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The mortality of elderly hip fracture patients is high. Eighty-five percent of all patients were followed until death. The three most protective factors for 1-year survival were ASA class; BMI; and age, and the four most protective factors for 14-year survival were age; BMI; ASA class; and subtrochanteric fracture type., Objective: Hip fractures are associated with increased mortality. The purpose of this study was to evaluate the protective preoperative factors regarding the survival of short-term (1 year) and long-term (14 years) follow-up in a hip fracture cohort in Finland., Methods: A total of 486 patients, operated on in 2005 and 2006, were retrospectively evaluated. Survival was analyzed using Bayesian multivariate analysis and relative survival with the life table method. All patients were followed for a minimum of 14 years., Results: We analyzed 330 women and 156 men, whose mean ages were 82.4 and 72.0 years, respectively. The overall mortality rate was 7% at 1 month, 22% at 12 months, and 87% at 14 years. Protective factors against mortality at 1 year were ASA class (1-3), BMI ≥ 20 kg/m 2 , age < 85 years, alcohol involvement, Alzheimer's disease, no comorbidities, certain operative methods, and female sex. Factors promoting survival at 14 years were age < 75 years, BMI ≥ 20 kg/m 2 , ASA class (1-2), subtrochanteric fracture, certain operative methods, alcohol involvement, and no comorbidities., Conclusions: Protective factors for 1-year survival in order of importance were ASA class, BMI, and age, and, correspondingly, for 14-year survival, age, certain operative methods, BMI, and ASA class. The relative survival of hip fracture patients was lower than that of the general population., (© 2022. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

The association between serum 25-hydroxyvitamin D level and post-fracture mortality indicates beneficial relatively high serum 25-hydroxyvitamin D concentrations. A 1-year cohort study on 245 hip fracture patients in Finland indicated the lowest 3-year mortality and highest survival among patients with serum 25-hydroxyvitamin D level of 50-74 nmol/L., Purpose: To explore pre-fracture serum 25-hydroxyvitamin D level as a factor associated with post-fracture survival among a cohort of hip fracture patients in Finland., Methods: A prospectively collected cohort of hip fracture patients (n = 245, 70% women) from two hospitals was followed for 3.2 post-hip fracture years. Serum 25-hydroxyvitamin D was measured in admission to the hospital and classified: < 50, 50-74, 75-99, and ≥ 100 nmol/L. Survival was analyzed with a Bayesian multivariate model. Relative survival was explored with the life table method according to serum 25-hydroxyvitamin D. Mortality according to serum 25-hydroxyvitamin D level and to the hospital was calculated., Results: Mortality in the patients with serum 25-hydroxyvitamin D level of 50-74 nmol/L was significantly lower than in all other patients together at every post-fracture year. The most important factors for survival were age under 85 years; living in an actual/private home; serum 25-hydroxyvitamin D level of 50-74 nmol/L, followed by 75-99 nmol/L; ASA classes 1-2 and 3; and female sex. The mean age of patients with serum 25-hydroxyvitamin D level of 50-99 nmol/L was significantly higher than in other levels. Relative survival was highest in men, women, and patients in hospital B with serum 25-hydroxyvitamin D level of 50-74 nmol., Conclusion: The highest 3-year survival and the lowest mortality in this cohort appeared in patients with pre-fracture serum 25-hydroxyvitamin D level of 50-74 nmol/L. This result differs from similar studies and is lower than the recommended level of 25-hydroxyvitamin D among hip fracture patients. The results should be examined in future research with larger data., (© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)

Background and Aims: Reoperations after operative treatment of hip fracture patients may be associated with higher costs and inferior survival. We examined the acute hospital costs, long-term reoperation rates, and survival of patients with a new hip fracture., Materials and Methods: A total of 490 consecutive new hip fracture patients treated at a single center between 31 December 2004 and 6 December 2006 were analyzed retrospectively. Fractures were classified according to Garden and AO. All medical records were checked manually. The costs of reoperations were calculated using the diagnosis-related groups (DRG)-based prices. Survival analysis was performed using the life-table method. The follow-up time was 10 years., Results: In all, 70/490 patients (14.3%) needed reoperations. Of all reoperations, 34.2% were performed during the first month and 72.9% within 1 year after the primary operation. The hemiarthroplasty dislocation rate was 8.5%, and mechanical failures of osteosynthesis occurred in 6.2%. Alcohol abuse was associated with a heightened risk of reoperation. The mean direct costs of primary fracture care were lower than the mean costs of reoperations (€7500 vs €9800). The mortality rate at 10 years was 79.8% among non-reoperated patients and 62.9% among reoperated patients., Conclusions: According to our hypothesis, the cost per patient of reoperation in acute care was 31% higher than the corresponding cost of a primary operation. Reoperations increased the overall immediate costs of index fractures by nearly 20%. One-third of all reoperations were performed during the first month and almost 75% within 1 year after the primary operation.

