Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients

Hansson, Susanne; Rolfson, Ola; Åkesson, Kristina; Nemes, Szilárd; Leonardsson, Olof; Rogmark, Cecilia

doi:10.1016/j.injury.2015.07.024

Cited by 60 publications

(52 citation statements)

References 23 publications

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“…(22)(23)(24) The impact of hip fractures on physical functioning is substantial. (26) Only about one-third to one-half of hip fracture survivors regain prior ambulatory function, (27)(28)(29) and around 13% may be unable to ambulate at all. (26) Only about one-third to one-half of hip fracture survivors regain prior ambulatory function, (27)(28)(29) and around 13% may be unable to ambulate at all.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…Approximately half of hip fracture patients who survive to 1 year do not regain their prior functionality (25) nor does their health status return to prefracture levels. (26) Only about one-third to one-half of hip fracture survivors regain prior ambulatory function, (27)(28)(29) and around 13% may be unable to ambulate at all. (30) Of patients surviving 1 year who needed no walking aids prior, approximately 40% require assistance.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

See 1 more Smart Citation

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

158

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

158

111

View full text Add to dashboard Cite

show abstract

“…The yearly incidences of pneumonia or UTIs in our study are lower compared to previous studies (with exception of UTI in one study (8) ), evaluating the risk after hip fracture surgery. (8)(9)(10)(11) However, these studies have several limitations; including only descriptive analysis and small study populations, (8)(9)(10)(11) measuring outcome as patient-reported, (11) or restricted to patients treated at a single institution or a selected university hospital. (8,9,11) We extended the knowledge by including community-based infections, evaluating trends over time, and considered death as competing risk to minimize potential bias.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…About 9% to 11% of hip fracture patients have been reported to develop hospital‐acquired pneumonia and 4% to 17.9% to develop urinary tract infection, within a varying follow‐up time window spanning from during admission to 6 months of follow‐up. Pneumonia is a leading cause of death among hip fracture patients, and is associated with an excess mortality risk among hip fracture patients .…”

Section: Introductionmentioning

confidence: 99%

“…(7) Although 1-year mortality decreased by 40% from 1980 through 2014, (5) despite an increase in the proportion of patients with severe comorbidity, hip fracture is still associated with a 10% mortality within 30 days and up to 30% within 1 year of surgery. (5,8) About 9% to 11% of hip fracture patients have been reported to develop hospital-acquired pneumonia and 4% to 17.9% to develop urinary tract infection, (8)(9)(10)(11) within a varying follow-up time window spanning from during admission to 6 months of follow-up. Pneumonia is a leading cause of death among hip fracture patients, (12,13) and is associated with an excess mortality risk among hip fracture patients.…”

Section: Introductionmentioning

confidence: 99%

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Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Kjørholt

Johnsen

Kristensen

et al. 2018

Journal of Bone and Mineral Research

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We aimed to examine trends in the incidence of treated infections following hip fracture surgery in Denmark from 2005 to 2016. We conducted a nationwide cohort study using individual‐level linked data from Danish population‐based registries. We calculated cumulative incidence considering death as competing risk and, based on the pseudo‐observation method, risk ratios (RRs) with 95% confidence interval (CI) using the period 2005–2006 as a reference. RRs were adjusted for age, sex, and comorbidity. A total of 74,771 patients aged 65 years or older with first‐time hip fracture surgery were included. The risk of postoperative (at 15, 30, 90, and 365 days) infections increased during 2005–2016. The 30‐day cumulative incidence of all hospital‐treated infections increased from 10.8% (95% CI, 10.2% to 11.3%) in 2005–2006 to 14.3% (95% CI, 13.7% to 15.0%) in 2015–2016 (adjusted RR 1.32; 95% CI, 1.23 to 1.42). Adjusted RR for 30‐day hospital‐treated pneumonia was 1.70 (95% CI, 1.49 to 1.92). The 30‐day cumulative incidence of redeeming community‐based antibiotic prescriptions increased from 17.5% (95% CI, 16.8% to 18.2%) in 2005–2006 to 27.1% (95% CI, 26.3% to 27.9%) in 2015–2016 (adjusted RR 1.54; 95% CI, 1.47 to 1.62). The largest increase was observed for broad‐spectrum antibiotic use (adjusted RR 1.79; 95% CI, 1.68 to 1.90). During 2005–2016, risk of infections was substantially higher in hip fracture patients than in the general population. The risk of hospital‐treated pneumonia and antibiotic prescriptions increased more over time among hip fracture patients. We found increased risks of postoperative treated infections following hip fracture surgery during the 12‐year study period, which could not entirely be explained by similar infection trends in the general population. Given the high mortality following infections in the elderly, further research is needed to identify patients at increased risk to target preventive treatment and potentially reduce complications and mortality in hip fracture patients. © 2018 American Society for Bone and Mineral Research.

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Muscle density is an independent risk factor of second hip fracture: a prospective cohort study

Wang

Lu²,

Yang

et al. 2022

J cachexia sarcopenia muscle

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Background Patients with a first hip fracture are at high risk of fracturing their other hip. Despite this, preventive therapy is often not given. Because little is known about specific risk factors of a second hip fracture, we investigated the association with areal bone mineral density (aBMD), muscle size, and density. We also investigated whether muscle parameters predict the risk of a contralateral fracture independently of aBMD. Methods Three groups were included, one without hip fracture (a subcohort of the China Action on Spine and Hip Status study), one with a first, and one with a second hip fracture. Subjects with fractures were recruited from the longitudinal Chinese Second Hip Fracture Evaluation (CSHFE). Computed tomography scans of CSHFE patients, which were obtained immediately following their first fracture, were used to measure cross-sectional area and density of the gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) muscles. Computed tomography X-ray absorptiometry was used to measure aBMD of the contralateral femur. Median follow-up time to second fracture was 4.5 years. Cox proportional hazards models were used to compute hazard ratios (HR) of second hip fracture risk in subjects with a first hip fracture. Multivariate logistic regressions were used to compare odds ratios (OR) for the risk of a first and second hip fracture. Results Three hundred and one participants (68.4 ± 6.1 years, 64% female) without and 302 participants (74.6 ± 9.9 years, 71% female) with a first hip fracture were included in the analysis. Among the latter, 45 (79.2 ± 7.1 years) sustained a second hip fracture. ORs for first hip fracture were significant for aBMD and muscle size and density. ORs for a second fracture were smaller by a factor of 3 to 4 and no longer significant for femoral neck (FN) aBMD. HRs for predicting second hip fracture confirmed the results. G.Med/MinM density (HR, 1.68; CI,) and intertrochanter aBMD (HR, 1.62; CI, 1.13-2.31) were the most significant. FN aBMD was not significant. G. Med/MinM density remained significant for predicting second hip fracture after adjustment for FN (HR, 1.66; Cl, 1.18-2.30) or total hip aBMD (HR, 1.50; 95% Cl, 1.04-2.15). Conclusions Density of the G.Med/MinM muscle is an aBMD independent predictor of the risk of second hip fracture. Intertrochanteric aBMD is a better predictor of second hip fracture than FN and total hip aBMD. These results may trigger a paradigm shift in the assessment of second hip fracture risk and prevention strategies.

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Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients

Cited by 60 publications

References 23 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Muscle density is an independent risk factor of second hip fracture: a prospective cohort study

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