Hip fracture mortality and morbidity - can we do better?

Aims To determine the mortality and morbidity from fractures of the neck of femur in Christchurch Hospital and to determine the extent that hip fractu re patients are investigated and treated for osteoporosis. Methods. All patients treated for a fractured hip at :Christchurch Hospital s between May 1998 and April 1999 were identified. Their radiographs were r eviewed and each fracture was classified. Dates of death were recorded wher e applicable. Surviving patients were contacted at least twelve months afte r their fracture and asked questions relating to functional outcome followi ng surgery. The numbers of patients who had ever had a bone density scan, t reatment for osteoporosis and/or a measurement of vitamin D were recorded. Results. There were 331 fractures among 329 patients (242 women, 87 men), m ean age of 79.7 (standard deviation 10.5) years. Twelve-month mortality was 26%. Men had a higher mortality rate than women for all fracture types tha t was independent of age. Follow up of the 231 surviving patients 12-24 mon ths later revealed. 27% still had pain and 60% had worsened mobility that t hey attributed to the fracture. Worsened mobility affected peopling living at home more than people living in institutional care. 32 people (15%) had had a vitamin D concentration measured and in 22 of these (69%) levels were below the reference range. Conclusions. The mortality and morbidity after hip fracture is high, especi ally in men. There were few significant correlates with great morbidity exc ept for fixation by hem arthroplasty. More attention to hip fracture preven tion is needed. Few subjects were on any therapy for osteoporosis other tha n calcium supplements. Vitamin D deficiency is an important but under-recog nised condition.