Hypovitaminosis D is a problem among hip fracture patients. In a 1-year cohort study comprising 245 hip fracture patients (mean age of females 81 years and males 78 years) from south-eastern Finland, the mean 25-hydroxyvitamin D [S-25(OH)D] concentration was 73(SD 31) nmol/L. Vitamin D supplementation has been integrated into our current practice., Introduction: The objectives of this study are to verify vitamin D levels among hip fracture patients and to compare the results with a similar study conducted in the same two hospitals covering the same geographic area 12 years ago., Methods: A prospective cohort comprising 245 Caucasian hip fracture patients was enrolled in the study in two acute hospitals in south-eastern Finland (61° N) over a 12-month period in 2015-2016. The S-25(OH)D was measured using 25-hydroxyvitamin D electrochemiluminescence binding assay. The S-25(OH)D concentrations were compared with the corresponding concentrations of a similar cohort analyzed in the same two hospitals 12 years ago., Results: Of the 245 patients, 70% were women with a mean age of 81 (SD 10) years, while the men had a mean age of 78 (SD 12) years (p < 0.01). The total mean S-25(OH)D concentration was 73 (SD 31.3) nmol/L. Regional differences were found: 15% in hospital A and 36% in hospital B had a S-25(OH(D level < 50 nmol/L, and the mean S-25(OH)D level was 79.2 (SD 31.7) nmol/L in hospital A and 62.4 (SD 27.5) nmol/L in hospital B (p < 0.001). No differences were found in S-25(OH)D concentrations by either the place of residence or the time of year. Overall, the percentage of patients with a sufficient vitamin D level (> 50 nmol/L) was remarkably higher in 2015-2016 (77%) than in 2003-2004 (22%)., Conclusion: Our results indicate that vitamin D supplementation has been widely integrated into our current practice. However, regional differences were found in the S-25(OH)D concentrations for which the reasons are unknown.

Background: Several studies have shown that the mortality of elderly hip fracture patients is higher than that in the general population, and is higher in male than in female hip fracture patients., Objective: The objective of this study was to investigate factors affecting overall mortality at a minimum of 11 years following a new hip fracture., Methods: The sex, age, pre-fracture serum 25-hydroxyvitamin D level, American Society of Anesthesiologists physical status classification (ASA class), 1- to 12-month mortality, and 2- to 11-year mortality of hip fracture patients were collected. The use of anti-osteoporotic medication and prescribed calcium and vitamin D supplements during the first 3 post-operative years were checked. The survival of the patients was analyzed using both the Bayesian multivariate analysis and the life table method., Results: The mean age of females at the time of the index hip fracture was 80.5 years and of males was 73 years. The protective factors were age <80 years; ASA class 1-2; serum 25-hydroxyvitamin level ≥ 50 nmol/L; post-fracture use of calcium and vitamin D supplementation; post-fracture concomitant use of calcium and vitamin D supplementation and anti-osteoporotic drugs; and male sex. The excess mortality was higher among women than men. Survival was highest among patients with a vitamin D level of ≥ 50 nmol/L. Post-fracture concomitant use of calcium and vitamin D and anti-osteoporotic drugs was positively associated with survival., Conclusion: Our results indicate a positive relationship between a sufficient pre-fracture vitamin D serum concentration (≥ 50 nmol/L) and survival, and a potential relationship between reduced mortality and the concomitant post-fracture use of prescribed calcium plus vitamin D supplementation and anti-osteoporotic medication.

