title: When and where do hip fractures occur? A population-based study.
abstract: We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects' psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days.
  
  
  BACKGROUND
  This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground.
  
  
  METHODS
  We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews.
  
  
  RESULTS
  The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95% confidence interval (CI), 1.12-4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95% CI, 1.40-6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95% CI, 1.02-1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors.
  
  
  CONCLUSIONS
  Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.
authors.affiliation: Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden. breiffni.leavy@surgsci.uu.se
authors.forename: B
authors.initials: B
authors.lastname: Leavy
authors.forename: A C
authors.initials: AC
authors.lastname: Åberg
authors.forename: H
authors.initials: H
authors.lastname: Melhus
authors.forename: H
authors.initials: H
authors.lastname: Mallmin
authors.forename: K
authors.initials: K
authors.lastname: Michaëlsson
authors.forename: L
authors.initials: L
authors.lastname: Byberg
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000061:Accidents, Home / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000009:adverse effects; D012111:Residence Characteristics; D012307:Risk Factors; D012621:Seasons; D012914:Snow; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D011619:Psychotropic Drugs