( PDF ) Rev Osteoporos Metab Miner. 2018; 10 (2): 61-62
2 Unidad Metabólica Ósea – Hospital Universitario Insular – Las Palmas de Gran Canaria (España)
3 Departamento de Medicina – Universidad de Sevilla- Sevilla (España)
The fracture of the proximal extremity of the femur, better known as hip fracture (HF), is a fragility or osteoporotic fracture that has some peculiarities that make it unique. On the one hand, due to its potential severity. In western countries, HF occurs mainly in the elderly, with an average age of 80 years, who present significant comorbidity1 and require hospital admission and surgical intervention, since patients who are not operated on have a higher mortality rate2. All this conditions the existence of an important mortality, as has recently been confirmed in several studies carried out in Spain1,3,4.
On the other hand, HF presents a different clinical behavior between men and women. Thus, although fragility fractures are generally more frequent in women, in the case of HF, in the most advanced age groups, the incidence becomes almost the same between both sexes and in some cases greater among men5, mortality being greater among them6. This has also been observed in other European countries in our environment. In a study conducted in the Picardy region in France, mortality in the acute phase, immediately after the fracture, was reported to be 8.1% in women and 10.2% in men. At 2 years, male/female mortality showed a ratio of 1.94/17.
Another peculiarity of HF is that its presence as a clinical antecedent significantly increases mortality in patients who suffer a second heart attack. Thus, in the EPIDOS study, conducted in France, in the acute phase of hospital admission, mortality for women was reportely 112.4 per 1,000 women and year, whereas mortality had not previously suffered the same fracture. it was noticeably lower, 27.3 per 1,000 people and year8.
Several studies carried out both in Spain and in other European countries have shown a tendency to stabilize the incidence of heart failure and even to decrease it9-13. But we must also be taken into account that, although incidence may decrease in absolute numbers, the number of fractures has increased, probably due to the aging of the population. For example, in Gran Canaria, comparing the incidence of HF cases in a period of 5 years separated by 20 years from each other, although the overall incidence showed a tendency to decrease, the number of fractures doubled in this period of time5. However, in other regions of Spain the exact opposite has been described: an increase in the incidence of HF14.
Given HF’s peculiarities in our environment, it is interesting to observe its behavior in other populations, its similarities and differences with Spain, as in the case of Latin America. In this issue, López Gavilánez et al.15 publish data on HF epidemiology in Ecuador, after collecting cases of this fracture after a thorough search. Their data are similar to those published in Spain a few years ago. Ecuador, like all of Latin America, is seeing an increase in life expectancy and it is precisely in these countries that a change in the population pyramid is taking place, with an increase in the elderly population, where an increase in HF incidence is expected in the coming years, as happened in Europe around 30 years ago11. Perhaps the observation of our experience and evolution in recent years, both in the acquisition of preventive and therapeutic measures and epidemiological studies that have been carried out here, may serve Latin American countries to slow down, in a shorter period, the foreseeable and feared increase of HF incidence, as we have achieved on this side of the Atlantic over three decades.
Conflict of interests: The authors declare that there are no conflicts of interest.
2. Berry SD, Rothbaum RR, Kiel DP, Lee Y, Mitchell SL. Association of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced Dementia. JAMA Intern Med. 2018;02131.
3. Etxebarria-Foronda I, Mar J, Arrospide A, Ruiz de Eguino J. Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera. Rev Esp Salud Publica. 2013;87:639-49.
4. Fernández-Ruiz M, Guerra-Vales JM, Trincado R, Medrano MJ, Benito-León J, Bermejo-Pareja F. Hip fracture in three elderly populations of central Spain: Data from the NEDICES study. Intern Emerg Med. 2014;9(1):33-41.
5. Sosa M, Saavedra P, de Tejada MJG, Navarro M, Cabrera D, Melton LJ. Trends in the incidence of hip fracture in Gran Canaria, Canary Islands, Spain: 2007-2011 versus 1989-1993. Osteoporos Int. 2015;26(4):1361-6.
6. Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, et al. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int. 2014;25(4):1267-74.
7. Baudoin C, Fardellone P, Bean K, Ostertag-Ezembe A, Hervy F. Clinical outcomes and mortality after hip fracture: A 2-year follow-up study. Bone. 1996;18(Suppl 3):149-57.
8. Empana JP, Dargent-Molina P, Bréart G. Effect of Hip Fracture on Mortality in Elderly Women: The EPIDOS Prospective Study. J Am Geriatr Soc. 2004;52(5):685-90.
9. Etxebarria-Foronda I, Mar J, Arrospide A, Esnal-Baza E. Trends in the incidence of hip fractures in women in the Basque country. Arch Osteoporos. 2010;5(1-2):131-7.
10. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R. Incidence of hip fracture over a 10-year period (1991-2000): Reversal of a secular trend. Bone. 2007;40(5):1284-9.
11. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2013;22(5):1277-88.
12. Hartholt KA, Oudshoorn C, Zielinski SM, Burgers PTPW, Panneman MJM, van Beeck EF, et al. The epidemic of Hip fractures: Are we on the right track? PLoS One. 2011;6(7):1-6.
13. Azagra R, Martin-Sánchez JC, Aguyé A. Europe PMC Funders Group Changing trends in the epidemiology of hip fracture in Spain. 2016;25(4):1267-74.
14. Hernández JL, Olmos JM, Alonso MA, González-Fernández CR, Martínez J, Pajarón M, et al. Trend in hip fracture epidemiology over a 14-year period in a Spanish population. Osteoporos Int. 2006;17(3):464-70.
15. López Gavilanez, E, Chedraui P, Guerrero Franco K, Marriott Blum D, Palacio Riofrio J, Segale Bajaña A. Fracturas osteoporóticas de cadera en adultos mayores en Ecuador 2016. Rev Osteoporos Metab Miner. 2018;10(2):63-70.