Background: Some hip fracture patients need one or more reoperations because of complications following initial operative treatment., Aims: The aim of this study was to identify all further surgical interventions in a cohort of patients with hip fractures over a period of 8 years after index fracture. Immediate direct costs of these reoperations were also calculated., Material and Methods: This retrospective study investigated 221 consecutive patients with hip fractures operated on at two different hospitals in southeastern Finland. The study period in hospital A was from 1 February 2003 to 31 January 2004, and in hospital B from 1 February 2003 to 30 April 2004. About 50% were femoral neck fractures, 41% trochanteric fractures, and 9% subtrochanteric fractures. Patients' medical records were checked from the hospital records and confirmed manually. Short- and long-term complications were recorded. Survival analysis was performed using a life-table method. The actual costs for reoperations and other further procedures for each patient were calculated using diagnosis-related groups-based costs for both hospitals in 2012., Results: A total of 20 patients (9%) needed reoperations. Overall, 10 patients (8.9%) with a femoral neck fracture (n = 112), 8 patients (8.7%) with trochanteric fracture (n = 92), and 2 patients (10.5%) with subtrochanteric fracture (n = 19) were reoperated on. The median interval between the primary operation of the acute hip fracture (n = 20) and the first reoperation was about 300 days (range: 2 weeks to 82 months). Among the women reoperated on, the excess mortality was lower than among those undergoing a single operation. The median costs of treatment per patient with one or more reoperations were €13,422 in hospital A (range: €1616-€61,755), €11,076 in hospital B (range: €1540-€17,866), and €12,850 in the total study group (p = 0.43). In the case of infections (3 patients), the mean costs per patient were €28,751 (range: €11,076-€61,755)., Conclusions: Almost 10% of hip fracture patients required reoperations, and these reoperations caused significant direct costs to health care. However, direct costs account for only approximately 25% of the first year's total costs. These costs should be taken into account when evaluating the economics of hip fractures and the burden of health care.

Unlabelled: To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort., Materials and Methods: Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups <75 years and ≥75 years. Patients' survival was analyzed with the life-table method., Results: One third of the hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures., Conclusions: The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

We previously found a positive association between calcium plus vitamin D and antiosteoporotic drugs and survival among hip fracture patients. Our aim was to verify this observation using a nationwide database. A retrospective cohort of home-discharged hip fracture patients aged 50 years or older (n = 23,615) was enrolled from the national database. Primary exposure was medical treatment for osteoporosis, and the outcome was all-cause mortality. Cumulative mortalities were calculated using the Kaplan-Meier estimator. The relationship between mortality and medication purchases was modeled using Cox's proportional hazards regression with time-dependent covariates for medication use. One in 4 women and 1 in 10 men with a hip fracture were treated for osteoporosis in Finland. Unadjusted 1-year mortality was lower among patients who purchased calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs than among those who did not purchase these medications [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.67-0.81]. The difference in unadjusted cumulative mortality remained in favor of the drug users for at least 5 years. Among men, the use of calcium plus vitamin D or vitamin D supplements was associated with lower 1-year mortality even after adjustments for observed confounders (HR = 0.74, 95% CI 0.56-0.97). Among women, the use of antiosteoporotic drugs was associated with lower mortality (HR = 0.79, 95% CI 0.67-0.93). There was a tendency to even better survival in both genders if calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs were used simultaneously, the HR being 0.72 (95% CI 0.50-1.03) in men and 0.62 (95% CI 0.50-0.76) in women., (Copyright © 2011 American Society for Bone and Mineral Research.)

Introduction: This article in the supplement on the PERFormance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project aims to measure the performance and quality of hip fracture treatment by analysing annual trends and regional differences in developed performance indicators., Material and Methods: The PERFECT Hip Fracture Database contains all hip fracture patients identified from the Hospital Discharge Register in Finland since 1999. Follow-up data from several administrative registers were also linked to the database. Several risk-adjusted performance indicators were developed., Results: In 2007 (compared with 1999), 4.1 percentage points fewer patients had died and 7.5 percentage points more patients were at home four months after fracture. The mean length of treatment had shortened from about 50 to about 45 days, and the mean costs of treatment per patient during the year following hip fracture had increased from about €18,000 to almost €20,000. There was extensive variation between the hospitals in the proportion of patients with an operative delay longer than two days and clear differences between hospital districts in several performance indicators., Conclusions: Outcomes of hip fracture treatment in Finland have been improved in recent years, but regional variation exists. Register-based data are useful for performance assessment of hip fracture treatment.

The national Finnish guidelines for medical treatment of hip fracture patients are: anti-osteoporotic drugs and the daily concomitant use of calcium plus vitamin D supplements. We investigated the incidence, the fracture type and the side of all second hip fractures among 221 consecutive hip fracture patients who were followed up for 5 years. The medication of the patients and the time interval between the first and second hip fracture were analyzed. Of the patients 12% (26/221) sustained a second hip fracture. The type of fracture was in most cases (76%) the same as in the first case, more often in trochanteric and subtrochanteric fractures than in cervical fractures. The mean interval between the fractures was 4±4.2 years (±S.D.); 3.2±3.5 years in men and 4.4±4.4 years in women. The number of patients using polypharmacy (5 or more drugs daily) was 9/25 (36%) at the time of the first hip fracture and 17/25 (68%) at the time of the second hip fracture. The use of at least one psychotropic drug regularly rose from 9/25 (36%) to 16 (64%) between the two fractures. Concomitant use of calcium plus vitamin D and anti-osteoporotic drugs was insufficient among the patients. More effort should be focused on the secondary prevention following the first hip fracture., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

