Incidence and Mortality of Proximal Femur Fractures in a City in the Southeast Region in Brazil

Incidence and Mortality of Proximal Femur Fractures in a City in the Southeast Region in Brazil | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence and Mortality of Proximal Femur Fractures in a City in the Southeast Region in Brazil VICTOR COELHO, Gabriela Garces, Henrique Mitsui, Vitor Henrique Oliveira This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7274668/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Proximal femoral fractures are undoubtedly the worst complication of osteoporosis. This disease often presents as the first and only symptom of a fragility fracture. This type of fracture is associated with a high mortality rate; studies indicate that up to 20% of patients die within the first year after the fracture, and almost 50% of patients lose some degree of their previous functional capacity. Objective To determine the incidence of proximal femur fractures in people older than 50 years of age in the Barbacena region and to analyze subgroups by sex and age groups. In addition, we defined mortality during hospitalization. Materials and Methods: This was a retrospective, observational, analytical and descriptive studyand included information from all patients admitted to the hospital between July 2021 and June 2024, with proximal femur fractures. This study was conducted in the city of Barbacena, located in the state of Minas Gerais, in the Southeast region. This hospital in Barbacena is the only reference for high complexity health care in the region, totaling 222,233 inhabitants. Results: During the 36 months of evaluation, 245 cases of proximal femur fractures were recorded and included in the study, corresponding to an annual incidence of 108.4 fractures/100,000 inhabitants (95% CI: 95.6-122.9); 165 were women (67.3%), and 80 were men (32.7%), corresponding to a mean incidence of 133.9 fractures/100,000 inhabitants/year (95% CI: 114.9–155.9) among women and 79.0 fractures/100,000 inhabitants/year (95% CI: 63.5–98.4) among men. The overall death rate was 15.4% (35 patients), with 23.3% among men and 11.6% among women. Conclusion: The incidence of proximal femur fractures was 108.4 fractures/100,000 inhabitants/year. This incidence is slightly greater than that found in the Brazilian literature. The incidence among women was much greater than that among men, reaching a ratio of 1:2.1. The incidence of fractures increases with age, but 60% of fractures occur in the population between 70 and 89 years of age. Notably, mortality increases with age and is greater among men in all age groups, with the mortality rate reaching 33% in men between 80 and 89 years of age. Figures Figure 1 Figure 2 INTRODUCTION Proximal femoral fractures, which include femoral neck, trans trochanteric and peri trochanteric fractures, are undoubtedly the worst complication of osteoporosis. This disease often presents as the first and only symptom of a fragility fracture. This type of fracture is associated with a high mortality rate; studies indicate that up to 20% of patients die within the first year after the fracture, and almost 50% of patients lose some degree of their previous functional capacity 1 , 2 ,15 . It is known that osteoporosis and fragility fractures affect women more than men due to factors such as menopausal hypoestrogenism. However, they can affect anyone, regardless of age or sex, who has risk factors such as corticosteroid use, rheumatoid arthritis, low weight, and smoking 7 , 9 . Studies show that the incidence of femur fractures varies greatly depending on the country or population under study. In Brazil, the BRAVOS study, with data from 2012, showed an incidence of hip fractures in people older than 50 years of age of 103.3/100,000 inhabitants. American and European studies have already shown a much greater incidence of this disease, reaching more than 500 femur fractures/100,000 inhabitants/year. As the population ages, there is an increase in the number of patients with osteoporosis and a consequent increase in hip fractures. On the other hand, countries such as the United States have noticed a reduction in the incidence of femur fractures in recent years, which is probably associated with improvements in the screening and treatment of osteoporosis 3 , 4 , 5 . Given the demographic changes and the high severity of femur fractures, continuous analysis of the epidemiology of these injuries and their outcomes is essential. The availability of multiple therapeutic strategies, including pharmacological and nonpharmacological approaches, highlights the need for systematic monitoring to support the formulation of preventive public policies and assess the quality of health services offered to the population. OBJECTIVE : To determine the incidence of proximal femur fractures in people older than 50 years of age in the Barbacena region and to analyze subgroups by sex and age groups. In addition, we defined mortality during hospitalization. MATERIALS AND METHODS This study was conducted in the city of Barbacena, located in the state of Minas Gerais in the southeastern region, which has a population of 125,317 inhabitants. Barbacena is a reference for high-complexity health care for 14 other municipalities in the region, totaling 222,233 inhabitants. The population of interest for the study included approximately 75,357 people aged more than 50 years (33.9% of the total population )8 (Table 1 ). Table 1 Populations of cities in the microregion of Barbacena, MG. City Inhabitants Alfredo Vasconcelos 6.931 Alto Rio Doce 10,891 Antônio Carlos 11,095 Barbacena 125,317 Capela Nova 4.362 Carandaí 23,812 Cipotânea 5,581 Desterro do Melo 2,994 Ibertioga 5.198 Paiva 1,474 Ressaquinha 4,548 Santa Bárbara do Tugúrio 4.208 Santa Rita do Ibitipoca 3.301 Santana do Garambéu 2.137 Sra dos Remédios 10.384 Total 222.233 This study was developed at Hospital Regional of Barbacena Dr. José Américo, a highly complex hospital in the FHEMIG network, Fundação Hospitalar do Estado de Minas Gerais, a level 2 hospital; a reference in the region for multiple traumas, strokes, and major burns; and orthopedic, general surgery, plastic surgery, neurosurgery, and vascular surgery services. The hospital has an emergency room that is a reference for prehospital care, in addition to meeting the spontaneous demand of the population. There were 135 beds, 45 of which were in the emergency room, 20 in the ICU, 70 in the ward, 34 in the surgical clinic, 25 in the medical clinic, and 11 in the stroke unit. It is the only hospital in the region with an orthopedic service in the Unified Health