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. The study included 562 hip fracture patients (HF) (age 70 years) admitted to a Danish university hospital. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of approximately 248000 subjects. The control group (Con) (n=1124) consists of subjects who have had PTH, total calcium (Ca) and 25OH-vitamin D (VitD) measured at the General Practitioners Laboratory of Copenhagen after referral from their general practitioner. Of the HF's 462 had a Ca measurement, 440 had a PTH measurement and 439 had a VitD measurement. Basic characteristics (values for age, Ca, PTH and VitD are mean (SD)): Sex (females/males) (%): 73.8/26.2. Age (years): 82.9 (5.7). Ca (mmol/l): Con 2.34 (0.13), HF 2.27 (0.13), p<0.0001 (chi-square). PTH (pmol/l): Con 6.4 (5.8), HF 6.6 (5.4), p=0.4 (chi-square). VitD (nmol/l): Con 53.3 (30.1), HF 49.3 (29.6), p=0.02 (chi-square).Introduction
Methods
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. A total of 1344 hip fracture patients (age 70 years) divided into three populations were included in this study. Mortality data were collected from the Danish Civil Registry. Population 1 (P1), n = 645 was included at GUH from January 1, 2006 to December 31, 2007. During the entire period, the patients had access to a senior consultant in geriatric medicine three times a week. In this population, the majority of patients were assessed for dementia (n = 636), delirium (n = 627) and Barthel Index (Barthel100) at admission (n = 394). Population 2 (P2), n = 381 included at BUH from September 1, 2009 until July 8, 2010 with orthogeriatric access. Population 3 (P3), n = 318 were included at BUH from September 28, 2008 until August 31, 2009 with no orthogeriatric access. Age mean (SD): P1 84.7 (6.8), P2 85.5 (7.3), P3 85.3 (14.3) P = 0.1(ANOVA) Sex ratio: females/males: P1 0.73/0.27, P2 0.80/0.20, P3 0.75/0.25 P = 0.09 Chi square). In-hospital mortality rate: P1 4.8%, P2 6.3%, P3 9.1% P = 0.03 (Chi square). Three month mortality: In P1 dementia, delirium and Barthel Index (below 50 versus above 50) were all strong predictors: No dementia: 53/383 (13.8%) versus dementia present 68/253 (26.9%) died, P = 0001 (log-rank test). No delirium 69/456 (15.1%) versus delirium present 47/171 (27.5%) died F = 0.0004 (log-rank test) Barthel Index 50 38/372 (10.2%) versus Barthel<50 7/22 (31.8%) died P = 0.0004Methods
Results
We studied the characteristics of patient attendances at the Camp Bastion Field Hospital in the peak period of clinical activity. It has been expected that the summer of 2009 in Afghanistan would cause increased battle intensity due to the Afghan presidential referendum. Furthermore it was expected that civilian casualties would make up an increasing share of the total number of patients. Data was collected retrospectively from medical records by an on-site researcher. Each attendance was counted as a separate activity; some patients attended the hospital more than once.Aim
Method
