This publication is part of Australian Centre for Monitoring Population Health
The summary of findings is presented here. To read the full report, please download the publication as a PDF (or in another format). All data and supplementary tables can be found under the Data tab. A Technical Notes document, available under Related material, provides more detail on the analysis methods used for the report.
Hip fractures are breaks occurring at the top of the thigh bone (femur). They place considerable burden on the wellbeing of the individual, their family and carers, and represent a substantial cost to the health care system in Australia.
This analysis is unique in Australia due to its significant population coverage and use of multiple linked data sets, including linked hospitals and residential aged care data. Linked data were used to explore a more complete picture of hip fracture patient pathways such as the transition to aged care, readmission to hospital, second hip fracture and mortality.
It complements available subnational and cohort clinical register data and provides a baseline for future population monitoring of hip fracture incidence, management, prevention and outcomes.
Up to 17,100 Australians over 45 fracture their hip for the first time each year
A cohort of 69,900 people aged 45 and over had a hip fracture between 1 July 2013 and 30 June 2017, based on national hospital data (excluding Western Australia and the Northern Territory). The majority of these (67,200 people) were experiencing their first hip fracture, with around 16,300 to 17,100 people experiencing their first hip fracture each year. Most first hip fracture patients were managed with surgery (90%).
Overall, the rate of first hip fractures between 1 July 2013 and 30 June 2017 was 200 per 100,000 people aged 45 and over. The rate of first hip fractures ranged between 198 per 100,000 population in 2016–17 and 204 per 100,000 population in 2014–15.
First hip fractures were the focus of this report as patients who are experiencing a second hip fracture may have poorer outcomes, including a higher likelihood of dying or experiencing complications, and may follow a different treatment pathway to first hip fracture patients.
At least 43% of patients had osteoporosis medications dispensed following hip fracture
Of first hip fracture patients, 19% had at least one prescription dispensed for an osteoporosis-related medication in the year before their fracture.
Over the one year following fracture, 43% of patients who survived had at least one osteoporosis medication dispensed according to PBS data. Some long-lasting osteoporosis medications administered in hospital may not be captured in this estimate.
Hip fractures were more common among older women and people from residential aged care
The rate of first hip fracture among surgical patients aged 45 and over:
- increased with age, from 12 per 100,000 population aged 45–54 to 2,900 per 100,000 population aged 95 and over
- was 2.1 times as high in women (239 per 100,000 population) as in men (116 per 100,000 population).
Among people aged 65 and over, the incidence rate of first hip fractures treated with surgery for people from residential aged care (RAC) was 5.1 times as high as for people from the community, after adjusting for age.
Hip fractures involve substantial in-hospital care
Among surgical patients, the median length of a hip fracture hospital stay, including acute, rehabilitation or other care, was 20 days. The length of stay ranged between 13 and 29 days for the middle 50% of patients. Length of stay increased with increasing age, from 7 days in patients aged 45–54, to 22 days in those aged 75–94. Patients living in the community before their hip fracture stay had a longer length of stay (median 26 days) than patients from residential aged care (median 8 days).
In addition, 16% of surgical patients were readmitted to hospital within 30 days after the end of their hospital stay. Over the year following first hip fracture, 3.0% (1,800) were hospitalised with a second hip fracture.
Over 1 in 7 patients from the community were in RAC at 120 days
Among surgical patients who were living in the community before their hip fracture, at 120 days after the end of their hip fracture hospital stay:
- 73% were in the community
- 15% (over 1 in 7) were in RAC
- 12% had died.
Around 1 in 4 first hip fracture patients aged 45 and over died within a year
The mortality rate was 8.5% at 30 days, 15% at 90 days and 26% at one year among first hip fracture patients aged 45 and over. Non-surgical patients were more likely to die within one year (40%) than surgical patients (24%).
Having a hip fracture was associated with higher one-year mortality than matched non-hip fracture controls who were hospitalised, particularly among patients from the community.
Many factors associated with mortality in the general population were also associated with dying after a hip fracture. One-year mortality was higher among hip fracture patients who:
- were older
- were male
- were in RAC before their hip fracture
- had a hip fracture from a fall in hospital
- had comorbidities.
- About this report
- What are hip fractures?
- Why report on hip fractures?
- Gaps addressed by the data in this report
2. About the data and key methods
- About the National Integrated Health Services Information data
- Project scope
- Defining hospital stays in linked data
3. First hip fractures: an overview
- The rate of hip fractures decreased slightly across the reference period
- The rate of hip fractures by socioeconomic and remoteness area
- Use of osteoporosis medications
- Most patients had hip fracture surgery
4. Demographic and fracture characteristics
- Characteristics of first hip fracture patients
- Characteristics of first hip fractures
5. Care received during the hip fracture hospitalisation
- Admission via the emergency department
- Length of hospital stay
- Characteristics associated with length of stay
- Procedures in hospital
6. Discharge pathways
- Why measure discharge to usual place of residence?
- Discharge pathway of patients aged 65 and over
- Location 120 days after hip fracture hospital stay
7. Readmission to hospital
- Defining readmission
- How many hip fracture patients are readmitted to hospital?
- Reason for readmission within 30 days
- Factors associated with 30-day readmission
- How many times are hip fracture patients readmitted to hospital within 30 days, 90 days and one year?
8. Second hip fracture within one year
- Defining second hip fractures
- How many patients have a second hip fracture?
- Characteristics of patients who have a second hip fracture
9. Non-surgical first hip fracture patients
- Characteristics of non-surgical patients
- Characteristics of non-surgical hip fractures
- Non-surgical patients had a shorter stay in hospital
- Non-surgical patients were much more likely to die at the end of the hospital stay
- Readmission among non-surgical patients
- Second hip fracture
10. Mortality following a first hip fracture
- More than 1 in 4 first hip fracture patients aged over 45 died within a year
- Factors associated with one-year mortality
- The rate of hip fractures decreased slightly
- Many hip fracture patients have comorbid conditions
- The patient’s pathway: entry via emergency department and discharge to usual residence
- Almost 1 in 6 first hip fracture patients treated with surgery were readmitted to hospital within 30 days
- Three per cent of patients had a second hip fracture within one year
- Almost 1 in 4 surgical first hip fracture patients died within a year
- First hip fracture patients were slightly more likely to die within one year than matched controls
- Residential aged care affects many parts of the care pathway
- Patient characteristics were consistent with unlinked data
- Limitations and future directions
End matter: Acknowledgements; Abbreviations; Symbols; Glossary; References.