System. This was a retrospective, observational, analytical and descriptive study. Information was collected from the PENTAHO database and included information from all patients admitted to the hospital between July 2021 and June 2024 with proximal femur fractures (ICD discriminators S72, S72.1 and S72.2) older than 50 years. Patients who were living in cities that were not part of the Barbacena microregion or who were not of registered age were excluded. Duplicate records, such as readmission records, were also excluded. To assess patient outcomes, discharge or death, patients who were transferred to other services were excluded. The data are presented in tables containing the patient's name, sex, age, date of hospitalization, date of discharge or death or transfer, municipality of residence and ICD. Information was collected from the IBGE website - Census 2022 with the creation of a table with the population of each municipality, sex and age group. Statistical analyses were performed using the statistical software R. Initially, a descriptive analysis of the sample was performed, followed by an inferential analysis using Fisher's exact test. In cases where the variable in question had many categories, the chi-square test was applied. RESULTS During the 36 months of evaluation, 245 cases of proximal femur fractures were recorded and included in the study, corresponding to an annual incidence of 108.4 fractures/100,000 inhabitants (95% CI: 95.6-122.9), with small variations throughout the period evaluated. In the first 12-month period (July 21 to June 22), the lowest incidence was 103.5 (95% CI: 81.8–129.1), or 78 or 31%. In the second period (July 22 to June 23), the highest incidence was 112.8 (95% CI: 90.1-139.4), 85 of which represented 34.7%. In the third period, the incidence was 108.8 (95% CI 95.7-122.9), with 82 cases (33.5% of the total). There was no significant difference between the years analyzed (Table 1 ). Table 1 Number of cases and incidence over the period analyzed. Frequency of cases Incidence Range of confidence 95% Jul 2021 - Jun 2022 78 (31.8%) 103.5 81.8–129.2 Jul 2022 - Jun 2023 85 (34.7%) 112.8 90.1–139.5 Jul 2023 - Jun 2024 82 (33.5%) 108.8 86.5–135.1 Total cases 245 (100%) 108.4 95.7–122.9 Among the 245 patients with femur fractures, 165 were women (67.3%), and 80 were men (32.7%), corresponding to a mean incidence of 133.9 fractures/100,000 inhabitants/year (95% CI: 114.9–155.9) among women and 79.0 fractures/100,000 inhabitants/year (95% CI: 63.5–98.4) among men. The M:W ratio was 1:2.1. Regarding the distribution of fractures by age, the mean age was 76 years (SD ± 11.7), with 73 years (SD ± 12.5) among men and 77 years (SD +- 11.1) among women. The number of fractures exponentially increased with increasing age. There was a greater incidence of age × sex distribution among women in all age groups, except for the age group between 50 and 59 years, where the incidence was slightly greater among men (Fig. 1 ) (Table 2 ). Table 2 Frequency of patients with proximal femur fractures by sex and age group Total Women Men Cases Incidence Cases Incidence Cases Incidence 50–59 years old 24 18.5 10 20.5 14 39.5 60–69 years old 47 48.6 28 77.9 19 59.0 70–79 years old 75 150.1 52 231.6 23 135.1 80–89 years old 70 344.9 54 553.2 16 280.9 90–99 years 28 647.2 21 983.3 7 872.2 > 100 years 1 491.2 0 0 1 7856.7 To assess mortality during hospitalization, patients who were transferred to other services were excluded, 17 patients (6.9%); leaving 228 patients in the analysis. Of the remaining 228 patients, 193 were discharged (84.6%), and 35 died (15.4%). There was a considerable difference in the death rates between men and women, with 23.3% (17 patients) among men and 11.6% (18 patients) among women. This difference was statistically significant (p = 0.03). The overall death rate was 15.4%. Mortality analysis revealed a mean age of 82 years (SD ± 9.8) among patients who died, 86 years (SD ± 6.7) among women and 77 years (SD ± 10.4) among men. The mortality rate increased with age, reaching 25.8% in patients aged 80 to 89 years (p = 0.034) and 33.3% in men aged 80 to 89 years. There were no deaths among women under 70 years of age. Mortality was greater among men in all age groups (Fig. 2 ). DISCUSSION This study revealed an incidence of 108.3 fractures/100,000 inhabitants, with little variation during the 3 years of evaluation. An analysis of the literature revealed that the incidence of this disease varies greatly according to the region, population or country studied. There was a variation greater than 10 times in the risk of hip fracture and in the probability of fracture between countries. European countries have incidences above 300 fractures/100,000 inhabitants/year. However, Brazilian studies, such as BRAVOS, which has a methodology similar to that of this study, have shown similar incidences − 103 fractures/100,000 inhabitants - for the Brazilian population. However, there are some regional differences, with the incidence being greater in metropolitan regions and the southeastern region and lower in the northern region 2 , 3 . The population of this study is located in the southeastern region; approximately half of the population lives in a city with more than 100,000 inhabitants, and the other half lives in small cities with an average population of approximately 7,000 inhabitants, totaling approximately 220,000 inhabitants. In Brazil, 44.8% of the municipalities have fewer than 10,000 inhabitants, and 99% of the cities have fewer than 500,000 inhabitants. Almost 70% of the Brazilian population lives in these cities. Given this demographic distribution, the findings of this study are likely to apply to the majority of the Brazilian population 8 . The difference in incidence between men and women, with women being more prevalent, is consistent with the findings of Brazilian and international literature, with a slightly greater incidence in this study (M: W = 1:2.1) than in previous Brazilian data (M: W: 1:1.67). This may indicate an increase in fractures in women compared to men in Brazil. These data are in line with the findings of studies conducted at the turn of the century in the U.S. and Europe, which showed an M: W ratio of 1:2, like the findings of this study 4 , 10 . The variation in the incidence of fractures with aging is also striking. It is worth remembering that, in general, the average incidence of fractures above the age of 50 years, without distinction between the sexes, is 108.3 fractures/100 thousand inhabitants/year; this number drops to 27.5 in the age group between 50 and 59 years, and from that point on, it doubles every 