Analysis of Hip Fractures in France During the First COVID-19 Lockdown in Spring 2020
Authors: Julien Paccou, Xavier Lenne, Grégoire Ficheur, Didier Theis, Bernard Cortet, Amélie Bruandet
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. <h3>Objective</h3> To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. <h3>Design, Setting, and Participants</h3> This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. <h3>Exposures</h3> The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. <h3>Main Outcomes and Measures</h3> The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. <h3>Results</h3> The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91;<i>P</i> &lt; .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01;<i>P</i> = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92;<i>P</i> &lt; .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71;<i>P</i> &lt; .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79;<i>P</i> &lt; .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54;<i>P</i> &lt; .001) in private for-profit hospitals. <h3>Conclusions and Relevance</h3> In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.