Proximal Humeral Fracture as a Risk Factor for Subsequent Hip Fractures

Clinton, Jeremiah; Franta, Amy K.; Polissar, Nayak L.; Neradilek, Blažej; Mounce, Doug; Fink, Howard A; Schousboe, John T.; Matsen, Frederick A.

doi:10.2106/jbjs.g.01529

Cited by 91 publications

(67 citation statements)

References 40 publications

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“…A second fragility fracture in the form of a hip fracture is one of the more common reasons for readmission during the first 90 days after surgery for a proximal humerus fracture. This is consistent with a previous report that patients who have a proximal humerus fracture are at increased risk for a subsequent hip fracture the first year after injury [7].…”

Section: Discussionsupporting

confidence: 93%

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Zhang

Schairer

Feeley

2014

Clinical Orthopaedics &Amp; Related Research

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Background With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission. Questions/purposes We measured (1) the frequency of unplanned hospital readmissions after surgical treatment of proximal humerus fractures, (2) the medical and surgical causes of readmission, and (3) the risk factors associated with unplanned readmissions. Methods The State Inpatient Database from seven different states was used to identify patients who underwent treatment for a proximal humerus fracture with open reduction and internal fixation (ORIF), hemiarthroplasty of the humeral head, or reverse total shoulder arthroplasty from 2005 through 2010. The database was used to measure the 30-day and 90-day readmission rates and identify causes and risk factors for readmission. Multivariate modeling and a Cox proportional hazards model were used for statistical analysis. Results A total of 27,017 patients were included with an overall 90-day readmission rate of 14% (15% for treatment with ORIF, 15% for reverse total shoulder arthroplasty, and 13% for hemiarthroplasty). The majority of readmissions were associated with medical diagnoses (75%), but treatment with ORIF was associated with the most readmissions from surgical complications, (29%) followed by reverse total shoulder arthroplasty (20%) and hemiarthroplasty (16%) (p \ 0.001). Risk of readmission was greater for patients who were female, African American, discharged to a nursing facility, or had Medicaid insurance. Conclusions As the majority of unplanned hospital readmissions were associated with medical diagnoses, it is important to consider patient medical comorbidities before surgical treatment of proximal humerus fractures and during the postoperative care phase. Level of Evidence Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 93%

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Zhang

Schairer

Feeley

2014

Clinical Orthopaedics &Amp; Related Research

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“…(24)(25)(26)(27)(28)(29)(30)(31) Therapeutic agents that reduce fracture risk rapidly are desirable for these patients.…”

Section: Goal-directed Selection Of Initial Therapymentioning

confidence: 99%

“…(4,(39)(40)(41)(42)(43)(44) Based on studies from patients who are not receiving treatment, the increase in risk of fracture associated with an incident nonvertebral fracture may be greatest in the first 5 years after the fracture occurs and then wane with time. (24)(25)(26)(27)(28)(29)(30)(31) Furthermore, in patients receiving zoledronic acid, incident nonvertebral fracture is an important risk factor for future nonvertebral fractures over the next 3 years if therapy is discontinued. (4) Therefore, it is the opinion of the Working Group that the occurrence of a nonvertebral fracture during treatment, even if the T-score goal has been reached, should prompt continuation, change, or addition of therapy, at least until the patient has been fracture-free for 3 to 5 years.…”

Section: Monitoring Response To Therapymentioning

confidence: 99%

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Cummings

Cosman

Lewiecki

et al. 2016

Journal of Bone and Mineral Research

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137

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The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goaldirected treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care.

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“…Пристального внимания заслуживают травматиче-ские повреждения опорно-двигательной системы, вы-ступающие как фактор риска развития посттравмати-ческой остеопении, остеопороза и в последующем -перелома [9,23,37,39,40,62,70,72]. В соответствии с рекомендациями 2013 года Национального фонда остеопороза (NOF) лица, имеющие перелом в анамне-зе, входят в группу повышенного риска по остеопоро-зу [22].…”

Section: обзоры литературы № 3/2013 остеопороз и остеопатииunclassified

“…Имеется обширная доказательная база, что пере-ломы в области лучевой кости в типичном месте, дис-тальном отделе плечевой кости, позвоночнике и прок-симальном отделе бедренной кости ассоциируются с повышением риска последующего перелома, что явля-ется отражением снижения МПК после предшествую-щего перелома [23,61].…”

Section: обзоры литературы № 3/2013 остеопороз и остеопатииunclassified

Fracture — A Risk Factor for Development and Progression of Osteopenia and Osteoporosis

Побел¹

2013

Osteopor Bone Dis

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Analyzed literature data demonstrates the influence of fracture in individuals of different age on the risk of post-traumatic osteopenia and osteoporosis, as well as increase in the risk of the recurrent fractures. It is proved that the fracture leads to a decrease in bone mineral density (BMD) not only in the injured limb, but also other parts of the skeleton. In majority of prospective studies and metaanalysis it was shown that there is no full recovery of BMD after sustained fracture. Posttraumatic osteopenia and osteoporosis increase the risk of re-fracture in the future.

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Proximal Humeral Fracture as a Risk Factor for Subsequent Hip Fractures

Cited by 91 publications

References 40 publications

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Fracture — A Risk Factor for Development and Progression of Osteopenia and Osteoporosis

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