures.Conclusion: Intertrochanteric fractures in the elderly are more common in women.The majority of fractures are caused by low energy,and the proportion of low energy fracture increase with age.Unstable fracture accounted for a higher proportion,as well as other medical diseases,and attention should be paid to the prevention and treatment of fracture in clinic.Part 2: The effect of anti-osteoporosis treatment after intertrochanteric fracture surgery in the elderlyPurpose: To investigate the impact of anti-osteoporosis mediation on postoperative functional recovery,re-fracture rate,complications and mortality using outcomes of geriatric patients with intertrochanteric fractures.Method: From January 2013 to December 2014,250 patients ≥ 65 years old with intertrochanteric fracture surgery were eligible for this study.Data collected for this study included general information,pre/post-operative anti-osteoporotic treatment history,functional outcome(Harris score,Parker score and EQ-5D score),re-fracture,complications and survival.Anti-osteoporotic medicine consists of essential medicine(Ca,Vit D)and advanced medicine(bisphosphonate,calcitonin etc.).Outcomes between anti-osteoporosis treatment patients(AO group)and non-anti-osteoporosis treatment patients(control group)were compared.Result: The data of 250 patients(85 males,34%;165 females,66%)were assessed with a mean age of 79.8±7.0 years old and 15.3±8.2 months follow-up period.We identified 50.4%(n=126)of intertrochanteric fracture patients on any anti-osteoporotic medication(AO group),signifying that 49.6%(n=124)of patients did not receive any anti-osteoporotic treatment after their fracture at all.Overall,14 patients suffered a re-fracture,and the re-fracture rate of AO group(n=3,2.4%)was significantly lower than that of CO group(n=11,8.9%)with reduced odds(OR=0.251,95% CI 0.068-0.920,p=0.024).Although functional outcomes showed no significantly differences between AO group and control group,the adjusted Harris scores and EQ-5D of essential drugs plus advanced drugs patients were significantly higher than patients with only essential drugs.In total,the mortality rate was 6%(15/250),and 5.5%(7/126)for AO group and 6.45%(8/124)for control group.There was no significant difference in postoperative complications and mortality between the anti-osteoporosis group and the non-anti-osteoporosis group.Conclusion: Anti-osteoporosis treatment is a protective factor after intertrochanteric fracture surgery which reduces the incidence and risk of re-fracture,while the influence of anti-osteoporosis treatment on functional recovery,quality of life,complication and mortality are limited.In the premise of essential anti-osteoporotic drugs,advanced anti-osteoporotic drugs could promote a better functional outcome,but further study is still needed to prove this.