10 years. The age group between 70 and 79 years is noteworthy, where the incidence almost tripled in relation to that of the previous 10 years (from 64.7 to 188.2). This growth curve behaves differently for men and women over time. Fractures begin more often in men than in women between the ages of 50 and 59 years, with an average incidence of 20.4 among women and 39.4 among men. There is a sudden acceleration in fractures among women, tripling every 10 years (incidence of 20.4; 77.9; 231.6) until the age of 90, while among men, there is a less intense increase in the initial decades (39.4; 59.0; 135.1; 280.9), tripling only after the age of 90, with an incidence of 872.1, between the ages of 90 and 99. These differences can be explained by several factors. The higher incidence among women is already well defined due to the effects of menopause and hypoestrogenism. There is also a lower peak bone mass in women. The paradoxical finding between the ages of 50 and 59 years, with a higher incidence among men, may be due to traumatic fractures, which affect more men than women. Studies with populations under 50 years of age indicate a higher incidence of proximal femur fractures among men 11 , 6 . Although the incidence of fractures increases with age, the highest number of cases occurred in the age group between 70 and 79 years, followed by the age group between 80 and 89 years; that is, 58% of the fractures (145 cases) were concentrated in those aged between 70 and 89 years. The mortality rate was significantly lower in females (11.6%) than in males (23.3%) (p = 0.03). There was also an increase in mortality with increasing age up to 90 years. The age group with the highest number of deaths was between 80 and 89 years, accounting for almost half of the deaths (17 deaths) (48%). This age group had a mortality rate of 25.8%. The 90- to 99-year-old age group also had a high mortality rate, reaching 24%, but with fewer cases and 6 deaths in total. This study did not seek to determine the reasons for the difference in mortality between the sexes since this was not the main objective of the study. An in-depth analysis of the subject is necessary. The literature contains several possible causes for this difference, including pre fracture comorbidities, the type of fracture, the greater vulnerability of men at the time of the fracture, and a greater risk of infection and sepsis among men. The higher mortality in older patients is also well documented 12 , 13 , 14 . CONCLUSION The incidence of proximal femur fractures found in this study was 108.4 fractures/100,000 inhabitants/year for the population of the Barbacena region older than 50 years. This incidence is slightly greater than that found in the Brazilian literature. The incidence of proximal femur fractures among women was much greater than that among men, reaching a ratio of 1:2.1. The incidence of fractures increases with age, but 60% of fractures occur in the population between 70 and 89 years of age. Notably, mortality increases with age and is greater among men in all age groups, with the mortality rate reaching 33% in men between 80 and 89 years of age. This work seeks to guide public policies within the scope of primary and secondary prevention, in addition to disseminating and improving access to treatment and prevention of falls, especially for the most affected groups (women between 70 and 90 years old). Furthermore, it seeks to direct the work of the referral hospital, especially in the most vulnerable population with greater chances of complications and deaths (men older than 80 years). Declarations Author details Hospital Regional de Barbacena Dr. José Américo - Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) , Avenida 14 de Agosto, Bairro Floresta, Barbacena, Minas Gerais CEP: 36202-850, Brasil. Faculdade de Medicina - Universidade Federal de Juiz de Fora , Av. Eugênio do Nascimento, s/n° - Dom Bosco, Juiz de Fora, Minas Gerais, CEP: 36038-330, Brasil. Funding: This study was funded by the author’s own resources. Consent for Publication The authors declare that they agree with the publication Consent for Publication The authors declare that they have no competing interests. Ethical approval The study was submitted to and approved by the Ethics Committee of Research at the Fundação Hospitalar do Estado de Minas Gerais, under the number (7.331.868) in January 2025, in accordance with the guidelines and regulatory standards for research involving human beings in Brazil (CNS Resolution no. 466/2012, CNS Resolution no. 510/2016 and complementary), under the conclusion of the National Research Ethics Commission. The research also observes the international ethical principles contained in the Declaration of Helsinki (World Medical Association, 1964, and subsequent revisions), the Belmont Report (1979), the CIOMS International Guidelines (2016), as well as the UNESCO Universal Declaration on Bioethics and Human Rights (2005). In the Latin American context, it also respects the references of the Declaration of Managua (1981) and other relevant regional ethical documents. Author Contribution All authors, VC, GG, VHO and HM, participated in data collection, statistical analysis, writing the text and reviewing it. References Baghdadi, S., Kiyani, M., Kalantar, SH et al. Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors. BMC Musculoskelet Disord 24, 693 (2023).https://doi.org/10.1186/s12891-023-06825-9. Accessed on January 11, 2025. Albergaria, BH., Zerbini, CAF, Szejnfeld, VL et al. An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS). Arch Osteoporos 17, 90 (2022). https://doi.org/10.1007/s11657-022-01127-4. Accessed on 07 Jan 2025 Walter, N., Szymski, D., Kurtz, S. M. et al. Epidemiology and treatment of proximal femoral fractures in the elderly US population. Sci Rep 13, 12734 (2023). https://doi.org/10.1038/s41598-023-40087-8. Accessed on 08 Jan 2025 BRAUER, Carmen A.. Incidence and Mortality of Hip Fractures in the United States. Jama, [SL], v. 302, no. 14, p. 1573, 14 Oct. 2009. American Medical Association (AMA). http://dx.doi.org/10.1001/jama.2009.1462. Available at: https://jamanetwork.com/journals/jama/fullarticle/184708#google_vignette. Accessed on: 07 Jan. 2025. Harrison's Internal Medicine - 2 Volumes - 19th Ed. 2017. AMGH Editora PINHEIRO, Marcelo M; CICONELLI, Rozana M; JACQUES, Natielen de O; GENARO, Patrícia s; A MARTINI, Lígia; FERRAZ, Marcos B. The impact of osteoporosis in Brazil: regional data on fractures in adult men and women - the brazilian osteoporosis study (brazos). Revista Brasileira de Reumatologia, [SL], v. 50, n. 2, p. 113-120, Apr. 2010. Springer Science and Business