Hip fractures are associated with excess mortality, and several studies have pointed out the burden on society health care costs and the need to optimize cost effectiveness in treatment. The goal of our study was to investigate if patients with a higher risk of death after hip fracture could be identified using routine blood tests taken on admission.

All 530 hip fracture patients admitted to the Department of Orthopedics, Bispebjerg University Hospital from October 2008 till December 2009 were included prospectively. Patients under the age of 60 (n = 39) were excluded. Furthermore, because the purpose was to identify blood tests at the time of admission that could predict outcome, we only included patients that had project blood samples taken at the day of admission resulting in 324 hip fracture patients for further analysis. Follow up data on mortality were obtained from the national civil registry the first of February 2010. Predictors for mortality were determined by logistic and cox regression models. P < 0.05 was regarded as statistically significant. Of the 324 hip fracture patients under study, 66 (20%) died within the study period.

The results of stepwise Cox multivariate regression models for survival during the first three months after admission revealed that age, plasma creatinine and albumin predict mortality. The hazard ratios were 1.04 (95% CI: 1.005–1.09, p = 0.02), 1.01 (per unit increase)(95% CI: 1.01–1.02, p<0.0001), and 0.87 (95% CI: 0.80–0.94, p = 0.002) for age, plasma creatinine and albumin respectively. The 90 day mortality was 13% and 42% in patients with normal and elevated plasma creatinine levels respectively.

Hip fracture patients are known to have a high risk of post- operative mortality. Our findings suggest that it might be possible to identify at- risk patients that could possibly benefit from increased attention the first months following surgery using already available blood samples.

Introduction

The calcium-PTH-vitamin D-axis has long been highlighted for its effects on bone status and much interest has been given to how this relates to the risk of sustaining an osteoporotic fracture. Little attention has on the other hand been given to how disturbances in this axis, as for example secondary hyperparathyroidism (SHPT), relate to mortality among hip fracture patients. We therefore wanted to determine if SHPT could predict mortality in this group of patients.

At Bispebjerg University Hospital in Denmark, an Optimized Hip Fracture Program, (OHP) is the standard of care for all hip fracture patients. Part of OHP is pain treatment with a femoral nerve catheter placed at the emergency room, dosed 4 times a day with Bupivacain until 4 days after surgery, combined with systemic analgesics as needed. In 2008, a database and a bio bank were created at the ward including all hip fracture patients to make a better description of the population and as a tool for further optimisation of the OHP. One of the aims was to identify possible subgroups having specific complications, which could lead to a differentiation of the OHP by markers known at the time of admission. In this analysis, we will focus on postoperative pain that inhibits mobilization by fracture type and type of surgery.

For some years, there has been vast international interest in creating models for joint efforts between geriatricians and orthopedic surgeons. We present data from two such models.

For the first time in Denmark, the Department of Orthopedics Bispebjerg University Hospital (BUP) recruited two full-time geriatricians in September 2009. They were assigned an independent unit meant for severely ill orthopaedic patients with high comorbidity and polypharmacy. These two geriatricians had, during the previous two years, consulted another orthopaedic department at Gentofte University Hospital (GUH) in a neighbouring community three times a week. The aim of their intervention was then to optimize treatment for comorbidity, to clarify indication of acute fall-assessment, osteoporosis diagnosis and treatment, presence of delirium and dementia.