We sought to determine whether specific characteristics of vertebral fractures in elderly men are associated with low bone mineral density (BMD) and osteoporosis.

Mister osteoporosis Sweden is a population based cohort study involving 3014 men aged 69 to 81 years. Of these, 1427 had readable lateral radiographs of the thoracic and lumbar spine. Total body (TB) BMD (g/cm²) and total right hip (TH) BMD were measured by dual energy x-ray absorptiometry. The proportion of men with osteoporosis was calculated from TH BMD. There were 215 men (15.1%) with a vertebral fracture. Those with a fracture had lower TB BMD than those without (p < 0.001). Among men with a fracture, TB BMD was lower in those with more than three fractures (p = 0.02), those with biconcave fractures (p = 0.02) and those with vertebral body compression of > 42% (worst quartile) (p = 0.03). The mean odds ratio (OR) for having osteoporosis when having any type of vertebral fracture was 6.1 (95% confidence interval (CI) 3.9 to 9.5) compared with those without a fracture. A combination of more than three fractures and compression in the worst quartile had a mean OR of 114.2 (95% CI 6.7 to 1938.3) of having osteoporosis compared with those without a fracture.

We recommend BMD studies to be undertaken in these subcohorts of elderly men with a vertebral fracture.

Cite this article: 2015;97-B:1106–10.

Aim: We have previously shown that long-term survival after hip fracture is highly dependent on age at the time of fracture and that fracture risk is similarly age-dependent. It has been suggested that the excess mortality occurs mainly during the first years after fracture, while mortality in a remaining life-time perspective is not well studied. The aim of this study was to evaluate short- and long-term mortality in relation to cause of death in a cohort of patients with hip fracture in comparison with the back-ground population.

Methods: All adult patients suffering a hip fracture due to low energy trauma 1984–1985 in Malmö, Sweden were identified; 1029 cases (766 women, 263 men). The cases were compared with two age- and gender matched controls from the same background population, all alive and living in the catchment area when the hip fracture occurred. Date of death and cause of death were available through the national database, EPIC. Cases and controls were followed until death or up to 22 years.

Results: The median survival was 4.4 yrs (+/− 0.2 [CI 95% 4.0–4.8]) in hip fracture patients and 7.7 yrs (+/− 0.2 [CI 95% 7.3–8.1]) in controls, equal to a median loss of 3.3 yrs. Mortality rate continued to be elevated for approximately 10 yrs, thereafter observed mortality approached expected mortality. Mean survival was 2.9 years shorter in fracture cases compared to controls (6.4 yrs (+/− 0.2 [CI 95% 6.0–6.8]) versus 9.4 yrs (+/− 0.2 [CI 95% 9.1–9.7])). Ischemic heart failure was the major underlying cause of death (25%) both among cases and controls.

Conclusion: In hip fracture patients, excess mortality is evident both in the short- and long-term with an increased risk beyond 10 yrs. Nevertheless, the major causes of death were similar to that of controls.

Objective: The Charnley grading system (A, B, C) has previously been shown to be a valid predictor concerning outcome after joint replacement surgery. In this study we hypothesized that anxiety/depression, one of five dimensions in the health related quality of life measurement tool EQ-5D, could predict the outcome after total hip replacement surgery.

Methods: Data from the Swedish Hip Arthroplasty Register including 6 158 patients with primary osteoarthritis were analysed. To examine the association of anxiety with respect to the outcome of pain (VAS) and satisfaction (VAS) a general linear regression model was used.

A subgroup of 481 patients in the Western Region of Sweden with complete data on individual CPP (cost per patient) was selected for the health economic analysis.

Results: The preoperative EQ-5D anxiety/depression dimension was a strong predictor for pain relief, patient satisfaction, and cost-effectiveness with surgery. Patients with comorbidity (Charnley category C) had a significant worse outcome with regards to pain relief, satisfaction and EQ-5D index scores than patients in Charnley category A and B (p< 0.001). Females generally had worse outcome scores than males in all three outcome measurements (p< 0.001).

Conclusion: Orthopaedic surgeons involved with the care of patients eligible for THR surgery should be alert to the fact that mental health may influence pain-experience and HRQoL outcome. Appropriate assessment of mental health may enable us to modify the approach in which we manage these patients, in order to optimize the outcome following joint replacement surgery.

In this study we hypothesised that anxiety/depression, one of five dimensions in the health-related quality of life (HRQoL) measurement tool EQ-5D, could predict outcome after total hip replacement surgery.

Pre-operative and one-year post-operative data from the Swedish Hip Arthroplasty Register, including 6158 patients with primary osteoarthritis of the hip, were analysed. In order to examine the association between anxiety and outcome with respect to pain and satisfaction an analysis of covariance was used.

The pre-operative EQ-5D anxiety/depression dimension was a strong predictor for pain relief and patient satisfaction (p < 0.001).

Orthopaedic surgeons involved in the care of patients eligible for total hip replacement surgery should be aware that mental health may influence post-operative pain and HRQoL. An appropriate assessment of mental health may enable a modification in the way these patients are managed in order to optimise the outcome after joint replacement surgery.