Media LLC. http://dx.doi.org/10.1590/s0482-50042010000200002. Available at: https://www.scielo.br/j/rbr/a/XLbB8vtvF4P5nwZWpPGTbsL/. Accessed on: Dec. 1, 2024. WALKER, Marcella Donovan; SHANE, Elizabeth. Postmenopausal Osteoporosis. New England Journal Of Medicine, [SL], v. 389, n. 21, p. 1979-1991, 23 Nov. 2023. Massachusetts Medical Society. http://dx.doi.org/10.1056/nejmcp2307353. Available at: https://www.nejm.org/doi/10.1056/NEJMcp2307353. Accessed on: 08 Dec. 2024. IBGE – BRAZILIAN INSTITUTE OF GEOGRAPHY AND STATISTICS. Brazilian Census of 2. Rio de Janeiro: IBGE, 2022. https://sidra.ibge.gov.br/tabela/9514#resultado SOARES, Danilo Simoni; MELLO, Luane Marques de; SILVA, Anderson Soares da; MARTINEZ, Edson Zangiacomi; NUNES, Altacílio Aparecido. Femur fractures in the elderly in Brazil: space-time analysis from 2008 to 2012. Public Health Notebooks, [SL], v. 30, n. 12, p. 2669-2678, Dec. 2014. FapUNIFESP (SciELO). http://dx.doi.org/10.1590/0102-311x00218113. WALKER, Marcella Donovan; SHANE, Elizabeth. Postmenopausal Osteoporosis. New England Journal Of Medicine, [SL], v. 389, n. 21, p. 1979-1991, 23 Nov. 2023. Massachusetts Medical Society. http://dx.doi.org/10.1056/nejmcp2307353. Available at: https://www.nejm.org/doi/10.1056/NEJMcp2307353. Accessed on: 15 Jan. 2025. RICCI, Guilherme; LONGARAY, Maurício Portal; GONÇALVES, Ramiro Zilles; UNGARETTI NETO, Ary da Silva; MANENTE, Marislei; BARBOSA, Luíza Barbosa Horta. Evaluation of one-year mortality rate after hip fracture and factors related to decreased survival in the elderly. Brazilian Journal of Orthopedics, [SL], v. 47, n. 3, p. 304-309, 2012. Georg Thieme Verlag KG. http://dx.doi.org/10.1590/s0102-36162012000300005. Available at: https://www.scielo.br/j/rbort/a/T6YNzccs8db9vz7rkTNzP4L/. Accessed on: January 9, 2025. Panula, J., Pihlajamäki, H., Mattila, V. M. et al. Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study. BMC Musculoskelet Disord 12, 105 (2011). https://doi.org/10.1186/1471-2474-12-105. Accessed on Jan 9, 2025 Bergh C, Möller M, Ekelund J, Brisby H. Mortality after Sustaining Skeletal Fractures in Relation to Age. J Clin Med. 2022 Apr 21;11(9):2313. doi: 10.3390/jcm11092313. PMID: 35566441; PMCID: PMC9103346. Accessed on Jan 9, 2025 KANIS, JA; ODÉN, A.; MCCLOSKEY, EV; JOHANSSON, H.; WAHL, DA; COOPER, C.. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International, [SL], v. 23, no. 9, p. 2239-2256, 15 March. 2012. Springer Science and Business Media LLC. http://dx.doi.org/10.1007/s00198-012-1964-3. Available at: https://link.springer.com/article/10.1007/s00198-012-1964-3. Accessed on: 07 Jan. 2025 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7274668","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507614582,"identity":"49975373-d685-4e7b-b1fb-7c94cb487e2a","order_by":0,"name":"VICTOR COELHO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDACZhiDnQdIsDHI8YM4CQV4tTA2QBgQLcaSIG6CAV57ULUkbjgA4uHRYnCc+fmDj3vs5PiZeQ8+YCjbxrj5/OrEDw8MGOT5xQ5g13KYzbBxxrNkY8lmvmQDhnO3mc1uvN0sAXSY4czZCVi1SDbzMDbzHDiQuOEwj5kEY9ttNrMbZzeAtCQY3CagZT9UC4/xjLObf+DTws8Ms4UZokXCgL93G15b+JnZDGfOOJBsLHGYx9gg4dxtA4kbvNssEgwkcPqFjf/wgw8fDgBDrL3H8MGHstv1/f1nN9/8UWEjzy+NXQsqAKuRgJBEKEe49QApqkfBKBgFo2AEAADbcVrn8Y6zJgAAAABJRU5ErkJggg==","orcid":"","institution":"Fundação Hospitalar do Estado de Minas Gerais","correspondingAuthor":true,"prefix":"","firstName":"VICTOR","middleName":"","lastName":"COELHO","suffix":""},{"id":507614583,"identity":"9d3369d2-42ba-4ade-8dad-478c462519c9","order_by":1,"name":"Gabriela Garces","email":"","orcid":"","institution":"Fundação Hospitalar do Estado de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"Gabriela","middleName":"","lastName":"Garces","suffix":""},{"id":507614584,"identity":"fccd4c85-84e8-4ccc-9d09-29b8d1d0bc6a","order_by":2,"name":"Henrique Mitsui","email":"","orcid":"","institution":"Universidade Federal de Juiz de Fora","correspondingAuthor":false,"prefix":"","firstName":"Henrique","middleName":"","lastName":"Mitsui","suffix":""},{"id":507614585,"identity":"ca66e8cd-70ad-42db-817d-7868654bf5e7","order_by":3,"name":"Vitor Henrique Oliveira","email":"","orcid":"","institution":"Fundação Hospitalar do Estado de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"Vitor","middleName":"Henrique","lastName":"Oliveira","suffix":""}],"badges":[],"createdAt":"2025-08-02 00:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7274668/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7274668/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90485948,"identity":"db9d11fe-dccd-4a27-ab2d-a1656089d9dc","added_by":"auto","created_at":"2025-09-03 08:51:47","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148121,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of femur fractures by sex and age group\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7274668/v1/51f2041047dca58894958492.jpeg"},{"id":90484934,"identity":"7426b8a8-5647-4d46-8817-6ac44cb28df6","added_by":"auto","created_at":"2025-09-03 08:43:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82322,"visible":true,"origin":"","legend":"\u003cp\u003eMortality rate according to age and sex.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7274668/v1/d428e7d38dd2b8675e9ba8ce.png"},{"id":96919737,"identity":"ab8b58c4-c002-43fa-ba16-8be9dca80abb","added_by":"auto","created_at":"2025-11-27 14:14:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":730431,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7274668/v1/0d3966f2-ccad-4f0a-82c6-c55540f92c46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIncidence and Mortality of Proximal Femur Fractures in a City in the Southeast Region in Brazil\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eProximal femoral fractures, which include femoral neck, trans trochanteric and peri trochanteric fractures, are undoubtedly the worst complication of osteoporosis. This disease often presents as the first and only symptom of a fragility fracture. This type of fracture is associated with a high mortality rate; studies indicate that up to 20% of patients die within the first year after the fracture, and almost 50% of patients lose some degree of their previous functional capacity\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,15\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is known that osteoporosis and fragility fractures affect women more than men due to factors such as menopausal hypoestrogenism. However, they can affect anyone, regardless of age or sex, who has risk factors such as corticosteroid use, rheumatoid arthritis, low weight, and smoking\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eStudies show that the