Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

Nakamura, Kazutoshi; Takahashi, Shunsuke; Oyama, Mari; Oshiki, Rieko; Kobayashi, Ryosaku; Saito, Toshiko; Yoshizawa, Yoshiaki; Tsuchiya, Yasuo

doi:10.1007/s00198-009-1081-0

Cited by 9 publications

(6 citation statements)

References 22 publications

(31 reference statements)

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“…Pooled risk of future fractures was similar in the presence of a prior hip (RR = 1.78, 95% CI = 1.04-3.05) or prior non-hip fractures (RR = 1.76, 95% CI = 1.51-2.05), but was slightly lower when any prior fracture was used in studies (RR = 1.43, 95% CI = 1.14- 1.79). Prior non-hip fractures were defined as upper or non-hip lower limbs (non-vertebral) in one of the studies [ 37 ] and by ICD 9 codes 821–829 in another [ 41 ]. The remaining study separated prior fractures into hip fractures and other prior fractures without defining either group more specifically [ 40 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…The three studies [ 36 , 37 , 40 ], reporting the association between mobility and fractures used different definitions and could not be pooled, and Nakamura [ 37 ] did not provide data to convert the effect measures from HR to RR. Results from these studies were heterogeneous.…”

Section: Resultsmentioning

confidence: 99%

“…Results from these studies were heterogeneous. One study reported [ 40 ] OR: 1.14, 95% CI: 0.78-1.64 in residents who could independently transfer; another study reported HR: 0.99, 95% CI: 0.79–1.23 per unit increase in mobility score [ 36 ]; and another study reported HR: 2.19, 95% CI: 1.35-3.57 in ambulatory residents [ 37 ]. Due to inconsistent results, and possible indirect evidence from one study in a selective population [ 37 ], there is very low quality evidence and the effect of mobility is uncertain.…”

Section: Resultsmentioning

confidence: 99%

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Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies

et al. 2014

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BackgroundThe risk factors associated with fractures have been well-characterized in community dwelling populations, but have not been clearly defined in long-term care (LTC) settings. The objective of this review was to identify risk factors for fractures in LTC settings.MethodsWe searched MEDLINE, the Cochrane Library, EMBASE and CINAHL up to June 2014, scanned reference lists of articles and consulted with experts in the field to identify relevant prospective cohort studies that evaluated risk factors associated with fracture incidence in LTC. We included studies that assessed the association between risk factors included in the WHO-Fracture Risk Assessment Tool (FRAX®) or other predictors relevant to LTC (psychotropic medications, cognitive impairment, mobility, and falls). All articles were screened and extracted by two authors. Available data on the association between a given risk factor and fracture incidence were pooled when possible. We used the GRADE criteria to provide a summary of evidence. The GRADE approach defines the quality of a body of evidence as the extent to which one can be confident that an estimate of effect or association is close to the quantity of specific interest.ResultsWe identified 13 prospective cohort studies which examined fracture incidence among LTC residents. Most predictors showed moderate increases in fracture risk, but the quality of the evidence was often low. Moderate quality evidence showed that prior fractures and falls may moderately increase the risk of fractures. Being a woman and cognitive impairment are probably associated with a small increase. The effect of mobility and psychotropic medication use is still uncertain primarily due to the various definitions used in the studies and difficulty summarising the results.ConclusionsIn addition to criteria used in the FRAX assessment tool, such as a previous fracture and female gender, we found that falls and cognitive impairment are also associated with a small to moderate increases in the risk of fractures in LTC. Developing an assessment tool that includes risk factors that are specific to LTC may improve the identification of individuals who can benefit from fracture prevention programs in these settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies

et al. 2014

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“…367 Regardless of first fragility fracture site, a patient's risk of hip fracture is doubled. 367 Despite this knowledge and the availability of multiple medications that can reduce this fracture risk by 25% to 50%, only about 16% to 20% of patients with hip fracture and wrist fracture receive an assessment for osteoporosis. Directed fragility fracture intervention programs have dramatically improved these rates of assessment and osteoporosis treatment and have demonstrated a decrease in fracture rates.…”

Section: Fragility Fracture As a Major Risk For Future Fracturementioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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“…Among Japanese nursing home residents, appendicular fractures other than the hip doubled the adjusted hazard ratio for hip fracture (37).…”

Section: Introductionmentioning

confidence: 99%

Official Positions for FRAX® Clinical Regarding Prior Fractures

Blank

2011

Journal of Clinical Densitometry

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The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as calculated by FRAX(®). To address these questions, PubMed was searched on the keywords "fracture, epidemiology, osteoporosis." Titles of retrieved articles were reviewed for an indication that risk for future fracture was discussed. Abstracts of these articles were reviewed for an indication that one or more of the questions listed above was discussed. For those that did, the articles were reviewed in greater detail to extract the findings and to find additional past work and citing works that also bore on the questions. The official positions and the supporting literature review are presented here. FRAX(®) underestimates fracture probability in persons with a history of multiple fractures (good, A, W). FRAX(®) may underestimate fracture probability in individuals with prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental history of non-hip fragility fracture (fair, B, W). Limitations of the methodology include performance by a single reviewer, preliminary review of the literature being confined to titles, and secondary review being limited to abstracts. Limitations of the evidence base include publication bias, overrepresentation of persons of European descent in the published studies, and technical differences in the methods used to identify prevalent and incident fractures. Emerging topics for future research include fracture epidemiology in non-European populations and men, the impact of fractures in family members other than parents, and the genetic contribution to fracture risk.

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Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

Abstract: A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.

Cited by 9 publications

References 22 publications

Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies

Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Official Positions for FRAX® Clinical Regarding Prior Fractures

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