The national Finnish guidelines for medical treatment of hip fracture patients are: osteoporosis medication and the daily concomitant use of vitamin D and calcium supplements. We investigated the post-fracture medical therapy for osteoporosis and the calcium and vitamin D therapy among hip fracture patients in two Finnish hospitals. The pre-fracture osteoporosis medication and use of calcium and vitamin D supplements of the patients were inquired on admission. The patient-specific use of osteoporosis medication and of prescribed calcium and vitamin D therapy during the follow-up time were checked from The Finnish Social Insurance Institution. At the end of the follow-up, those who were alive were inquired about the use of medication at the time. Eight percent of the 223 patients used osteoporosis medication and 8% used prescribed calcium and vitamin D supplements before the fracture. During the follow-up, the figures were 39% (52/133) and 53% (70/133), respectively, and at the end of the follow-up, correspondingly, 25% (29/114) and 44% (50/114). The follow-up time was 19.5-35 months. The post-fracture medical therapy for osteoporosis was insufficient. More effort should be focused on the secondary prevention following hip fracture in order to ensure the recommended treatment of osteoporosis.

Background: Several studies have shown excess mortality among hip fracture patients compared with the normal population of the same age. Finnish guidelines for medical treatment of hip fracture patients recommend anti-osteoporosis medication and the daily concomitant use of prescribed calcium and vitamin D supplements. However, whether post-fracture use of calcium and vitamin D supplements is associated with survival in such patients has not been evaluated., Objective: To study the association between survival in hip fracture patients and patients' sex and age, pre-fracture vitamin D status, American Society of Anesthesiologists - Physical Status (ASA-PS) class, type of fracture and post-fracture use of prescribed calcium plus vitamin D and anti-osteoporotic medication., Methods: The study population was 221 hip fracture patients primarily treated in acute care for a new hip fracture in 2003-4 in two Finnish hospitals. After a median of 27.5 months from the fracture, a questionnaire was sent to all patients who were still alive at the time (n = 137). The patients were queried about their use of prescribed calcium plus vitamin D supplementation and of anti-osteoporotic drugs. The follow-up time for use of anti-osteoporotic medication and prescribed calcium and vitamin D was 19.5-36 months (median 27.5 months). Data on the use of prescribed calcium plus vitamin D supplementation and anti-osteoporotic drugs were checked against information on reimbursement of drug prescriptions held by the Finnish Social Insurance Institution. A total of 4 years' (48 months') survival data for all patients in the study population was also obtained, with the dates of patient deaths being checked against Official National and Regional population statistics. Patient survival was analysed using both the Bayesian multivariate analysis and the life table method., Results: In the multivariate analysis, the combination of variables that best explained post-fracture survival was as follows: age <80 years; ASA-PS class 1-2 (ASA-PS class 1 and 2 data were combined in calculations); post-fracture use of prescribed calcium plus vitamin D supplements concomitantly with anti-osteoporotic drugs; post-fracture use of prescribed calcium plus vitamin D supplements; post-fracture use of anti-osteoporotic drugs only; and type of fracture (femoral neck or subtrochanteric). This model correctly predicted 74% of cases. At 36 months, we observed a 36% reduction in deaths in females who used prescribed calcium plus vitamin D supplementation and a corresponding 43% reduction in males. Survival of females who used anti-osteoporotic drugs concomitantly was even greater (43% reduction in deaths) over the entire follow-up period. Excess mortality was highest in females and males who used neither anti-osteoporotic drugs nor prescribed calcium and vitamin D., Conclusion: Our results indicate a potential relationship between reduced mortality and post-fracture use of prescribed calcium plus vitamin D supplementation and, in females, concomitant use of anti-osteoporotic drugs. However, further investigations are needed to understand the reason for the reduction in the risk of death. Population-based, randomized, placebo-controlled trials with total mortality as the main endpoint should be conducted to verify our results.