incidence of femur fractures varies greatly depending on the country or population under study. In Brazil, the BRAVOS study, with data from 2012, showed an incidence of hip fractures in people older than 50 years of age of 103.3/100,000 inhabitants. American and European studies have already shown a much greater incidence of this disease, reaching more than 500 femur fractures/100,000 inhabitants/year. As the population ages, there is an increase in the number of patients with osteoporosis and a consequent increase in hip fractures. On the other hand, countries such as the United States have noticed a reduction in the incidence of femur fractures in recent years, which is probably associated with improvements in the screening and treatment of osteoporosis\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eGiven the demographic changes and the high severity of femur fractures, continuous analysis of the epidemiology of these injuries and their outcomes is essential. The availability of multiple therapeutic strategies, including pharmacological and nonpharmacological approaches, highlights the need for systematic monitoring to support the formulation of preventive public policies and assess the quality of health services offered to the population.\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eOBJECTIVE\u003c/b\u003e:\u003c/div\u003e\u003cp\u003eTo determine the incidence of proximal femur fractures in people older than 50 years of age in the Barbacena region and to analyze subgroups by sex and age groups. In addition, we defined mortality during hospitalization.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis study was conducted in the city of Barbacena, located in the state of Minas Gerais in the southeastern region, which has a population of 125,317 inhabitants. Barbacena is a reference for high-complexity health care for 14 other municipalities in the region, totaling 222,233 inhabitants. The population of interest for the study included approximately 75,357 people aged more than 50 years (33.9% of the total population\u003csup\u003e)8\u003c/sup\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePopulations of cities in the microregion of Barbacena, MG.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInhabitants\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlfredo Vasconcelos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.931\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlto Rio Doce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10,891\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnt\u0026ocirc;nio Carlos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarbacena\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125,317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCapela Nova\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.362\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaranda\u0026iacute;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23,812\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCipot\u0026acirc;nea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDesterro do Melo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,994\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIbertioga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.198\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaiva\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRessaquinha\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSanta B\u0026aacute;rbara do Tug\u0026uacute;rio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSanta Rita do Ibitipoca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSantana do Garamb\u0026eacute;u\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSra dos Rem\u0026eacute;dios\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.384\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e222.233\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis study was developed at Hospital Regional of Barbacena Dr. Jos\u0026eacute; Am\u0026eacute;rico, a highly complex hospital in the FHEMIG network, Funda\u0026ccedil;\u0026atilde;o Hospitalar do Estado de Minas Gerais, a level 2 hospital; a reference in the region for multiple traumas, strokes, and major burns; and orthopedic, general surgery, plastic surgery, neurosurgery, and vascular surgery services. The hospital has an emergency room that is a reference for prehospital care, in addition to meeting the spontaneous demand of the population. There were 135 beds, 45 of which were in the emergency room, 20 in the ICU, 70 in the ward, 34 in the surgical clinic, 25 in the medical clinic, and 11 in the stroke unit. It is the only hospital in the region with an orthopedic service in the Unified Health System.\u003c/p\u003e\u003cp\u003eThis was a retrospective, observational, analytical and descriptive study. Information was collected from the PENTAHO database and included information from all patients admitted to the hospital between July 2021 and June 2024 with proximal femur fractures (ICD discriminators S72, S72.1 and S72.2) older than 50 years. Patients who were living in cities that were not part of the Barbacena microregion or who were not of registered age were excluded. Duplicate records, such as readmission records, were also excluded. To assess patient outcomes, discharge or death, patients who were transferred to other services were excluded.\u003c/p\u003e\u003cp\u003eThe data are presented in tables containing the patient's name, sex, age, date of hospitalization, date of discharge or death or transfer, municipality of residence and ICD. Information was collected from the IBGE website - Census 2022 with the creation of a table with the population of each municipality, sex and age group.\u003c/p\u003e\u003cp\u003eStatistical analyses were performed using the statistical software R. Initially, a descriptive analysis of the sample was performed, followed by an inferential analysis using Fisher's exact test. In cases where the variable in question had many categories, the chi-square test was applied.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the 36 months of evaluation, 245 cases of proximal femur fractures were recorded and included in the study, corresponding to an annual incidence of 108.4 fractures/100,000 inhabitants (95% CI: 95.6-122.9), with small variations throughout the period evaluated. In the first 12-month period (July 21 to June 22), the lowest incidence was 103.5 (95% CI: 81.8\u0026ndash;129.1), or 78 or 31%. In the second period (July 22 to June 23), the highest incidence was 112.8 (95% CI: 90.1-139.4), 85 of which represented 34.7%. In the third period, the incidence was 108.8 (95% CI 95.7-122.9), with 82 cases (33.5% of the total). There was no significant difference between the years analyzed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNumber of cases and incidence over the period analyzed.