Short-term risk factors for a second hip fracture in a UK population

Abstract

Introduction A hip fracture carries significant morbidity and mortality—a second fracture of the contralateral hip carries even higher complications. Most second hip fractures occur within 48 months of the first. The aim of this study was to comprehensively analyse all identifiable variables that may increase the risk of a contralateral hip fracture within this time period. Methods We retrospectively analysed 1242 consecutive patients with hip fractures presenting to our institution. All patient-related, surgery-related and inpatient variables were collected from the index admission. We then identified patients with a subsequent contralateral hip fracture in the following 2 years. Univariate and multivariate analyses were performed to identify risk factors associated with a second fracture. Results A total of 66 patients (5.3%) had a contralateral hip fracture in the 2 years following initial hip fracture. Mean age at first presentation was 81 years, and mean time to second fracture was 305 days. Following multivariate analysis, the patients at highest risk of a second fracture were those with dementia, acute inpatient chest infection, urinary tract infection and multiple comorbidities as measured by the Charlson score. Discharge destination after initial fracture was not associated with the risk of a second fracture. Conclusions We have identified a number of discrete risk factors that are associated with a short- to medium-term risk of contralateral hip fracture that may be useful in screening for patients at risk and provide them with focused medical rehabilitation.

Disease-dependent variations in the timing and causes of readmissions in Germany: A claims data analysis for six different conditions

“…Our results are also consistent with reported 30-d readmission rates for COPD (16.5-22.6%) [31,32,44], or DM (14.2-25%) [45][46][47][48]. Studies on osteoporotic fractures are heterogeneous regarding population age, examined diagnoses, and timeframe of readmissions [49][50][51][52][53] and they focus rather on surgical options [50], complications, or reoccurrence of hip…”

“…Our results are also consistent with reported 30-d readmission rates for COPD (16.5-22.6%) [ 31 , 32 , 44 ], or DM (14.2-25%) [ 45 – 48 ]. Studies on osteoporotic fractures are heterogeneous regarding population age, examined diagnoses, and timeframe of readmissions [ 49 – 53 ] and they focus rather on surgical options [ 50 ], complications, or reoccurrence of hip fractures [ 49 , 51 , 53 ]. In our analysis, we chose a more holistic view and included cases diagnosed with OS (ICD-10 codes M80 and M81) independent of the occurrence of a fracture.…”

Incidence of Non-Simultaneous Contralateral Second Hip Fractures: A Single-Center Irish Study

“…Figure 1 in our study demonstrates that for our cohort the risk of a second hip fracture is highest in the first year, with most of the remaining fractures occurring within five years of the initial hip fracture. These findings are supported by the literature where several studies have demonstrated that most contralateral hip fractures will occur within the first 48 months following an initial hip fracture [ 8 ]. However, Sobolev et al demonstrated that the risk of a contralateral hip fracture persists for at least 10 years following the initial hip fracture [ 10 ].…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…Incidence of second hip fractures is greater among older patients [232,234,235,237,247,248], and females [232,236,244,248]; other risk factors described are dementia, malnutrition, Parkinson's disease, cerebrovascular disease, hepatic disease, osteoporosis, intrahospital pneumonia, urinary tract infection, higher Charlson comorbidity index, increased length of stay (surrogate of comorbidity), initial trochanteric fracture and initial treatment with an arthroplasty [232,234,236,239,244,248,249], but also less dependent patients [250]. Patients using non-steroidal anti-inflammatory drugs (NSAIDs) have a higher dose-dependent risk of second hip fracture [247,248].…”

“…Patients using non-steroidal anti-inflammatory drugs (NSAIDs) have a higher dose-dependent risk of second hip fracture [247,248]. Some authors found no relation regarding destination at discharge [249], but others describe living in a nursing home as a risk factor [232]; Cabalatungan reported more patients with second hip fractures had been admitted from nursing homes [250].…”