Background and Aims: Hip fractures are common events that require intensive operative hospital care and a lengthy rehabilitation. The effect of hip fracture type on successful rehabilitation is not well known. The aim of this study is to model and compare the length of the care episodes between intra- and extracapsular hip fractures in Finland., Material and Methods: 15544 hip fracture patients living at home in Finland 1998-2001 were followed using register-based data. Patient characteristics, outcomes, and length of stay (LOS) distributions were analyzed using a Bayesian nonparametric multilayer perceptron (MLP) network model., Results: Mortality was similar in intra- and extracapsular hip fractures. Patients were more likely to need long-term care after extracapsular hip fracture. The average LOS at the surgical ward was similar for intra- and extracapsular fractures (1.7 weeks), but there was a considerable difference for the total inpatient LOS between the groups (5.2 weeks vs. 6.9 weeks). Intracapsular fractures had a simple unimodal LOS distribution, whereas the LOS distribution for the extracapsular fractures was multimodal with two clear peaks. Patients with more comorbidities required a longer LOS., Conclusions: The causes for differences in LOS between fracture types were most likely due to the different surgical methods and rehabilitation practices for the fracture types. As national guidelines suggest similar rehabilitation for all hip fracture patients, there is a need for early and aggressive rehabilitation of patients with extracapsular fractures, including full-weight bearing for all but selected patients.

Objectives: To compare prospective audit data and secondary administrative register data in the production of performance assessment information in the case of hip fracture treatment, and to cross-validate the quality of information., Methods: First, a conceptual model for the performance assessment of hip fracture treatment was defined. This model was then utilized in comparisons between the prospective audit data concerning 106 consecutive hip fracture patients from the Kuusankoski Regional Hospital and corresponding register data from the Finnish Health Care Register and the Causes of Death Register. We examined the completeness of registration of patients and also the accuracy and degree of completeness of the registered data. Observed differences were checked against the medical records., Results: Register data lack clinical detail, but outperform prospective data in the recording of inpatient care history. Completeness of the register data is very good. The accuracy of easily measurable variables in the register is at least 95%. The agreement between register and audit data was 86.3% for detailed hip fracture diagnosis. Polyserial correlation between the functional dependency variables was 0.68., Conclusions: Register and audit data have certain limitations and problems, but both seem to be suitable for the performance assessment of hip fracture treatment. To improve the feasibility of the administrative register data, the voluntary input of additional hip fracture event data to the register should be made possible. Standardized instructions that guide the use of available register classifications in a sensible way would improve the quality of data.

Aim: To assess the very recent use of alcohol among patients admitted to two Finnish hospitals due to an acute hip fracture., Method: Very recent use of alcohol was recorded according to the patient's or the relatives' report. Ethanol was measured in blood samples taken at admission. Serum gamma-glutamyltransferase, aspartate aminotransferase and alanine aminotransferase, and vitamin D concentration were measured. Reported use of medication, vitamin D, and/or calcium supplementation was recorded., Results: Complete data were obtained on 222 of 375 eligible patients; 71% of those enrolled were women. The mean age of women was 80.5 years (SD 10) and of men 73 years (SD 12) (P < 0.001). The fracture type was femoral neck in 50%, trochanteric in 41%, and subtrochanteric in 9%. The use of alcohol within 24 h before the accident leading to hip fracture was reported by 21.5% of men and 7% of women; positive serum alcohol levels were noted in 17% (19% of men and 16% of women) and 2.2% had a level of >1.0 mg/l. Recent alcohol use was more common among patients in the age group of 65-74 years than among older patients (P < 0.001). The use of alcohol was associated strongly with tobacco use (P = 0.00012) but had no association with vitamin D levels. Alcohol users used less medication than non-users (P < 0.01). Women seemed to conceal their use of alcohol more than men (P < 0.005)., Conclusions: Alcohol consumption was common among patients with an acute hip fracture, being more common in younger than in older patients. Use of alcohol in the 24 h prior to the injury was reported by 21.5% of men and 7% of women. Alcohol concentration in blood was positive in 19% of men and 16% of women.