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003eof cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRange of\u003c/p\u003e\u003cp\u003econfidence 95%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJul 2021 - Jun 2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (31.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.8\u0026ndash;129.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJul 2022 - Jun 2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (34.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.1\u0026ndash;139.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJul 2023 - Jun 2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (33.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86.5\u0026ndash;135.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95.7\u0026ndash;122.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong the 245 patients with femur fractures, 165 were women (67.3%), and 80 were men (32.7%), corresponding to a mean incidence of 133.9 fractures/100,000 inhabitants/year (95% CI: 114.9\u0026ndash;155.9) among women and 79.0 fractures/100,000 inhabitants/year (95% CI: 63.5\u0026ndash;98.4) among men. The M:W ratio was 1:2.1.\u003c/p\u003e\u003cp\u003eRegarding the distribution of fractures by age, the mean age was 76 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7), with 73 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5) among men and 77 years (SD +- 11.1) among women. The number of fractures exponentially increased with increasing age. There was a greater incidence of age \u0026times; sex distribution among women in all age groups, except for the age group between 50 and 59 years, where the incidence was slightly greater among men (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of patients with proximal femur fractures by sex and age group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;79 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e231.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80\u0026ndash;89 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e344.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e553.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e280.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90\u0026ndash;99 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e647.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e983.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e872.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;100 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e491.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7856.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo assess mortality during hospitalization, patients who were transferred to other services were excluded, 17 patients (6.9%); leaving 228 patients in the analysis. Of the remaining 228 patients, 193 were discharged (84.6%), and 35 died (15.4%). There was a considerable difference in the death rates between men and women, with 23.3% (17 patients) among men and 11.6% (18 patients) among women. This difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.03). The overall death rate was 15.4%.\u003c/p\u003e\u003cp\u003eMortality analysis revealed a mean age of 82 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8) among patients who died, 86 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7) among women and 77 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4) among men. The mortality rate increased with age, reaching 25.8% in patients aged 80 to 89 years (p\u0026thinsp;=\u0026thinsp;0.034) and 33.3% in men aged 80 to 89 years. There were no deaths among women under 70 years of age. Mortality was greater among men in all age groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study revealed an incidence of 108.3 fractures/100,000 inhabitants, with little variation during the 3 years of evaluation. An analysis of the literature revealed that the incidence of this disease varies greatly according to the region, population or country studied. There was a variation greater than 10 times in the risk of hip fracture and in the probability of fracture between countries. European countries have incidences above 300 fractures/100,000 inhabitants/year. However, Brazilian studies, such as BRAVOS, which has a methodology similar to that of this study, have shown similar incidences \u0026minus;\u0026thinsp;103 fractures/100,000 inhabitants - for the Brazilian population. However, there are some regional differences, with the incidence being greater in metropolitan regions and the southeastern region and lower in the northern region\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe population of this study is located in the southeastern region; approximately half of the population lives in a city with more than 100,000 inhabitants, and the other half lives in small cities with an average population of approximately 7,000 inhabitants, totaling approximately 220,000 inhabitants. In Brazil, 44.8% of the municipalities have fewer than 10,000 inhabitants, and 99% of the cities have fewer than 500,000 inhabitants. Almost 70% of the Brazilian population lives in these cities. Given this demographic distribution, the findings of this study are likely to apply to the majority of the Brazilian population\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe difference in incidence between men and women, with women being more prevalent, is consistent with the findings of Brazilian and international literature, with a slightly greater incidence in this study (M: W\u0026thinsp;=\u0026thinsp;1:2.1) than in previous Brazilian data (M: W: 1:1.67). This may indicate an increase in fractures in women compared to men in Brazil. These data are in line with the findings of studies conducted at the turn of the century in the U.S. and Europe, which showed an M: W ratio of 1:2, like the findings of this study \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe variation in the incidence of fractures with aging is also striking. It is worth remembering that, in general, the average incidence of fractures above the age of 50 years, without distinction between the sexes, is 108.3 fractures/100 thousand inhabitants/year; this number drops to 27.5 in the age group between 50 and 59 years, and from that point on, it doubles every 10 years. The age group between 70 and 79 years is noteworthy, where the incidence almost tripled in relation to that of the previous 10 years (from 64.7 to 188.2).