Low-trauma fractures indicate increased risk of hip fracture in frail older people

Abstract

This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n ¼ 953), the nonhip fracture group (n ¼ 194), and the hip fracture group (n ¼ 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p ¼ .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture. ß

The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study

“…It is well established that the presence of one low trauma fracture significantly increases the risk of a further fracture [5][6][7][8].…”

Antiresorptive therapies for osteoporosis: a clinical overview

“…5 People who have had a low-trauma fracture are also at increased risk of sub sequent fractures. [6][7][8] Despite the high prevalence of osteoporosis and its potentially severe consequences, less than one-third of patients with a prior fracture are currently receiving specific medication for osteoporosis in developed countries. 9 Mechanistically, osteoporosis can be viewed as a state of net bone loss, resulting from an increase in bone resorp tion relative to bone formation.…”

Exploring the Nurse Practitioner Role in Managing Fractures in Long-Term Care

“…For residents at highest risk of fractures, hip protectors and osteoporosis medications are options that should be considered (Sawka, Ismaila, Cranney, et al, 2010). A prior fracture is a major risk factor for future fractures, independent of bone mineral density (BMD), and should be a trigger to assess and consider treatment (Chen et al, 2011; Kanis et al, 2008). Future work is needed to explore new models of care to optimize post-fracture care and prevent future fractures from occurring.…”