Short summary

Hip fracture patients are on average approximately 80 years and the choice of surgery depends on fracture type and age. This due to younger patients having better bone quality, better bone blood supply and better nutritional status. However, the literature on patients under 60 years old is very scarce but some studies identify risk factors such as hormonal deficiency, low cognitive function, smoking and alcohol abuse. We suspect a hip fracture to be a sign of frailty, regardless of the patient's age. The papers from this study will help to describe this subgroup.

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Rationale

A hip fracture is a severely debilitating event for the patient fraught with complications and costly for the society. In Denmark approximately 8000 patients are annually admitted with a HF, consuming 2-3% of the total hospitalization. The literature is significant regarding the elderly hip fracture patients, but little is in fact known about the fewer younger ones.

Hip fracture patients under 60 years are heterogenic with the healthiest sustaining their fracture in high-energy accidents, while others have severe diseases, functional limitations or alcohol/drug abuse. Some studies identify risk factors such as hormonal deficiency, low cognitive function, smoking and alcohol abuse. The choice of surgery is in newer treatment algorithms beyond fracture types also depending on age, as younger patients may have better bone quality, better bone blood supply and better nutritional status. On the other hand, we suspect a hip fracture to be a sign of frailty, regardless of the patient's age. The exact failure rate in younger patients is not known, and they may have better ability to heal their fracture than the average geriatric hip fracture population.

Still, the literature is scarce, mainly because of the low incidence and variations in both patient characteristics and injury mechanisms. For collecting sufficient data on the subpopulation of younger patients, multi-center co-work is necessary.

The overall aim is to explore and analyze the epidemiology of hip fractures in younger patients (regarding hormonal status, bone density and health profiles in comparison to a standard population), the fracture treatment and outcome as well as patient satisfaction.

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Description of the cohort

The study is a prospective multi-centre cohort study of young and middle-aged adults with hip fracture, describing the epidemiology of hip fracture in this age group, clinical results and patient reported outcome during two years. Patients aged 18 to 59 years, who sustain a non-pathological hip fracture (defined by ICD-codes S72.00, S72.10 and S72.20) and are treated at one of the participating hospitals, are invited to participate in the study. All patients are invited, regardless of medical, cognitive and functional pre-fracture status. The patients' informed consent is to be obtained before inclusion in the study.

Participating hospitals and approximately annual number of hip fractures in patients under 60 years of age:

• Odense University Hospital (Odense and Svendborg, Denmark) - 50
• Kolding Hospital - part of Lillebaelt Hospital (Kolding, Denmark) - 50
• Skåne University Hospital (Malmö and Lund, Sweden) - 45
• Hvidovre Hospital (Copenhagen, Denmark) - 50

Data and biological material

Basic demographic indicators:

• Gender
• Age
• Type of living
• Work level

Health indicators:

• BMI, comorbidity (ASA and Charlson), history of previous fractures, hospital admission during the year preceding the hip fracture, use of particular medication, AUDIT- and DUDIT-questionnaires, physical activity level.

Laboratory blood works:

• s-Hgb, s-Leuco+diff, s-trombocytes, SR (Normal blodsamples and pathological)
• s-electrolytes (S, P), s-Creatinin (Kidney function)
• s-calcium, s-PTH (Hypo- or hyperparathyroidisme)
• s-25-OH-vitamine D (Vitamine D insufficiens)
• s-alkaline phosphatase, pK INR (Bonemetabolisme, liver disease)
• s-TSH, T3, T4 (Metabolisme disease)
• s-testosterone (male) s-estradiol (female) (Hypogonadisme)
• S-gliadinantibodies/transglutaminase (Coeliaki)

Regarding the injury:

• Information about the accident (mechanism of injury, other injuries), fracture type classification according to Garden and AO, type of surgery and implant

Outcome:

Patient reported outcome measure (EQ5D, Oxford hip score), VAS pain and satisfaction, Level of physical ability (work/leisure time), Functional outcome (Timed up and go, walking speed and handgrip strength), Radiological outcome, Complications/reoperations < 2 years

Collaborating researchers and departments

Department of Orthopeadic Surgery, Odense University Hospital

• Consultant Carsten Fladmose Madsen
• Professor Søren Overgaard

Department of Radiology, Odense University Hospital

• Consultant and Clinical associate professor Trine Torfing

Department of Orthopeadic Surgery, Lillebaelt Hospital, Kolding

• Postdoc Bjarke Løvbjerg Viberg
• Consultant Lis R. Andersen

Department of Orthopeadic Surgery, Hvidovre Hospital

• Consultant and Clinical associate professor Henrik Palm

Department of Physical Therapy, Hvidovre Hospital

• Senior Researcher Morten Tange Kristensen

Department of Endocrinology, Hvidovre Hospital

• Consultant Jens-Erik Bech Jensen

Department of Orthopeadic Surgery, Skåne University Hospital

• Consultant and Clinical associate professor Cecilia Rogmark
• Physician Sebastian Rönnquist 
• Professor Kristina Åkesson