\u003c/p\u003e\u003cp\u003eThis growth curve behaves differently for men and women over time. Fractures begin more often in men than in women between the ages of 50 and 59 years, with an average incidence of 20.4 among women and 39.4 among men. There is a sudden acceleration in fractures among women, tripling every 10 years (incidence of 20.4; 77.9; 231.6) until the age of 90, while among men, there is a less intense increase in the initial decades (39.4; 59.0; 135.1; 280.9), tripling only after the age of 90, with an incidence of 872.1, between the ages of 90 and 99.\u003c/p\u003e\u003cp\u003eThese differences can be explained by several factors. The higher incidence among women is already well defined due to the effects of menopause and hypoestrogenism. There is also a lower peak bone mass in women. The paradoxical finding between the ages of 50 and 59 years, with a higher incidence among men, may be due to traumatic fractures, which affect more men than women. Studies with populations under 50 years of age indicate a higher incidence of proximal femur fractures among men\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough the incidence of fractures increases with age, the highest number of cases occurred in the age group between 70 and 79 years, followed by the age group between 80 and 89 years; that is, 58% of the fractures (145 cases) were concentrated in those aged between 70 and 89 years.\u003c/p\u003e\u003cp\u003eThe mortality rate was significantly lower in females (11.6%) than in males (23.3%) (p\u0026thinsp;=\u0026thinsp;0.03). There was also an increase in mortality with increasing age up to 90 years. The age group with the highest number of deaths was between 80 and 89 years, accounting for almost half of the deaths (17 deaths) (48%). This age group had a mortality rate of 25.8%. The 90- to 99-year-old age group also had a high mortality rate, reaching 24%, but with fewer cases and 6 deaths in total.\u003c/p\u003e\u003cp\u003eThis study did not seek to determine the reasons for the difference in mortality between the sexes since this was not the main objective of the study. An in-depth analysis of the subject is necessary. The literature contains several possible causes for this difference, including pre fracture comorbidities, the type of fracture, the greater vulnerability of men at the time of the fracture, and a greater risk of infection and sepsis among men. The higher mortality in older patients is also well documented \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe incidence of proximal femur fractures found in this study was 108.4 fractures/100,000 inhabitants/year for the population of the Barbacena region older than 50 years. This incidence is slightly greater than that found in the Brazilian literature. The incidence of proximal femur fractures among women was much greater than that among men, reaching a ratio of 1:2.1. The incidence of fractures increases with age, but 60% of fractures occur in the population between 70 and 89 years of age. Notably, mortality increases with age and is greater among men in all age groups, with the mortality rate reaching 33% in men between 80 and 89 years of age.\u003c/p\u003e\u003cp\u003eThis work seeks to guide public policies within the scope of primary and secondary prevention, in addition to disseminating and improving access to treatment and prevention of falls, especially for the most affected groups (women between 70 and 90 years old). Furthermore, it seeks to direct the work of the referral hospital, especially in the most vulnerable population with greater chances of complications and deaths (men older than 80 years).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eHospital Regional de Barbacena Dr. Jos\u0026eacute; Am\u0026eacute;rico - Funda\u0026ccedil;\u0026atilde;o Hospitalar do Estado de Minas Gerais (FHEMIG)\u003c/strong\u003e, Avenida 14 de Agosto, Bairro Floresta, Barbacena, Minas Gerais CEP: 36202-850, Brasil.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFaculdade de Medicina - Universidade Federal de Juiz de Fora\u003c/strong\u003e,\u0026nbsp;Av.\u0026nbsp;Eug\u0026ecirc;nio do Nascimento, s/n\u0026deg; - Dom Bosco, Juiz de Fora, Minas Gerais, CEP: 36038-330, Brasil.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the author\u0026rsquo;s own resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they agree with the publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was submitted to and approved by the Ethics Committee of Research at the Funda\u0026ccedil;\u0026atilde;o Hospitalar do Estado de Minas Gerais, under the number (7.331.868) in January 2025, in accordance with the guidelines and regulatory standards for research involving human beings in Brazil (CNS Resolution no. 466/2012, CNS Resolution no. 510/2016 and complementary), under the conclusion of the National Research Ethics Commission. The research also observes the international ethical principles contained in the Declaration of Helsinki (World Medical Association, 1964, and subsequent revisions), the Belmont Report (1979), the CIOMS International Guidelines (2016), as well as the UNESCO Universal Declaration on Bioethics and Human Rights (2005). In the Latin American context, it also respects the references of the Declaration of Managua (1981) and other relevant regional ethical documents.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors, VC, GG, VHO and HM, participated in data collection, statistical analysis, writing the text and reviewing it.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaghdadi, S., Kiyani, M., Kalantar, SH et al. Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors. BMC Musculoskelet Disord 24, 693 (2023).https://doi.org/10.1186/s12891-023-06825-9. Accessed on January 11, 2025.\u003c/li\u003e\n\u003cli\u003eAlbergaria, BH., Zerbini, CAF, Szejnfeld, VL et al. An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS). Arch Osteoporos 17, 90 (2022). https://doi.org/10.1007/s11657-022-01127-4. Accessed on 07 Jan 2025\u003c/li\u003e\n\u003cli\u003eWalter, N., Szymski, D., Kurtz, S. M. et al. Epidemiology and treatment of proximal femoral fractures in the elderly US population. Sci Rep 13, 12734 (2023). https://doi.org/10.1038/s41598-023-40087-8. Accessed on 08 Jan 2025\u003c/li\u003e\n\u003cli\u003eBRAUER, Carmen A.. Incidence and Mortality of Hip Fractures in the United States. Jama, [SL], v. 302, no. 14, p. 1573, 14 Oct. 2009. American Medical Association (AMA). http://dx.doi.org/10.1001/jama.2009.1462. Available at: https://jamanetwork.com/journals/jama/fullarticle/184708#google_vignette. Accessed on: 07 Jan. 2025.