1. Hip Fracture Registry of Thailand (A Pilot Project & Interim Analysis)
MBOG Annual Meeting 2015
โรงแรมเจริญธานี ขอนแก่น พย. 59 เวลา 15:30-16:00
Sattaya Rojanasthien MD
Department of Orthopedics
Faculty of Medicine
Chiang Mai University, Thailand

2. Incidence of Hip fracture in Chiang Mai 1997 & 2006
Crude Incidence of Hip Fracture in Chiang Mai Province (per 100,000)
The overall crude incidence increased 2.02% per year
Phadungkiat S, et al. J Med Assoc Thai 2002 May;85(5):
Wongtriratanachai P, et al. J Clin Densitom 2013 Jul-Sep;16(3):

3. Age-specific Incidence of Hip Fracture in Chiang Mai 2006
690 hip-fracture patients within one year period
Patients aged ≤ 60 had low incidence of hip fracture in 1997 & 2006 studies
Exponential increase can be seen after age of 70
Wongtriratanachai P, et al. J Clin Densitom 2013 Jul-Sep;16(3):

4. Mechanism of Hip Fracture
691 hip fracture patients in 2006
79%
The most commom mechanism of hip fracture was a simple fall which was 79 % of patients
Wongtriratanachai P, Luevitoonvechkij S, Songpatanasilp T, Rojanasthien S. JCD 2013 Funding by TOPF, Acknowledgement to all Orthopaedists in Chiang Mai

5. Mortality and Median Survival Time after Osteoporotic Hip Fracture in Chiang Mai, Thailand12
Long-term (1998 to 2007) survival analysis of 367 osteoporotic hip fracture patients, mean age 74 yrs
Ten-year mortality was 68 %
One-year mortality was 18% that was 8 times higher than age-matched general population
One-year mortality (%)
Median survival time (months)
Male 31 40
Female 16 84
Overall 18 72
Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S. Journal of Clinical Densitometry. 2010, Vol 13

6. Associated Factors of Death after Hip fracture
Hazard ratio (95% CI)
P Value
Age (yr)
<70
70-80
>80 1
1.45 ( )
1.90 ( )
0.030
<0.001
Gender
Male
Female
1.72 ( )
Type of treatment
Operative
Nonoperative
1.81 ( )
0.001
Antiresorptive agents
0.73 ( )
0.354
Tanawat Vaseenon , Sirichai Luevitoonvechkij, Prasit Wongtriratanachai, Sattaya Rojanasthien. Journal of Clinical Densitometry. vol 13, 2010

7. at Maharat Nakhon Ratchasima Hospital
Mortality and ambulatory status after intertrochanteric fracture treated
at Maharat Nakhon Ratchasima Hospital
A retrospective cohort study of 496 intertrochanteric fracture patients at least 60 years of age, treated between October 2002 and September 2006 (4 years)
overall one-year mortality rate 23.6%
median survival time years
at 2 years: 55% walk independently, 28% needs walking aid, 17% wheelchair or confined to bed
Home traction 245, operation 251
Associated Factors
Odd Ratio
P Value
95% CI
Traction vs operation
3.00
0.000
Female vs male
0.48
0.003
Age per year of increase
1.05
0.001
Lewsirirat S, Thanomsingh P. JRCOST VOL.34 NO. 3-4 July-October 2010

8. One-year Mortality after Hip Fracture in Chiang Mai on different period of Time
Chaysri R, Leerapun T, Klunklin K, Chiewchantanakit S, Luevitoonvechkij S, Rojanasthien S. J Med Assoc Thai 2015; 98 (1):

