{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:43:45Z","timestamp":1789508625282,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The increase in life expectancy and the share of the elderly population has the effect of increasing the number of osteoporotic hip fractures. At the same time, the number of total hip arthroplasty (THA) interventions is continuously increasing. The objective of this study is to investigate the incidence rates of hip fractures during the period 2008\u20132019, in Romania, among people who are at least 40 years old, as well as to determine the extent to which the increase in the prevalence of people who have undergone THA has affected the incidence of hip fractures, given that the operated hip no longer presents a risk of fracture. Methods: We extracted the information, between 2008 and 2019, from nationwide retrospective studies about the incidence and time trend of hip fractures in Romania. Information on primary THA interventions during the period 2001\u20132019 was obtained from the Romanian Arthroplasty Register (RAR). We obtained the population size, by gender and age groups, from the reports of the National Institute of Statistics. For the period 2008\u20132019, we calculated the standardized annual hip fracture incidence rates by sex and by age. Given that each person has two hips at risk of fracture, we calculated hip fracture rates in a scenario without THA interventions. For this, we subtracted 0.5 people from the at-risk population for each prevalent hip prosthesis. Thus, we revealed the effects of decreasing fracture rates due to having hip prostheses. Results: From 2008 to 2019, age-standardized incidence rates of hip fractures increased by 10.8% in women, and by 2.8% in men. By excluding hips being replaced with prostheses in the at-risk population, we obtained higher hip fracture incidence rates. These recorded values were considerably higher for the elderly population. The variation in hip fracture rates during the observed period was 10.16% (9.76% in women and 11.68% in men) lower due to the increased prevalence of hip prostheses. Conclusions: Although the incidence of hip fractures has continued to rise, the growing number of people who have undergone THA and are living with hip prostheses has helped to blunt this increase.<\/jats:p>","DOI":"10.3390\/jcm14134636","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T13:06:17Z","timestamp":1751288777000},"page":"4636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The Impact of Total Hip Arthroplasty on the Incidence of Hip Fractures in Romania"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9643-584X","authenticated-orcid":false,"given":"Flaviu","family":"Moldovan","sequence":"first","affiliation":[{"name":"Orthopedics\u2014Traumatology Department, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0654-1911","authenticated-orcid":false,"given":"Liviu","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Xu, B.Y., Yan, S., Low, L.L., Vasanwala, F.F., and Low, S.G. (2019). Predictors of poor functional outcomes and mortality in patients with hip fracture: A systematic review. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2950-0"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s00590-016-1744-4","article-title":"Thirty-day mortality after hip fractures: Has anything changed?","volume":"26","author":"Giannoulis","year":"2016","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/jbmr.4821","article-title":"Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality","volume":"38","author":"Sing","year":"2023","journal-title":"J. Bone Miner. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1007\/s00198-012-1964-3","article-title":"A systematic review of hip fracture incidence and probability of fracture worldwide","volume":"23","author":"Kanis","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11657-020-0706-y","article-title":"Fragility fractures in Europe: Burden, management and opportunities","volume":"15","author":"Karlsson","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.injury.2018.04.015","article-title":"Epidemiology and social costs of hip fracture","volume":"49","author":"Veronese","year":"2018","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00198-023-06907-3","article-title":"Global burden of hip fracture: The Global Burden of Disease Study","volume":"35","author":"Feng","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.gerinurse.2024.10.030","article-title":"Risk factors for falls in older people with pre-frailty: A systematic review and meta-analysis","volume":"62 Pt A","author":"Jing","year":"2025","journal-title":"Geriatr. Nurs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1177\/1120700018757940","article-title":"Projections of hip arthroplasty in OECD countries up to 2050","volume":"28","author":"Pabinger","year":"2018","journal-title":"Hip Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10067-018-4270-4","article-title":"Osteoarthritis: A call for research on central pain mechanism and personalized prevention strategies","volume":"38","author":"Valdes","year":"2019","journal-title":"Clin. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/01.NAJ.0000412649.02926.35","article-title":"Rehabilitation interventions for pain and disability in osteoarthritis","volume":"112","author":"Iversen","year":"2012","journal-title":"Am. J. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.surge.2018.05.005","article-title":"Comparison of revision risks and complication rates between total HIP replacement and HIP resurfacing within the similar age group","volume":"16","author":"Eethakota","year":"2018","journal-title":"Surgeon"},{"key":"ref_13","unstructured":"Na\u021bional Institute of Statistics (2025, June 06). Serii Istorice de date. Populatia Romaniei 1860\u20132020 (Historical Data Series. Population of Romania 1860\u20132020). Available online: https:\/\/insse.ro\/cms\/files\/publicatii\/Populatia-Romaniei\/populatia-romaniei-1860-2020-serii-istorice-de-date.pdf."},{"key":"ref_14","unstructured":"Na\u021bional Institute of Statistics (2025, June 06). Tempo Ins. Available online: https:\/\/insse.ro\/cms\/ro\/content\/pachetul-tempo."},{"key":"ref_15","unstructured":"Eurostat Population Structure (2025, June 06). Age Groups. Available online: https:\/\/ec.europa.eu\/eurostat\/documents\/12743486\/14207636\/RO-RO.pdf."},{"key":"ref_16","unstructured":"(2025, June 06). Populatia Romaniei (Romania\u2019s Population). Available online: https:\/\/populatia.ro\/."