Hip Fractures are a Burden on the Healthcare System, Finds Doctoral Study

Hip Fractures are a Burden on the Healthcare System, Finds Doctoral Study

Dr Sapna Shivani Dela, an honorary staff member in the School of Clinical Medicine graduated with a PhD in Medicine for her study on the Incidence of Hip Fractures (HF) and Development of Fracture Risk Assessment (FRAX®) Models for South Africa.

The study produced a remarkable five papers in peer-reviewed publications.

Dela said that the study was motivated by the lack of sufficient data on the incidence and burden of HF in the multi-ethnic population of South Africa and the fact that there are currently no country-specific FRAX® models to screen patients and assess fracture risk. ‘As the global population ages, the prevalence of osteoporosis (OP) is expected to increase exponentially over the next 50 years. Hip fractures, a dreaded clinical complication underlying OP, are associated with significant morbidity and mortality. This is attributable in large part to inadequate screening, and delays in and failure to initiate treatment in high-risk patients.’ 

The study was conducted at public and private hospitals in eight districts in KwaZulu-Natal, Gauteng and the Western Cape. The participants were patients aged 40 and older with consecutive low trauma HF admitted between 1 April 2017 and 31 March 2018. The median age of the 2 767 HF subjects was 75, with a female to male ratio of 2:1. The majority were White (40.9%), followed by African (26.4%), Coloured (18.7%) and Indian subjects (13.9%). 

In the four FRAX® models developed, 10-year fracture probabilities rose with age for all race groups, with the probabilities consistently higher among Indian than Coloured men and women, and in turn, higher than among Africans. For White subjects, the probabilities were lower than among Indians but higher than among Coloureds and Africans up to the age of 80. Thereafter, they increased for all race groups. 

Of the 1 996 subjects who completed the questionnaire, 67.5% were admitted to public hospitals. In 661 subjects (33%), admission was delayed for more than 24 hours following the HF. The time from HF to admission was significantly longer in public than in private hospitals. Furthermore, surgery was delayed by more than 48 hours in 69% of the cases and the delays were significantly longer in public than in private hospitals (130 versus 45.4 hours) in KwaZulu-Natal and when admission occurred after hours. 

Dela commented, ‘Projected incident rates were higher by the year 2040 and increased further by the year 2050. Estimates of the overall annual number of HF in South Africa increased from approximately 11 000 in 2020 to approximately 26 400 by 2050, placing a huge burden on the healthcare system. I would strongly advocate for a review of health policies and pathways to improve diagnosis and treatment of OP and improve access to care and outcomes after an HF.’ 

Dela grew up in Durban and enrolled to study medicine at the young age of 17. She is currently a specialist physician at Harry Gwala Regional Hospital in Pietermaritzburg. She said, ‘I am passionate about improving the quality of healthcare for the elderly. My interest is in the prevention of osteoporotic hip fractures and the formation of ortho-geriatric units at public hospitals to improve outcomes after a hip fracture. I hope to become a Geriatrician in the future and continue to serve in the public health sector, where the majority of older people seek treatment. 

‘My heartfelt gratitude goes to Professor Bilkish Cassim and Dr Farhanah Paruk for their steady guidance over the past six years, my fantastic family for their unwavering love and support and my colleagues at work, especially Dr Doug Wilson for encouraging me to finish the PhD. Lastly, I thank my partner for his love and faith in me – I could not have finished this degree without him. 

‘I also feel it’s important for healthcare workers to find time to do the activities we love. I look after feral cats at my hospital, having founded the Edendale Feral Cat Club with my friend Jeannie Marchese. We bring out a yearly Feral Cat Annual and host art sales to raise funds for cat food. I also love going on road trips with my partner and exploring South Africa – we have the most beautiful country in the world!’ said Dela. 

Words: MaryAnn Francis

Photograph: Sethu Dlamini