Risk of Mortality in Individuals with Hip Fracture and Traumatic Brain Injury

Abstract

Importance: Mortality is significantly increased after hip fracture, with 20–30% of hip fracture patients dying within one year. Causes of the excess mortality observed in hip fracture patients are not well understood. Traumatic brain injury (TBI) sustained during hip fracture may be a cause of excess mortality in this population. Objective: To estimate the prevalence of diagnosed TBI among hospitalized hip fracture patients and examine its association with all-cause mortality. Design: Nested cohort study Setting: National sample of Medicare beneficiaries 2006–2010 Participants: Beneficiaries aged ≥65 years and hospitalized with hip fracture Exposure: TBI at the time of hip fracture was defined using ICD-9-CM codes Main Outcome: All-cause mortality during follow-up Results: Prevalence of TBI among hip fracture patients was 2.7% The absolute risk of mortality attributable to TBI among hip fracture patients was 15/100 person-years. TBI was significantly associated with increased risk of death in multivariable analysis (HR 1.24; 95% CI: 1.14–1.35). Conclusions and Relevance: TBI was associated with increased risk of mortality among hip fracture patients. Practitioners should consider evaluating for presence of TBI in this vulnerable population.

Crosstalk of Brain and Bone—Clinical Observations and Their Molecular Bases

“…Similar to TBI, isolated spinal cord injury (SCI) was associated with reduced BMD and osteoporosis [ 145 ], predominantly observed within the trabecular metaphysical-epiphyseal areas of the distal femur and proximal tibia [ 146 , 147 , 148 , 149 ]. Further, patients suffering from SCI also frequently show HO as well as accelerated and enhanced callus formation [ 20 ], which was reproduced in vitro utilizing serum of SCI patients [ 150 , 151 ].…”

“…Despite the positive effect of trauma on bone regeneration, the ‘afferent’ bone-brain interaction of peripheral injury such as fracture was discovered to negatively modulate and potentially further deteriorate TBI [ 22 ]. While a neurological impact of fracture healing is considered to be constrained by the BBB, trauma patients suffering from TBI and concomitant skeletal injury show higher functional deficits and mortality rates [ 151 ]. Clinical multitrauma studies identified systemic inflammatory changes [ 152 , 153 , 154 ] with the capacity to modulate the neuroinflammatory response following TBI [ 22 ].…”

Effects of Neurological Disorders on Bone Health

“…An additional contributor to low BMD risk in TBI patients is the use of anti-epileptic drugs, which induce the cytochrome P450 system and likely increase the conversion of vitamin D to its inactive forms, resulting in less biologically active vitamin D, decreased calcium absorption, hypocalcemia, increased PTH levels, and compensatory mobilization of calcium stores from bone (Smith et al, 2016). Polytrauma with TBI and concomitant fracture has been shown to result in higher functional deficits and mortality rates (Albrecht et al, 2019). Studies using two mouse models of TBI showed that neurological inflammation and brain damage was increased in animals with fracture and that this damage could be alleviated by blocking the inflammatory effects of fracture (Shultz et al, 2015;Yang et al, 2016).…”

The risk factors of postoperative delirium in patients with hip fracture: implication for clinical management

“…Hip fracture is a very common kind of disease in clinically elderly patients. According to reports, by 2050, the number of patients with hip fractures each year around the world is about 4.5 million[ 1 , 2 ]. The incidence of hip fractures in the elderly has increased year by year, with female patients accounting for 75 % of all hip fracture patients[ 3 ].…”