Background and Objective: CNS drugs are a risk factor for falls and fractures among older people. Our aim was to describe the use of benzodiazepines and benzodiazepine-related drugs among patients admitted to two Finnish hospitals as a result of an acute hip fracture, and to analyse the concordance of benzodiazepine findings from different data sources., Patients and Methods: We studied the use of benzodiazepines and benzodiazepine-related drugs by (i) asking the patient or his/her relatives about his/her use of hypnotics; (ii) checking the patient's medical records; and (iii) analysing for the presence of benzodiazepines in serum and urine. Blood and urine samples were taken at admission. Detection of benzodiazepines in serum and urine was achieved by the fluorescence polarisation method. Concordance in benzodiazepine findings between medical records and laboratory results was estimated by calculating the degree of agreement (kappa) and described graphically using a Venn diagram., Results: A total of 223 patients were enrolled in the study. Of these, 71% were women. The mean age of women was 80.5 years (SD: 10) and of men, 73 years (SD: 12) [p < 0.0001]. Thirty percent of the patients reported that they used hypnotics. Benzodiazepine in serum or urine was detected in 83 (37%) patients. Over half of the patients coming from residential homes (53%) and institutions (54%) were benzodiazepine-positive. For home dwellers the proportion of patients that were benzodiazepine-positive was 29%. In 48% (40/83) of the benzodiazepine-positive patients, the type of benzodiazepine could not be identified because of a lack of drug records regarding benzodiazepines. A total of 113 (51%) patients used benzodiazepines or benzodiazepine-related drugs when both laboratory results and medical drug records were taken into account. Thirty-nine percent of these patients were home dwellers, 69% came from residential care and 76% from institutional care. The concordance between medical records and laboratory results expressed as overlap area was 32% in men and 59% in women, 38% in community-dwelling patients, 63% in residential home patients, and 68% in patients from institutions., Conclusion: Half of patients with an acute hip fracture used benzodiazepines or benzodiazepine-related drugs. The highest prevalences were found in institutional and residential care where it should be well known that the use of CNS drugs increases the risk of hip fracture. Concordance of benzodiazepine findings was moderate in all patients and poorest among men. Concordance was poorer among home dwellers than among those living in residential homes and institutions. Analysing benzodiazepine in serum seems to be the most reliable method for ascertaining benzodiazepine exposure. This laboratory test could be performed routinely when the elderly patient is admitted to hospital because of a fall or, at least, in case of hip fracture. Then, if needed, the patient should be informed about the risks of benzodiazepine use, and further falls and fractures could be prevented.

Vitamin D deficiency may be one important contributing risk factor for an osteoporotic fracture among elderly. We analyzed serum 25-hydroxyvitamin D [S-25(OH)D] status in patients with an acute hip fracture in southeastern Finland (61 degrees N). Consecutive patients with a fresh hip fracture (n=223) in two Finnish hospitals during 12 months and 15 months were registered prospectively. S-25(OH)D concentrations (nmol/l) were measured by radioimmunoassay-method. Hypovitaminosis D was defined as S-25(OH)D < 37.5 nmol/l and severe hypovitaminosis D: < 20 nmol/l. The highest threshold of S-25(OH)D in our analysis was > 74 nmol/l. The seasonal variation in S-25(OH)D concentrations was followed. Hypovitaminosis D was found in 53% of the patients. In 9% hypovitaminosis D was severe. Half (50%) of the patients living in their own homes, 55% of those in residential homes, and 61% of institutionalized elderly had hypovitaminosis D. Patients who used both vitamin D and calcium supplement had S-25(OH)D levels between 37.5 nmol/l and 74 nmol/l and > 74 nmol/l more often than non-users (Wx=3.85, p=0.0001). Most (41/61) of the patients who sustained the fracture during the late summer months had S-25(OH)D concentration > or = 37.5 nmol/l, whereas, in winter months the situation was quite the opposite (24/67) (Wx=3.42, p=0.0006). Twenty-two percent (50/223) had S-25(OH)D concentration > 50 nmol/l and four patients > 78 nmol/l. Half of the patients with a hip fracture suffered from hypovitaminosis D. The situation was worst in institutional and residential care, although there are personnel for taking care of vitamin D supplementation. In the late summer, one-third and in late winter two-thirds of the patients suffered from hypovitaminosis D. The geographical location of Finland indicates extensive efforts to increase the use of vitamin D supplements among elderly.

Introduction: The most serious complication resulting from osteoporosis is fracture of the hip. This injury often has serious consequences for the patient, because it is linked to a considerable level of mortality and deterioration of functional capacity., Materials and Methods: The data from 106 consecutive patients with a hip fracture were registered for 1 year following the fracture by trained nurses in an area of six municipalities and 92,500 inhabitants. The total costs of these patients were calculated per patient, including the costs of acute and post-acute care and rehabilitation, home assistance and home care, outpatient visits, assistive devices, transportation, medication, and forensic autopsies as well as the patients' own share of the treatment costs. The costs were calculated according to the 2003 price level., Results: The average costs during the first post-fracture year were around euro 14,410. Slightly less than one-fourth of these costs was caused by acute care. If a previously home-dwelling patient had to be admitted to permanent institutional care after the fracture, the average costs rose to euro 35,700. The centralisation of post-acute rehabilitation lowered the amount of the total costs., Conclusion: The average 1-year total costs of a patient with a hip fracture were euro 14,410. About one-fourth of the costs were caused by acute care. The centralisation of post-acute rehabilitation was profitable.