\u003c/li\u003e\n\u003cli\u003eHarrison\u0026apos;s Internal Medicine - 2 Volumes - 19th Ed. 2017. AMGH Editora\u003c/li\u003e\n\u003cli\u003ePINHEIRO, Marcelo M; CICONELLI, Rozana M; JACQUES, Natielen de O; GENARO, Patr\u0026iacute;cia s; A MARTINI, L\u0026iacute;gia; FERRAZ, Marcos B. The impact of osteoporosis in Brazil: regional data on fractures in adult men and women - the brazilian osteoporosis study (brazos). Revista Brasileira de Reumatologia, [SL], v. 50, n. 2, p. 113-120, Apr. 2010. Springer Science and Business Media LLC. http://dx.doi.org/10.1590/s0482-50042010000200002. Available at: https://www.scielo.br/j/rbr/a/XLbB8vtvF4P5nwZWpPGTbsL/. Accessed on: Dec. 1, 2024.\u003c/li\u003e\n\u003cli\u003eWALKER, Marcella Donovan; SHANE, Elizabeth. Postmenopausal Osteoporosis. New England Journal Of Medicine, [SL], v. 389, n. 21, p. 1979-1991, 23 Nov. 2023. Massachusetts Medical Society. http://dx.doi.org/10.1056/nejmcp2307353. Available at: https://www.nejm.org/doi/10.1056/NEJMcp2307353. Accessed on: 08 Dec. 2024.\u003c/li\u003e\n\u003cli\u003eIBGE \u0026ndash; BRAZILIAN INSTITUTE OF GEOGRAPHY AND STATISTICS. Brazilian Census of 2. Rio de Janeiro: IBGE, 2022. https://sidra.ibge.gov.br/tabela/9514#resultado\u003c/li\u003e\n\u003cli\u003eSOARES, Danilo Simoni; MELLO, Luane Marques de; SILVA, Anderson Soares da; MARTINEZ, Edson Zangiacomi; NUNES, Altac\u0026iacute;lio Aparecido. Femur fractures in the elderly in Brazil: space-time analysis from 2008 to 2012. Public Health Notebooks, [SL], v. 30, n. 12, p. 2669-2678, Dec. 2014. FapUNIFESP (SciELO). http://dx.doi.org/10.1590/0102-311x00218113.\u003c/li\u003e\n\u003cli\u003eWALKER, Marcella Donovan; SHANE, Elizabeth. Postmenopausal Osteoporosis. New England Journal Of Medicine, [SL], v. 389, n. 21, p. 1979-1991, 23 Nov. 2023. Massachusetts Medical Society. http://dx.doi.org/10.1056/nejmcp2307353. Available at: https://www.nejm.org/doi/10.1056/NEJMcp2307353. Accessed on: 15 Jan. 2025.\u003c/li\u003e\n\u003cli\u003eRICCI, Guilherme; LONGARAY, Maur\u0026iacute;cio Portal; GON\u0026Ccedil;ALVES, Ramiro Zilles; UNGARETTI NETO, Ary da Silva; MANENTE, Marislei; BARBOSA, Lu\u0026iacute;za Barbosa Horta. Evaluation of one-year mortality rate after hip fracture and factors related to decreased survival in the elderly. Brazilian Journal of Orthopedics, [SL], v. 47, n. 3, p. 304-309, 2012. Georg Thieme Verlag KG. http://dx.doi.org/10.1590/s0102-36162012000300005. Available at: https://www.scielo.br/j/rbort/a/T6YNzccs8db9vz7rkTNzP4L/. Accessed on: January 9, 2025.\u003c/li\u003e\n\u003cli\u003ePanula, J., Pihlajam\u0026auml;ki, H., Mattila, V. M. et al. Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study. BMC Musculoskelet Disord 12, 105 (2011). https://doi.org/10.1186/1471-2474-12-105. Accessed on Jan 9, 2025\u003c/li\u003e\n\u003cli\u003eBergh C, M\u0026ouml;ller M, Ekelund J, Brisby H. Mortality after Sustaining Skeletal Fractures in Relation to Age. J Clin Med. 2022 Apr 21;11(9):2313. doi: 10.3390/jcm11092313. PMID: 35566441; PMCID: PMC9103346. Accessed on Jan 9, 2025\u003c/li\u003e\n\u003cli\u003eKANIS, JA; OD\u0026Eacute;N, A.; MCCLOSKEY, EV; JOHANSSON, H.; WAHL, DA; COOPER, C.. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International, [SL], v. 23, no. 9, p. 2239-2256, 15 March. 2012. Springer Science and Business Media LLC. http://dx.doi.org/10.1007/s00198-012-1964-3. Available at: https://link.springer.com/article/10.1007/s00198-012-1964-3. Accessed on: 07 Jan. 2025\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7274668/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7274668/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eProximal femoral fractures are undoubtedly the worst complication of osteoporosis. This disease often presents as the first and only symptom of a fragility fracture. This type of fracture is associated with a high mortality rate; studies indicate that up to 20% of patients die within the first year after the fracture, and almost 50% of patients lose some degree of their previous functional capacity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To determine the incidence of proximal femur fractures in people older than 50 years of age in the Barbacena region and to analyze subgroups by sex and age groups. In addition, we defined mortality during hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis was a retrospective, observational, analytical and descriptive studyand included information from all patients admitted to the hospital between July 2021 and June 2024, with proximal femur fractures. This study was conducted in the city of Barbacena, located in the state of Minas Gerais, in the Southeast region. This hospital in Barbacena is the only reference for high complexity health care in the region, totaling 222,233 inhabitants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eDuring the 36 months of evaluation, 245 cases of proximal femur fractures were recorded and included in the study, corresponding to an annual incidence of 108.4 fractures/100,000 inhabitants (95% CI: 95.6-122.9); 165 were women (67.3%), and 80 were men (32.7%), corresponding to a mean incidence of 133.9 fractures/100,000 inhabitants/year (95% CI: 114.9–155.9) among women and 79.0 fractures/100,000 inhabitants/year (95% CI: 63.5–98.4) among men. The overall death rate was 15.4% (35 patients), with 23.3% among men and 11.6% among women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe incidence of proximal femur fractures was 108.4 fractures/100,000 inhabitants/year. This incidence is slightly greater than that found in the Brazilian literature. The incidence among women was much greater than that among men, reaching a ratio of 1:2.1. The incidence of fractures increases with age, but 60% of fractures occur in the population between 70 and 89 years of age. Notably, mortality increases with age and is greater among men in all age groups, with the mortality rate reaching 33% in men between 80 and 89 years of age.\u003c/p\u003e","manuscriptTitle":"Incidence and Mortality of Proximal Femur Fractures in a City in the Southeast Region in Brazil","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 08:43:43","doi":"10.21203/rs.3.rs-7274668/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7096df9-431f-4d5d-9f11-db10ff43c197","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T22:53:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 08:43:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7274668","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7274668","identity":"rs-7274668","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}