Ellenoldali csípőtáji törések epidemiológiai aspektusai

Abstract

Hip fractures have outstanding significance among osteoporotic fractures because of healthcare, social, and economic burden. There is an increasing tendency with aging society, resulting in an increasing public health problem worldwide.The number of hip fracture was estimated 1.2 million in 1990, with an estimated increase to 8 million by 2050. There is a changing trend depending on age, gender and geographic region. The lowest incidence was reported in Africa (Nigeria 2/100.000), the highest in Northern European countries (Denmark 574/100.000, Norway 563/100.000, Sweden 539/100.000). Based on literature data the incidence of second hip fracture is between 2 and 20 % among patients suffered from hip fracture. The cumulaive incidence of second or further hip fracture was found 9% in Netherland, 5,08% in Finland, 2,2% among women in Taiwan and 1.8% among men in Taiwan. Several national studies report on correlation between the incidence of hip fracture and different risk factors. The risk factors of primary hip fracture are the followings: age, female gender, bone density, body mass index, estrogen deficiency, frequent falls, disability, immobilization, low physical activation, low calcium intake, osteomalacia, thyreotoxicosis, smoking, alcoholism, diabetes mellitus. Age, female gender, alcoholism, previous hip fracture, location of hip fracture, functional status, dementia and osteoporosis are reported as the risk factors of second hip fracture, however there is not enough mostly Hungarian data about what are the factors and how they influence the incidence of further or second hip fracture, which can explain the parallel epidemiological investigation of these fracture with primary hip fracture. The average time until the second hip fracture can change within wide range in the studies published in the topic and using varios methodologies. Detection of the factors influencing the time until second hip fracture can contribute to the identification of patients with high risk. Among the osteoporotic fractures the health care costs of hip fractures are extremely high. 600.000 new hip fractures occurred in European Union in 2010. The health care costs were estimated 20 billion euro, which represent the 54% of cost associated with osteoporotic fractures. According to some estimates with the increase in the number of hip fracture from 79.000 to 104.000 the health care and social costs will increase from 2 billion pounds to 3 billion pounds. The complication after the treatment of second hip fracture are wound infection, dislocation, cardiac and pulmonary complication, urinary tract infection, and death. Compared to primary hip fracture the second hip fracture are associated with higher mortality. The one year mortality was detected 15,9% by patients with primary hip fracture, the five year mortality 45,4%, while others found it 24,1% and 66,5% by patients with second hip fractures. A Scottish study reported on 68% one year survival by patients with primary hip fracture, while the one year survival by patiets with further hip fracture was found 63%. Considering the occurrence, the incidence of complication, the high mortality, the high health care costs of second hip fracture published in the international literature, and the partial or complete deficiency of Hungarian data of second hip fracture, there is a need of epidemiological analysis based on Hungarian data, to develop efficacious prevention and treatment strategies.