Milka Maravic

Epidemiology of osteoporosis-related fractures in France: a literature review.

OBJECTIVES To evaluate the health implications and economic burden on society of osteoporotic fractures as a major source of morbidity and mortality in the ageing population. METHODS We have summarised the findings of a literature review of French studies published between 1960 and 2009, characterised the epidemiology of osteoporosis and osteoporotic fractures, and predicted future trends. RESULTS Published data for France supported the observation that osteoporosis is under-diagnosed in many countries. The incidence of fracture increased exponentially with age, alongside a concurrent decrease in bone mineral density, a risk factor for fracture. Combined with a projected rise in the French elderly population, this poses a significant burden for the future. The incidence of fracture was high in the osteopenic population; consequently, fragility fractures may be underestimated if reports focus on osteoporotic women only. As in many other countries, French data revealed that women have a higher incidence of osteoporotic fractures than men, although mortality from hip fracture was higher in men. DISCUSSION Due to ageing of the population, an increase in the number of people suffering from fractures is predicted over the next few decades unless preventative action is taken, highlighting the need for improved diagnosis and screening in postmenopausal women.

Changes in number and incidence of hip fractures over 12 years in France

The incidence of hip fractures decreased in France in both genders, especially in the elderly, from 2002 to 2008, in parallel with availability of bone densitometry and effective anti-osteoporotic treatments. However prescriptions of these treatments are decreasing, since 2008, and recent studies show declining of osteoporosis management after fragility fractures. The aim of this study was to assess the incidence of hip fractures in men and women aged 60 years and over, from 2002 to 2013 in France. Data were drawn from the French Hospital National Database which includes all hospitalizations of the country. Hospital data for hip fractures between 2002 and 2013 were numbered and the incidence rates per 1,000,000 adjusted on age (60-74; 74-84, and ≥ 85 years), and gender was calculated using the data of the French population. The number of hip fractures increased in women (+5%; from 49,287 in 2002 to 50,215) and in men (+22%, from 12,716 to 15,482) aged over 60 years. Between 2002 and 2013, the French population increased by 21 and 29% in women and men of this age group; thus, incidence of hip fractures decreased by 14% in women (6929 and 5987 per million in 2002 and 2013, respectively) and a slight decrease of -1% was observed in men (2344 and 2316). The decrease in incidence is also confirmed in the very elderly (≥ 85 years), with a decrease of -29% and -24% in women and men respectively. Over the last 12 years, the incidence of hip fractures decreased in France in women and men aged over 60 years. This decrease is also observed in the subjects (≥ 85 years and older in both genders). Further studies are needed to assess potential changes in risk factors of hip fractures during the last decade.

Decrease of inpatient mortality for hip fracture in France

OBJECTIVE Hip fracture is the most devastating osteoporotic fracture, increasing the risk of mortality. Recent data suggest a decrease in incidence of this fracture. Few data are available on potential changes in mortality. We studied the change of inpatient mortality from 2002 to 2008 in France. METHODS Data were extracted from the French Hospital National Database. The absolute number of inpatient mortality for hip fracture was described as well as the case fatal rate and mortality rate adjusted on age and gender. Risk factors of inpatient mortality were assessed by multiple regressions. RESULTS Inpatient mortality stay decreased from 3057 to 2350 in patients aged 40 years and over and in both gender. Inpatient mortality stays were more important in women and increased with age, but the case fatal rate was higher in men than in women (5.4 vs. 2.8% in 2008). During the study period, the mortality rate (per 1,000,000) varied from 132 to 88 and from 82 to 64 in women and men, respectively. In the older patients, case fatality and mortality rates decreased significantly during the study period. From 2008 data, age more or equal to 85 years, male gender, stay in intensive care and existence of some chronic or acute disease, especially cardiovascular disease, hepatic disease, renal insufficiency, and infection were significant determinants of inpatient mortality. CONCLUSION Inpatient mortality after hip fracture decreased in France between 2002 and 2008, although age, male gender and comorbidities were identified as determinants of inpatient mortality.

Biotherapy and rheumatoid arthritis: a medico-economic evaluation from 2008 French Hospital Database.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 3 aout 2011

Hospital burden of gout, pseudogout and other crystal arthropathies in France.

OBJECTIVE To describe the hospital burden of microcrystal arthropathies in France. METHODS Data were extracted from the 2009-2011 French hospital national databases. We selected all hospital stays for microcrystal arthropathies (gout, chondrocalcinosis, other) encoded as primary or secondary diagnoses in patients older than 18. A descriptive analysis focused on number of patients and hospital stays, age, gender, comorbidities related to metabolic syndrome, and hospital costs based on 2012 public-sector costs. RESULTS 132,275 hospitalizations involving 109,734 patients were related to microcrystal arthropathies encoded as primary or secondary diagnosis (61% related to gout, 34% to chondrocalcinosis, and 5% to other microcrystal arthropathies). 23,362 hospitalizations involving 25,105 patients were due to microcrystal diseases, encoded as primary diagnosis, (48% related to gout, 43% to chondrocalcinosis, and 9% to other microcrystal arthropathies). In this population, patients with chondrocalcinosis were older (mean 75.6±13.5 versus 71±16 years for other microcrystal arthropathies and 69.7±14.7 for gout). Men represented 70% of the patients with gout, 39% of those with chondrocalcinosis and 52% of the patients with other microcrystal arthropathies. Hypertension, diabetes, dyslipidemia, cardiac ischemia, and renal failure were more frequent in patients with gout than other patients. The hospital costs for microcrystal arthropathies encoded as primary diagnosis were 82.3 million Euros, 45% related to gout, 45% to chondrocalcinosis and 11% to other microcrystals. CONCLUSION In terms of hospital costs, gout and chondrocalcinosis represented the main part of the economic burden of crystal arthropathies and a high level of diseases belonging to the metabolic syndrome. Specific education programs favouring accurate microcrystal diagnosis and adherence to treatment could diminish this hospital economic burden.

Qu’en est-il de l’évaluation pragmatique dans la polyarthrite rhumatoïde ?

Resume L’objectif de notre travail est de faire un etat des lieux sur l’evaluation pragmatique dans la polyarthrite rhumatoide. Nous avons fait une analyse critique de litterature apres realisation d’une recherche documentaire sur PubMed de janvier 1990 a mai 2001, a partir de mots-cles (rheumatoid arthritis, clinical practice, physician’s practice patterns, health service research). Nous avons observe une grande variabilite dans la prise en charge de la polyarthrite rhumatoide qu’il s’agisse de la prescription des examens complementaires au debut, de la prise en charge therapeutique initiale, de l’evolution de l’etat clinique du patient en fonction du nombre de consultations, de la prescription et de la surveillance des traitements de fond, de l’utilisation des criteres de suivi, des resultats cliniques en fonction de la couverture sociale, de la pratique face a un cas simule. Il existait egalement une variabilite dans la methodologie utilisee qui reposait soit sur des enquetes, soit sur l’analyse de donnees prospectives. Cette revue de la litterature souligne la necessite d’elaborer des recommandations dans la prise en charge de la polyarthrite rhumatoide.