},{"key":"ref_17","first-page":"505","article-title":"Incidence and time trend of hip fractures in Romania: A nationwide studyfrom 2008 TO 2018","volume":"15","author":"Grigorie","year":"2019","journal-title":"Acta Endocrinol."},{"key":"ref_18","first-page":"60","article-title":"Osteoporotic Hip Fracture Incidence Rates in the Main Urban Area of Romania","volume":"17","author":"Dobre","year":"2021","journal-title":"Acta Endocrinol."},{"key":"ref_19","first-page":"18","article-title":"Analiza episoadelor de spitalizare determinate de osteoporoz\u0103 \u00een Rom\u00e2nia \u00een perioada 2008-2020 (Analysis of hospitalization episodes due to osteoporosis in Romania in the period 2008\u20132020)","volume":"4","author":"Sacu","year":"2021","journal-title":"Health Manag."},{"key":"ref_20","unstructured":"(2025, June 06). Romanian Arthroplasty Register. Available online: https:\/\/www.rne.ro\/?lang=en."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1002\/jbmr.4660","article-title":"Impact of Total Hip Replacements on the Incidence of Hip Fractures in Norway During 1999\u20132019. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study","volume":"37","author":"Kjeldgaard","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/j.1524-4733.2009.00686.x","article-title":"The effect size in uncertainty analysis","volume":"13","author":"Barendregt","year":"2010","journal-title":"Value Health"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. (2025). A Modeling Study for Hip Fracture Rates in Romania. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093162"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1002\/jbmr.2218","article-title":"Secular trends in hip fractures worldwide: Opposing trends east versus west","volume":"29","author":"Ballane","year":"2014","journal-title":"J. Bone Miner. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.regg.2019.08.009","article-title":"Diabetes mellitus y riesgo de fractura de cadera. Revisi\u00f3n sistem\u00e1tica [Diabetes mellitus and risk of hip fracture. A systematic review]","volume":"55","author":"Formiga","year":"2020","journal-title":"Rev. Esp. Geriatr. Gerontol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00223-020-00688-1","article-title":"Medications as a Risk Factor for Fragility Hip Fractures: A Systematic Review and Meta-analysis","volume":"107","author":"Mortensen","year":"2020","journal-title":"Calcif. Tissue Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11657-021-00893-x","article-title":"Multivitamins and risk of fragility hip fracture: A systematic review and meta-analysis","volume":"16","author":"Beeram","year":"2021","journal-title":"Arch. Osteoporos."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s00774-021-01230-5","article-title":"Modifiable lifestyle factors associated with fragility hip fracture: A systematic review and meta-analysis","volume":"39","author":"Mortensen","year":"2021","journal-title":"J. Bone Miner. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1002\/acr.23197","article-title":"Lifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multina\u021bional Analysis Using Na\u021bional Registry Data","volume":"69","author":"Ackerman","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.promfg.2018.03.135","article-title":"New Approaches and Trends in Health Care","volume":"22","author":"Moldovan","year":"2018","journal-title":"Procedia Manuf."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Moldovan, F., Gligor, A., Moldovan, L., and Bataga, T. (2023). An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania. Medicina, 59.","DOI":"10.3390\/medicina59020314"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13075-023-03179-4","article-title":"Association of knee and hip osteoarthritis with the risk of falls and fractures: A systematic review and meta-analysis","volume":"25","author":"Zhang","year":"2023","journal-title":"Arthritis Res. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Johnsen, M.B., Hellevik, A.I., Sm\u00e5stuen, M.C., Langhammer, A., Furnes, O., Flugsrud, G.B., Nordsletten, L., Zwart, J.A., and Storheim, K. (2017). The mediating effect of body mass index on the relationship between smoking and hip or knee replacement due to primary osteoarthritis. A population-based cohort study (the HUNT Study). PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0190288"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/art.21659","article-title":"The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: A cohort study in 1.2 million persons","volume":"54","author":"Flugsrud","year":"2006","journal-title":"Arthritis Rheum."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Soh, S.E., Barker, A.L., Morello, R.T., and Ackerman, I.N. (2020). Applying the Interna\u021bional Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: Data from the Osteoarthritis Initiative. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-3160-5"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Moldovan, F., Moldovan, L., and Bataga, T. (2023). Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. Medicina, 59.","DOI":"10.3390\/medicina59040796"},{"key":"ref_37","unstructured":"Na\u021bional Institute of Statistics (2025, June 06). Proiectarea Popula\u0163iei Rom\u00e2niei \u00een Profil Teritorial, la Orizontul Anului 2060 (Projection of Romania\u2019s Population in Territorial Profile, on the Horizon of 2060). Available online: https:\/\/insse.ro\/cms\/sites\/default\/files\/field\/publicatii\/proiectarea_populatiei_romaniei_in_profil_teritorial_la_orizontul_2060.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1210\/jc.2019-00192","article-title":"Efficacy of Pharmacological Therapies for the Prevention of Fractures in Postmenopausal Women: A Network Meta-Analysis","volume":"104","author":"Barrionuevo","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.proeng.2017.02.503","article-title":"Computer Aided Learning Process","volume":"181","author":"Mikolajczyk","year":"2017","journal-title":"Procedia Eng."},{"key":"ref_40","first-page":"67","article-title":"Dynamic Numerical Simulation of the 6-PGK Parallel Robot Manipulator","volume":"20","author":"Moldovan","year":"2019","journal-title":"Proc. Rom. Acad. Ser. A"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/j.protcy.2016.01.157","article-title":"Brain Research Using Computer Test","volume":"22","author":"Mikolajczyk","year":"2016","journal-title":"Procedia Technol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:12Z","timestamp":1760032932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":41,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134636"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134636","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}