Background and Aims: The use of antibiotic prophylaxis in open reduction and osteosynthesis of closed hip fractures is still controversial. The aim of this study was to demonstrate the effect of antibiotic prophylaxis in osteosynthesis of these fractures., Material and Methods: A total of 224 patients operated on between November 1994 and February 1998 in six hospitals by internal fixation for a fresh hip fracture were prospectively and randomly allocated to either a ceftriaxone antibiotic prophylaxis or no prophylaxis group and followed for one year., Results: Within 6 weeks after the operation, 2.6% wound infections were recorded in the antibiotic group and 4.7% in the control group. Two (1.9%) of the five infections in the control group were deep infections (both sensitive to ceftriaxone). There were no statistically significant differences between the infection rates in both groups. However, when analyzing all complications recorded within 6 weeks, significantly more complications were found in the control group (p < 0.01). In the multivariate analysis the most important factor predicting postoperative complications was the lack of antibiotic prophylaxis., Conclusion: In this study the antibiotic prophylaxis group had significantly less postoperative complications than the control group within 6 weeks after the operation.

To improve the knowledge of the current trends in the number and incidence of osteoporosis-related pelvic fractures, patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first osteoporotic pelvic fracture were selected from the National Hospital Discharge Register. The overall incidence (per 100,000 inhabitants) of osteoporosis-related pelvic fractures (high energy traumas were excluded) in a population aged 60 years or more was 20 in 1970 and 63 in 1991. The increase was most pronounced in the older age groups (patients aged 80 years or more) and was observed in both sexes. The proportion of these osteoporotic pelvic fractures of all pelvic fractures increased from 18% in 1970 to 52% in 1991. Similarly, the proportion of patients over 60 years of age increased from 28% in 1970 to 62% in 1991. In 1991, 78% of the patients with an osteoporotic pelvic fracture were women. Across the study period, the age-adjusted total incidence of osteoporotic pelvic fractures also increased in both women and men 60 years of age and over. The proportional increase was more pronounced in men. We conclude that the number of osteoporotic pelvic fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and that effective preventive measures are urgently needed to control the increasing number of these age-related fractures.

We studied the survival of 390 patients with fresh hip fractures sustained in 1989 by a population of about 441 thousand in two health care regions in Finland during four years. The most significant explanatory factors of mortality were place of injury, place after primary treatment and age. The excess mortality of men compared with the reference population at one year was 21% and in women 16%. After this, the excess mortality rates increased slowly in both sexes and were 37% for men and 24% for women at four years. In those who had sustained the fracture in a traffic accident the mortality at four years was slightly lower than that in the reference population, and in those who had sustained the fracture in other accident outdoors there was a 10% excess mortality. Patients who had sustained the injury at home had at four years a 25% and those who had sustained the injury in institutions a 46% excess mortality. The excess mortality at four years was lowest in those who were discharged home (14%) and highest in those who were discharged to other institutions (27%).

In a prospective study, incidences of hip fractures among the aged in urban and rural populations were compared in two health care regions in Finland in 1989. Both the administrative and the more informative functional classification of the municipalities were used. During 1989, a total of 366 patients, aged 55 years and above, who had a permanent place of domicile in either one of the two health care regions, were treated for a fresh hip fracture. In both regions women sustained 80% of the fractures. No significant differences were found in the incidences of hip fractures between the urban and rural populations. However, a significant difference was found in the mean incidence between the towns of the two health care regions (t = 4.228, d.f. = 6, p < 0.01).

Hip fractures in the elderly are a worldwide epidemic, and aging of the populations is increasing the burden of these fractures on the health care systems. To improve the knowledge of whether the number of hip fractures is increasing even more rapidly than can be accounted for by the demographic changes only, all patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. There was a steady, average 7.7% annual increase in the total number of hip fractures in Finland during this period so that the number of fractures was 2239 in 1970 and 6071 in 1991. The proportion of patients aged 60 years or more increased steadily from 75% in 1970 to 91% in 1991. In 1991, 74% of the patients were women. Across the study period, the age-adjusted total incidence of hip fractures also increased in both women and men 50 years of age and over. This increase was more pronounced in men. Thus, the increasing incidence of hip fractures in Finland was not only due to the fact that the population was aging but also due to the increasing age-adjusted incidence. We conclude that the number of hip fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and this will seriously challenge the Finnish health care system in the future.