9. Hip Fracture Registry Initiative in Thailand
Multi-center, hospital-based, prospective observational, epidemiological study was conducted since October 2010 in 7 tertiary care hospitals
The primary objective:
To determine the rate of subsequence osteoporotic fractures within 1 year after hip fracture in clinical practice in Thailand
The secondary objectives:
To determine treatment-related outcomes of hip fracture treatments
To describe epidemiological data of hip fracture patients in Thailand
Srinagarind Hospital
Ramathibodi Hospital
Siriraj Hospital
King Chulalongkorn Memorial Hospital
Phramongkutklao Hospital
Chiang Mai University Hospital
Police General Hospital
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Study Design
Observational , multicenter trial in 7 tertiary care hospitals
Thai male or female 50 year of age or older
Clinical osteoporosis hip fracture determine by radiographic verification (radiographic report or review/confirmation of radiograph by the study investigator)
Treatments or prescriptions were based on routine clinical care under uncontrolled conditions
One-year data collection
Patients demography, surgical treatment, osteoporosis treatment, cost, complications
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14. Baseline & Follow-up Visit
Parameters
Total number of patients of Baseline visit
664
Follow-up period (n=565)
Median (months)
2.79
Mean (months)
Range (months)
0.30 – 12.0
Time between baseline visit to visit 1
1.21
0.30 – 10.10
No. of patients completed 1 year follow-up 61
Median (Min,Max) follow-up visits
2 (1, 9)
Total person-years under observation
261.1
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15. Baseline Characteristics
7 Study Sites
(n = 664)
Age (years) (n=664)
    Mean (SD)
77.7
(9.4)
    Median (Min:Max)
78.7
(50.0: 100)
50 – 70
134
20.2%
71 – 80
269
40.5%
81 or greater
261
39.3%
Gender, Responded (n=663)
(1 : 2.9)
    Male:Female
169:494
25.5%:74.5%
Smoking status, Responded (n=657)
Current smoking 17
2.6%
Alcohol intake, Responded (n=657)
Current intake 22
3.4%
Steroid intake, Responded (n=621)
Current intake ≧ 7.5 mg/day 3
0.5%
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16. Baseline Characteristics
7 Study sites
(n=664)
Weight (kg), Responded (n=536)
    Mean (SD)
51.2
(10.8)
    Median (Min:Max)
51.5
(30 : 88)
Height (cm), Responded (n=534)
156.5
(8.4)
155
(120 : 180)
Body mass index (BMI), Responded (n = 532)
21.9
(3.7)
21.7
(12.9 : 35.6)
Less than 18.5 87
16.3%
18.5 – 22.9
258
48.5%
23.0 – 30.0 or greater
187
35.2%
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17. Previous History of Hip Fracture (parental or self)
Characteristics
7 Study sites (n=664)
Hip fracture – family history, Responded (n=650)
Parenteral hip fracture 19
2.9%
Hip fracture – self history, Responded (n=648)
Patients with previous fracture (any fractures)
109
16.8%
Hip fracture (43.1% of any fracture) 47
7.1% of total
Characteristics
7 Study sites (n=664)
Patient with previous fracture (any fractures)
Patients with previous hip fracture only
Patients with previous fractures
109
16.4% of 664 47
7.1% of 664
Patients received OP treatment
(one patient might receive ≥ one drug) 52
47.1% of 109 20
42.6% of 47
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18. Location of Hip Fracture
Characteristics
7 Study sites
(n=664)
Diagnosis of hip fracture, Responded (n=655)
Femoral neck hip fracture
312
47.0%
Intertrochanteric hip fracture
306
46.1%
Subtrochanteric hip fracture 32
4.8%
Atypical subtrochanteric hip fracture 5
0.8%
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Treatment Method
Characteristics
7 Study sites
(n=664)
Fracture treatment (n=664)
Patients underwent non-operation 93
14.0%
Patients underwent operation
571
86.0%
Fixation
297
44.7%
Hemiarthroplasty
248
37.4%
Total hip replacement 22
3.3%
Other operation techniques 4
0.6%
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20. New Fracture within 1 year
Kaplan-Meier survival analysis
Complications
Person-year
Events
Rate/100 patients per year
95%CI
Lower limit
Upper limit
New fracture
258.1 11
4.3
2.4
7.7
Eleven (11) new fracture includes
Six (6) new hip fractures
Femoral neck (3)
Intertrochanteric (3)
One (1) spine
Four (4) others
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21. Complications within 1 year (n =1,036)
Person-years
Events
Rate/100 patients per year
95%CI
Lower limit
Upper limit
Any
249.6 56
22.4
17.3
29.2
Death
261.1 12
4.6
2.6
8.1
Stroke
260.4 2
0.8
0.2
3.1
DVT
260.6 1
0.4
0.1
2.7
CHF
260.9 MI 4
1.5
0.6
4.1
Electrolyte imbalance
258.5 9
0.03
0.01
Pulmonary embolism
0.0
GI bleed
Deep infection
259.7 7
1.3
5.7
Superficial infection 5
1.9
New fracture
258.1 11
4.3
2.4
7.7
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22. Cost-utility Analysis of Osteoporotic Hip Fractures in Thai
Data: From January 1, 2008 to December 31, 2008 at Ramathibodi Hosp.
Inclusion: Osteoporotic hip fracture patients, aged ≥51
Result is lower than other developed countries due to
Strong family support
Insufficient rehabilitation program
Cost
(Baht)
QALY
Cost/QALY
(USD)*
Total Cost
126,319.5
0.636
198,615.57
6,620.52
Direct Cost
60,558.3
95,217.45
3,173.92
*30 Baht = USD
Wajanavisit W, et al. J Med Assoc Thai 2015; 98 (Suppl. 8): S65-S69.

23. TREATMENT-RELATED EXPENSE
Characteristics
Expense (Baht)
Mean (SD) total treatment expense (n = 483)
73,970.01
(46,909.78)
Median (Min:Max) total treatment expense
65,004
(2,986:421,685)
Mean (SD) implantation cost (n=381)
26,228
(37,356.89)
Median (Min:Max) implantation cost
20,493
(0:653,786)
Mean (SD) total medication cost (n=267)
22,944.17
(22,933.0)
Median (Min:Max) total medication cost
17,193.5
(0 : 245,868.5)
Mean (SD) osteoporotic medication cost (n=232)
503.4
(44,73.2)
Median (Min:Max) osteoporotic medication cost
34.8
(0 : 65,000)
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Conclusion
Incidence of hip fracture in Thailand is increasing
Average age of hip fracture is increasing
One year all causes mortality after hip fracture is also increasing
Hip Fracture Registry Initiative, pilot study of 7 tertiary care hospitals
664 cases, average age 77 years, 80% aged over 70 years
Male : Female = 1 : 2.9
Mean FU was very short as 3.8 months
Most were treated by surgery
Half by fixation, half by arthroplasty
Refracture rate was 4.3/ 100 persons year
Mortality was the most common complication: 4.6 / 100 persons year
Further analysis for OP treatment rate, Expense, Mortality, Success or failure of internal fixation and arthroplasty
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