uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
When and where do hip fractures occur?: A population-based study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Show others and affiliations
2013 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, no 9, 2387-2396 p.Article in journal (Refereed) Published
Abstract [en]


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.


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.


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.


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.


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.

Place, publisher, year, edition, pages
2013. Vol. 24, no 9, 2387-2396 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-199982DOI: 10.1007/s00198-013-2333-6ISI: 000323062700002PubMedID: 23532356OAI: oai:DiVA.org:uu-199982DiVA: diva2:621886
Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2015-04-17Bibliographically approved
In thesis
1. Fall-Related Hip Fracture: Predisposing and Precipitating Factors
Open this publication in new window or tab >>Fall-Related Hip Fracture: Predisposing and Precipitating Factors
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A physically inactive lifestyle is a predisposing risk factor for fall-related hip fracture. The circumstances, or precipitating factors, surrounding hip fractures are, however, not well understood, a factor of relevance for Swedish adults who have one of the highest hip fracture risks in the world. The aims of this thesis, therefore, were: to explore perceptions of physical activity (PA) among older adults, to describe the circumstances surrounding hip fracture events and the health characteristics of those who experience them.

Four observational studies were conducted involving qualitative, epidemiological and mixed method designs. Participants in study I were recruited from community settings in Stockholm and Dublin (n=30). Studies II-IV (sample sizes, n=484, n=125, n=477) were based on a population-based sample of people admitted to Uppsala University hospital due to hip fracture. Study IV also incorporated the background population of Uppsala county in 2010 (n=117 494).

Analysis of PA perceptions in study I revealed that PA which is functional nature is perceived as most meaningful among certain participants. The uptake of PA in later years was a means of creating a new self-identify and being active in outdoor environments was an important culture-specific motivator to PA among Swedish participants. Analysis of hip fractures patterns in studies II-III showed that: hip fractures among psychotropic drug users were twice as likely to occur during night-time hours compared to those occurring among people not receiving these drugs. Additionally, the fall-related hip fractures of community dwellers with poorest health and function tended to occur indoors during positional changes. In study IV, all categories of disease (according to the International Classification of Diseases, 10th Revision) were seen to be positively associated with hip fracture.  Cardiovascular disease and previous injury (including previous fracture) posed the highest relative and absolute fracture risks.

Detailed investigation of hip fracture circumstances reveal patterns in health and functional characteristics, which provide information regarding predisposing and precipitating factors for these events. This knowledge, in combination with findings regarding PA perceptions, can be used when identifying individuals at high risk for hip fracture and when tailoring fracture prevention at an individual level to those at risk. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 84 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1082
Co-existing disease, Epidemiology, Fall circumstances, Hip fracture, In-depth interviews, Mixed methods, Physical activity perceptions, Psychotropic drugs, Qualitative
National Category
Medical and Health Sciences
Research subject
Orthopaedics; Epidemiology; Geriatrics; Physiotherapy
urn:nbn:se:uu:diva-247286 (URN)978-91-554-9202-1 (ISBN)
Public defence
2015-05-07, Rosénsalen, Ingång 95/96, Akademiska Sjukhuset, Uppsala, 09:15 (English)
Available from: 2015-04-13 Created: 2015-03-17 Last updated: 2015-04-17

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Leavy, BreiffniÅberg, Anna CristinaMelhus, HåkanMallmin, HansMichaëlsson, KarlByberg, Liisa
By organisation
OrthopaedicsGeriatricsClinical pharmacogenomics and osteoporosis
In the same journal
Osteoporosis International
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 305 hits
ReferencesLink to record
Permanent link

Direct link