The incidence of hip fracture in Finland was studied for the year 1988. During 1988, 6139 patients were treated for a fresh hip fracture. Three out of four hip fracture patients were women, and the occurrence of cervical fractures was 2.8 times and that of trochanteric fractures 2.5 times more common in women than in men. The incidence rates of hip fractures per 100,000 were 174 in women, 70 in men and 123 in the whole population. The mean hospitalization time for fresh hip fractures was 33 days for cervical fractures and 38 days for trochanteric fractures. The costs of primary hospitalizations due to fresh hip fractures in 1988 were estimated at US $66 million.

We studied prospectively the demographic data, fracture types and modes of treatment in 390 patients with acute traumatic hip fractures in two health care regions in Finland, the Middle Finland region and the Kymenlaakso region in 1989. In Middle Finland population (251,203 inhabitants) 199 patients with a hip fracture were admitted to two acute care hospitals, while 191 patients were admitted in Kymenlaakso (population 189,726) to four acute hospitals. There were no significant differences in the sex- and age-specific incidences between the two regions. In Middle Finland, 70% of the fractures were of the femoral neck, 28% were trochanteric and 2% subtrochanteric. The corresponding figures in Kymenlaakso were 57%, 38% and 5% (P < 0.05). In Middle Finland, 73% of the femoral neck fractures were treated primarily with a hemiendoprosthesis, 2% with primary total hip replacement and 25% by osteosynthesis. The corresponding figures in Kymenlaakso were 81%, 7% and 12% (P < 0.001). The mean duration of hospital stay was 14 days in Middle Finland and 21 days in Kymenlaakso (P < 0.01).

We studied prospectively the occurrence of hip fractures among the over 49-year-old urban populations (n = 88,206) in the cities Tampere, Jyväskylä and Kotka in 1989 and compared the results with a parallel Scandinavian multicentre study. During 1989, there were 266 inhabitants who were treated for a hip fracture, 213 of them were women. Women had in 132 cases a femoral neck fracture and in 81 cases a trochanteric fracture, and the corresponding numbers for men were 22 and 31. Among women, the total hip fracture incidence in Jyväskylä (n = 22) was the lowest when compared with the ones in Tampere (n = 47) and Kotka (n = 36). These incidences were on average lower than in the other Scandinavian cities studied in parallel. The all over ratio of femoral neck/trochanteric fractures was 1.1 in Tampere, 3.0 in Jyväskylä and 2.2 in Kotka and in Tampere, women had 9.3 times more femoral neck fractures than men. Our study showed that in Finland in three major cities the hip fracture incidence was lower than what has been similarly registered in corresponding urban populations in other Scandinavian countries. We also point out that the relative part of trochanteric fractures appears to be increasing.

During 1985, 4,490 patients with a hip fracture were treated in Finland. From 1970 to 1985, the number almost doubled. The predicted annual number of patients with a hip fracture by the year 2000 will rise to 5,800 if the calculations are based on available demographic data, and to 7,100 if the trend observed during the period 1970 to 1985 continues.

The social destiny of 54 patients with femoral neck and trochanteric fractures was analysed by interview three to five years after the operation and the results were compared with those of 48 control subjects of the same age. In addition to this 50 patients with a similar fracture not yet operated were asked the same questions and the results were compared with those of control subjects of the same age . The groups did not differ in terms of marital status, education and in state of health. The operated patients walked daily less than the control subjects. The capacity for self care of the not yet operated patients before the injury was more often reduced and they had to be helped in all daily activities more often than the control subjects. At follow up the ability to move of operated patients had deteriorated and every second patient had died. Of the operated patients, which were prior to the injury able to work, 40 per cent returned to work after the convalescent.

In 1980 2449 patients with femoral neck and 1096 with trochanteric fractures were treated in Finland. The female--male ratio was 3:1 for femoral neck and 2:1 for trochanteric fractures. The age-specific incidence was higher for women than for men in both fracture types. About 3/4 of the patients were over 70 years old. The mean hospitalization time was 37 days for the patients with a femoral neck and 34 days for those with a trochanteric fracture. These patients accounted for 9% of all surgical hospitalization days in Finland during the year 1980. The injuries occurred evenly during every month. The number of femoral neck fractures will double during the period 1968 to 1985.

From 1970 to 1980, cervical hip fractures in Finland increased by 55 per cent and trochanteric fractures by 46 per cent. The demographic pattern and increasing fracture risks in the elderly will cause twice as many hip fractures in 1990 as in 1970.

A correction is presented to the article "Relatively low and moderate pre‑fracture serum 25‑hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland."