6 ms·

Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell tes

Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.

luu 7y ago
This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378
- AstralStorm 7y ago
  This suggests that sicker people get more disabled by surgery. Which we already knew. (Similarly institutionalised or not independent = sicker, having comorbidities, low fall injury suggests balance problems or advanced osteoporosis = sicker, just older = likely sicker) But it does point slightly towards surgery bring beneficial (fixation reduced risk)
sambroner 7y ago
Just to tune your smell test, my suspicion is that the vast majority of people over 65 that break their hip are somewhere on the frailty scale from this article. Healthy people are very unlikely to trip and break their hip.
- alkonaut 7y ago
  “Once someone who’d likely die from a broken hip breaks their hip, they are likely to die” This passes the smell test without problem.
- newnewpdro 7y ago
  Post-menopausal women tend to suffer from osteoporosis, their bones are weak and all it takes is a fall. My grandfather who rode a bicycle everywhere into his 80s, never owned an automobile (Europe) broke his hip in a minor fall. He was moved to the USA to get the operation and lived with us permanently afterwards, it was definitely the beginning of the end.
  - superpermutat0r 7y ago
    https://www.youtube.com/watch?v=k6GHHzIByOk https://www.youtube.com/watch?v=k6GHHzIByOk Pretty simple way to reverse the osteoporosis.
    - AstralStorm 7y ago
      Give me the RCTs proving that anything actually reverses osteoporosis. Best we have is minor prevention with effect sizes of below 20%. This including special exercises combined with collagen rich diet, D3, K2 and bisphosphonates. Teriparatide shows promise in reversal but effect sizes are low too. The main result is prolonging age until occurrence anyway, not prevention. And definitely not cure.
    - newnewpdro 7y ago
      Are you trolling or do you actually believe that's "reversing osteoporosis"? It's just pushing it back a bit, of course she saw some improvement relative to a completely sedentary condition and that's great. It's not going to stay on that trajectory indefinitely, which is what's implied by "reverse".

Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.

luu 7y ago

This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378

AstralStorm 7y ago
This suggests that sicker people get more disabled by surgery. Which we already knew. (Similarly institutionalised or not independent = sicker, having comorbidities, low fall injury suggests balance problems or advanced osteoporosis = sicker, just older = likely sicker) But it does point slightly towards surgery bring beneficial (fixation reduced risk)

sambroner 7y ago

Just to tune your smell test, my suspicion is that the vast majority of people over 65 that break their hip are somewhere on the frailty scale from this article. Healthy people are very unlikely to trip and break their hip.

alkonaut 7y ago
“Once someone who’d likely die from a broken hip breaks their hip, they are likely to die” This passes the smell test without problem.
newnewpdro 7y ago
Post-menopausal women tend to suffer from osteoporosis, their bones are weak and all it takes is a fall. My grandfather who rode a bicycle everywhere into his 80s, never owned an automobile (Europe) broke his hip in a minor fall. He was moved to the USA to get the operation and lived with us permanently afterwards, it was definitely the beginning of the end.
- superpermutat0r 7y ago
  https://www.youtube.com/watch?v=k6GHHzIByOk https://www.youtube.com/watch?v=k6GHHzIByOk Pretty simple way to reverse the osteoporosis.
  - AstralStorm 7y ago
    Give me the RCTs proving that anything actually reverses osteoporosis. Best we have is minor prevention with effect sizes of below 20%. This including special exercises combined with collagen rich diet, D3, K2 and bisphosphonates. Teriparatide shows promise in reversal but effect sizes are low too. The main result is prolonging age until occurrence anyway, not prevention. And definitely not cure.
  - newnewpdro 7y ago
    Are you trolling or do you actually believe that's "reversing osteoporosis"? It's just pushing it back a bit, of course she saw some improvement relative to a completely sedentary condition and that's great. It's not going to stay on that trajectory indefinitely, which is what's implied by "reverse".