Nordic hip fracture registries: comparisons toward a minimal common and standardized Nordic Hip Fracture Dataset (Nordic-HFD)
DOI:
https://doi.org/10.2340/17453674.2026.46720Keywords:
FFN Global, hip, hip fracture, Minimal common dataset, registriesAbstract
Background and purpose: National hip fracture registries in Denmark, Norway, and Sweden collect extensive pre- and post-fracture data. Inspired by the Global Fragility Fracture Network (Global FFN) minimum common dataset, which is not specifically tailored to Nordic healthcare systems, we aimed to evaluate the feasibility of developing a standardized Nordic Hip Fracture Dataset (Nordic-HFD).
Methods: We compared 4 Nordic hip fracture registries: the Danish Multidisciplinary Hip Fracture Registry, the Norwegian Hip Fracture Register, the Swedish Fracture Register, and the Swedish Hip Fracture Register (RIKSHÖFT). Variables available in at least 3 registries, including those obtainable through linkage with national health registries, were assessed for definitions and grouped into demographic, surgical, postoperative, complications, and PROM domains.
Results: Across registries, 38 variables were identified. The number of variables available in all 4 registries was 11, while 31 were available in at least 3 registries. After quality review, 30 variables were ultimately considered suitable for inclusion in the proposed Nordic-HFD.
Demographic variables such as age, sex, fracture type, pathological fracture, laterality, ASA score, surgical variables such as surgical method, date of surgery, time to surgery, and mortality were directly comparable. Variables on mobility, cognitive impairment, complications, and PROMs may require further harmonization.
Conclusion: Establishing a Nordic-HFD is feasible using existing national registries’ infrastructures. The remaining challenge is harmonizing variable definitions to specific research questions and future validation studies. A Nordic-HFD would enhance robust cross-country benchmarking and support international initiatives such as the Global FFN.
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Tian C, Shi L, Wang J, Zhou J, Rui C, Yin Y, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr 2025; 133: 105832. doi: 10.1016/j.archger.2025.105832. DOI: https://doi.org/10.1016/j.archger.2025.105832
Johansen A, Golding D, Brent L, Close J, Gjertsen J E, Holt G, et al. Using national hip fracture registries and audit databases to develop an international perspective. Injury 2017; 48(10): 2174-9. doi: 10.1016/j.injury.2017.08.001. DOI: https://doi.org/10.1016/j.injury.2017.08.001
Johansen A, Ojeda-Thies C, Poacher A T, Hall A J, Brent L, Ahern E C, et al. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J 2022; 104-b(6): 721-8. doi: 10.1302/0301-620x.104b6.Bjj-2022-0080.R1. DOI: https://doi.org/10.1302/0301-620X.104B6.BJJ-2022-0080.R1
Kanis J A, Odén A, McCloskey E V, Johansson H, Wahl D A, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012; 23(9): 2239-56. doi: 10.1007/s00198-012-1964-3. DOI: https://doi.org/10.1007/s00198-012-1964-3
Sundkvist J, Möller M, Rogmark C, Wolf O, Mukka S. Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register. Acta Orthop 2022; 93:413-416. doi: 10.2340/17453674.2022.2460. DOI: https://doi.org/10.2340/17453674.2022.2460
Havelin L I, Fenstad A M, Salomonsson R, Mehnert F, Furnes O, Overgaard S, et al. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 2009; 80(4): 393-401. doi: 10.3109/17453670903039544. DOI: https://doi.org/10.3109/17453670903039544
Mäkelä K T, Furnes O, Hallan G, Fenstad A M, Rolfson O, Kärrholm J, et al. The benefits of collaboration: the Nordic Arthroplasty Register Association. EFORT Open Rev 2019; 4(6): 391-400. doi: 10.1302/2058-5241.4.180058. DOI: https://doi.org/10.1302/2058-5241.4.180058
Irmola T, Ponkilainen V, Mäkelä K T, Robertsson O, A W D, Furnes O, et al. Impact of Nordic Arthroplasty Register Association (NARA) collaboration on demographics, methods and revision rates in knee arthroplasty: a register-based study from NARA 2000–2017. Acta Orthop 2022; 93: 866-73. doi: 10.2340/17453674.2022.5256. DOI: https://doi.org/10.2340/17453674.2022.5256
Laugesen K, Ludvigsson J F, Schmidt M, Gissler M, Valdimarsdottir U A, Lunde A, et al. Nordic health registry-based research: a review of health care systems and key registries. Clin Epidemiol 2021; 13: 533-54. doi: 10.2147/clep.S314959. DOI: https://doi.org/10.2147/CLEP.S314959
Schmidt M, Pedersen L, Sørensen H T. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 2014; 29(8): 541-9. doi: 10.1007/s10654-014-9930-3. DOI: https://doi.org/10.1007/s10654-014-9930-3
Ludvigsson J F, Almqvist C, Bonamy A K, Ljung R, Michaëlsson K, Neovius M, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol 2016; 31(2): 125-36. doi: 10.1007/s10654-016-0117-y. DOI: https://doi.org/10.1007/s10654-016-0117-y
Danish Multidisciplinary Hip Fracture Registry (DMHFR). Annual Reports 2020–2024. Available from: https://www.sundk.dk/kliniske-kvalitetsdatabaser/dansk-tvaerfagligt-register-for-hoftenaere-laarbensbrud/viden-fra-databasen/ (accessed March 19, 2026).
Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sørensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi: 10.2147/clep.S91125. DOI: https://doi.org/10.2147/CLEP.S91125
Kristensen P K, Röck N D, Christensen H C, Pedersen A B. The Danish Multidisciplinary Hip Fracture Registry 13-year results from a population-based cohort of hip fracture patients. Clin Epidemiol 2020; 12: 9-21. doi: 10.2147/clep.S231578. DOI: https://doi.org/10.2147/CLEP.S231578
Norwegian Hip Fracture Registry (NHFR). Annual report 2025. Available from: https://www.helse-bergen.no/4a01cd/contentassets/227cba5a5f094ba1bc08d780f667b86d/rapport-2025.pdf (accessed March 19, 2026).
Möller M, Wolf O, Bergdahl C, Mukka S, Rydberg E M, Hailer N P, et al. The Swedish Fracture Register: ten years of experience and 600,000 fractures collected in a National Quality Register. BMC Musculoskelet Disord 2022; 23(1): 141. doi: 10.1186/s12891-022-05062-w. DOI: https://doi.org/10.1186/s12891-022-05062-w
Swedish Fracture Registry (SFR). Annual Report 2024. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://registercentrum.blob.core.windows.net/sfr/r/-rsrapport-2024-Q9dBtbCBJ.pdf (accessed March 19, 2026).
Swedish Fracture Registry (SFR). Registry Homepage; online statistics. Available from: https://sfr.registercentrum.se/statistik/antal-frakturer/p/SJU8_v5PX (accessed March 19, 2026).
RIKSHÖFT. Annual Report 2025. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://rcsyd.se/rikshoft/wp-content/uploads/sites/24/2025/10/Arsrapport-Rikshoft-2025.pdf (accessed March 19, 2026).
Meyer A C, Hedström M, Modig K. The Swedish Hip Fracture Register and National Patient Register were valuable for research on hip fractures: comparison of two registers. J Clin Epidemiol 2020; 125: 91-9. doi: 10.1016/j.jclinepi.2020.06.003. DOI: https://doi.org/10.1016/j.jclinepi.2020.06.003
RIKSHÖFT. Annual Report 2023 [in Swedish]. Available from: https://rcsyd.se/rikshoft/wp-content/uploads/sites/24/2025/10/Arsrapport-Rikshoft-2023.pdf (accessed March 19, 2026).
Hjelholt T J, Edwards N M, Vesterager J D, Kristensen P K, Pedersen A B. The positive predictive value of hip fracture diagnoses and surgical procedure codes in the Danish Multidisciplinary Hip Fracture Registry and the Danish National Patient Registry. Clin Epidemiol 2020; 12: 123-31. doi: 10.2147/clep.S238722. DOI: https://doi.org/10.2147/CLEP.S238722
Jensen S S, Rønnegaard A B, Gundtoft P H, Kold S, Viberg B. An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register. Acta Orthop 2025; 96: 66-72. doi: 10.2340/17453674.2024.42633. DOI: https://doi.org/10.2340/17453674.2024.42633
Knutsson S B, Wennergren D, Bojan A, Ekelund J, Möller M. Femoral fracture classification in the Swedish Fracture Register: a validity study. BMC Musculoskelet Disord 2019; 20(1): 197. doi: 10.1186/s12891-019-2579-z. DOI: https://doi.org/10.1186/s12891-019-2579-z
Kristoffersen M H, Dybvik E, Steihaug O M, Bartz-Johannesen C A, Martinsen M I, Ranhoff A H, et al. Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord 2019; 20(1): 268. doi: 10.1186/s12891-019-2633-x. DOI: https://doi.org/10.1186/s12891-019-2633-x
Sund A, Dybvik E, Gjertsen J E. Orthopaedic surgeons’ ability to detect pathologic hip fractures: review of 1484 fractures reported to the Norwegian Hip Fracture Register. J Orthop Surg Res 2023; 18(1): 832. doi: 10.1186/s13018-023-04336-w. DOI: https://doi.org/10.1186/s13018-023-04336-w
Global Fragility Fracture Network (Global FFN). Minimum Common Dataset ‘Core 2022 MCD’. Available from: https://docs.google.com/spreadsheets/d/1XO7WDR2EhX6JAc9Sdqb-F94YeCOAFa4E/edit?gid=1668284129#gid=1668284129 (accessed March 19, 2026).
Johansen A, Hall A J, Ojeda-Thies C, Poacher A T, Costa M L. Standardization of global hip fracture audit could facilitate learning, improve quality, and guide evidence-based practice. Bone Joint J 2023; 105-b(9): 1013-19. doi: 10.1302/0301-620x.105b9.Bjj-2023-0281. DOI: https://doi.org/10.1302/0301-620X.105B9.BJJ-2023-0281
Ojeda-Thies C, Sáez-López P, Currie C T, Tarazona-Santalbina F J, Alarcón T, Muñoz-Pascual A, et al. Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporos Int 2019; 30(6): 1243-54. doi: 10.1007/s00198-019-04939-2. DOI: https://doi.org/10.1007/s00198-019-04939-2
Hailer N P, Furnes O, Mäkelä K, Overgaard S. Register-based randomized trials: the new power-tool in orthopedic research? Acta Orthop 2023; 94: 490-2. doi: 10.2340/17453674.2023.19661. DOI: https://doi.org/10.2340/17453674.2023.19661
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Copyright (c) 2026 Christian R Schmidt, Henrik Palm, Bjarke Viberg, Margareta Hedström, Olof Wolf, Cecilia Rogmark, Jan-Erik Gjertsen, Eva Dybvik, Alma B Pedersen
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