Factors associated with a second hip fracture: a systematic review

Egan, Mary; Jaglal, Susan; Byrne, Kerry; Wells, Jennie; Stolee, Paul

doi:10.1177/0269215507081573

Cited by 64 publications

(46 citation statements)

References 59 publications

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“…Higher risk of second fractures was reported among patients with cognitive impairment, lower bone mass, senile dementia, respiratory diseases, and alcoholism. [3,18,19] This study has several limitations. First, it was not possible to ascertain hip fractures that occurred before 2000.…”

Section: Discussionmentioning

confidence: 94%

Risk factors for contralateral hip fractures following femoral neck fractures in elderly: analysis of the Hungarian nationwide health insurance database

Juhász¹,

Boncz

Patczai

et al. 2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada demografik ve klinik etkenlerin ileri yaşlı Macar nüfusunda ikinci (kontralateral) kalça kırığı insidansı üzerindeki önemi Macaristan'daki ulusal sağlık sigortası veri tabanı kullanılarak araştırıldı. Hastalar ve yöntemler: Çalışmaya 2000 yılında düşük enerjili travma nedeniyle primer monotravmatik femur boyun kırıkları için tedavi edilen toplam 3.783 hasta (917 erkek, 2.866 kadın) dahil edildi. Aşağıdaki prognostik etkenleri değerlendirmek için Cox regresyon ve Kaplan-Meier sağkalım analizleri ve log sıra testi uygulandı: Yaş, cinsiyet, yaşanan yer, primer kırık tipi ve cerrahi girişim, primer kırık için tedavi veren hastane ve eşlik eden hastalıklar. Bulgular: Toplam 312 hastada (%8.2) ikinci kalça kırığı vardı. Tek değişkenli Cox regresyon analizi ikinci kalça kırığı için daha yaşlı (p= 0.001), kadın cinsiyetli (p= 0.022), başkentte yaşayan (p= 0.024) ve artroplastisi olan (p= 0.001) hastalarda anlamlı derecede daha yüksek risk gösterdi. Çok değişkenli analize göre, daha yaş (p≤0.001) ve artroplastili olmak (p= 0.004) ikinci kalça kırıkları için anlamlı risk faktörleri idi. Log sıra testi erkeklere göre kadınlarda (p<0.001) ve osteosentezli olanlara göre artroplastili hastalarda (p= 0.013) anlamlı derecede daha uzun sağkalım olduğunu gösterdi. Sonuç: Etkili korunma stratejileri oluşturmak için yüksek riskli grupların tanımlanması gereklidir. Çalışmamız ikinci kalça kırığına maruz kalma riskinin kadınlarda, ileri yaşlı nüfusta, başkentte yaşayanlarda ve artroplasti geçiren hastalarda daha yüksek olduğunu göstermektedir.Anahtar sözcükler: Yaşlı nüfus; femur boyun kırığı; insidans; risk faktörleri; ikinci kalça kırığı. ABSTRACTObjectives: This study aims to investigate the significance of demographic and clinical factors on incidence of second (contralateral) hip fracture in elderly Hungarian population using the nationwide health insurance database in Hungary. Patients and methods:The study included a total of 3,783 patients (917 males, 2,866 females) treated for primary monotraumatic femoral neck fractures caused by low-energy trauma in the year 2000. Cox regression and Kaplan-Meier survival analyses, and log-rank test were performed to evaluate the following prognostic factors: age, gender, place of living, type of primary fracture and surgical intervention, hospital providing treatment for primary fracture, and comorbidities. Results: A total of 312 patients (8.2%) suffered second hip fractures. The univariate Cox regression analysis showed a significantly higher risk for second hip fracture in patients having advanced age (p= 0.001), female gender (p= 0.022), living in capital (p= 0.024), and having arthroplasty (p= 0.001). Advanced age (p≤0.001) and having arthroplasty (p= 0.004) were significant risk factors for second hip fractures according to multivariate analysis. Log-rank test showed significantly longer survival in females (p<0.001) than in males and in patients with arthroplasty (p= 0.013) compared with those having osteosynthesis. Conclusion: Identification of high-risk groups...

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Section: Discussionmentioning

confidence: 94%

Risk factors for contralateral hip fractures following femoral neck fractures in elderly: analysis of the Hungarian nationwide health insurance database

Juhász¹,

Boncz

Patczai

et al. 2016

Eklem Hastalik Cerrahisi

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“…The reviews identified 3,5,9,10,14,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and their reference lists were the starting point for identifying both…”

Section: Scoping the Literaturementioning

confidence: 99%

“…5,9 Similarly, no single pathway provides the answers to all patient issues because of the complexity of comorbidities with which hip fracture patients can present. 8,29,49,240 Geriatric orthopaedic rehabilitation units are likely not to be cost-effective but can be beneficial for frailer patients to reduce complication rates, readmissions, nursing home placements and in-hospital deaths; however, they showed little effect on the rate of death post discharge, in both the short term and the long term.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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“…Previous studies have identified the various risk factors associated with the incidence of subsequent osteoporotic fractures, particularly for a second hip fracture (not assessed in this study) (Dretakis et al 1998;Saxena and Shankar 2000;Chapurlat et al 2003;Yamanashi et al 2005;Egan et al 2008;Angthong et al 2009;Mitani et al 2010). However, there is little information as to the risk factors for a subsequent osteoporotic vertebral compression fracture following an initial hip fracture.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Survival Rates for Hip Fracture Patients with or without Subsequent Osteoporotic Vertebral Compression Fractures

Angthong

Harnroongroj

2012

Tohoku J. Exp. Med.

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Little is known about the effect of a subsequent osteoporotic vertebral compression fracture on the survival rate of patients with a previous hip fracture. In this study, we aimed to compare the survival rates of hip fracture patients with and without subsequent osteoporotic vertebral compression fractures and determine the risk factors associated with subsequent fracture. During 2000-2008, 933 initial hip fracture patients were reviewed and divided into two groups: subsequent fracture group (160 patients) and single hip fracture group (i.e., no subsequent fracture; 773 patients). All information pertaining to their most recent fracture event(s), including mortality causes/rates, were recorded. Differences in mortality rates and hazard ratios (HRs) between the two groups were also analyzed. The 1-year and 1-to-5-year mortality rates were 1.3% and 1.9%, respectively, in the subsequent fracture group, and 4.7% and 1.4%, respectively, in the single hip fracture group, with no significant differences observed. Interestingly, the HR for mortality was significantly higher in the single hip fracture group than in the subsequent fracture group (p < 0.05). The significant risk factors for subsequent fractures were identified as knee osteoarthritis, neurological disease, and an initial hip fracture with intertrochanteric involvement. Our findings indicate that the occurrence of a vertebral compression fracture after an initial hip fracture does not greatly impact patient survival. Conversely, patients presenting with a single hip fracture have a significantly higher mortality-HR, indicating that single hip fracture patients without subsequent fracture should be provided with the same standard of care as patients with subsequent fractures.

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Factors associated with a second hip fracture: a systematic review

Abstract: A number of easily observed risk factors may help identify those individuals at higher risk for subsequent fracture.

Cited by 64 publications

References 59 publications

Risk factors for contralateral hip fractures following femoral neck fractures in elderly: analysis of the Hungarian nationwide health insurance database

Risk factors for contralateral hip fractures following femoral neck fractures in elderly: analysis of the Hungarian nationwide health insurance database

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

A Comparison of Survival Rates for Hip Fracture Patients with or without Subsequent Osteoporotic Vertebral Compression Fractures

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