Advertisement

Risk of institutionalization following fragility fractures in older people

  • P. BenzingerEmail author
  • S. Riem
  • J. Bauer
  • A. Jaensch
  • C. Becker
  • G. Büchele
  • K. Rapp
Original Article
  • 70 Downloads

Abstract

Summary

Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home.

Introduction

Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture.

Methods

Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied.

Results

Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture.

Conclusions

The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.

Keywords

Epidemiology Falls Femoral fractures Hip factures Humeral fractures Osteoporosis Spinal fractures 

Notes

Acknowledgements

We thank Marianna Hanke-Ebersoll from the Allgemeine Ortskrankenkasse Bavaria (AOK) for her support of our analyses.

Compliance with ethical standards

The study was approved by the ethical committee of Ulm University.

Conflicts of interest

None.

Supplementary material

198_2019_4922_MOESM1_ESM.docx (108 kb)
ESM 1 (DOCX 107 kb)

References

  1. 1.
    Rapp K, Rothenbacher D, Magaziner J, Becker C, Benzinger P, König HH, Jaensch A, Büchele G (2015) Risk of nursing home admission after femoral fracture compared with stroke, myocardial infarction, and pneumonia. J Am Med Dir Assoc 16:715.e7–715.e12.  https://doi.org/10.1016/j.jamda.2015.05.013 CrossRefGoogle Scholar
  2. 2.
    Bliuc D (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521.  https://doi.org/10.1001/jama.2009.50 CrossRefGoogle Scholar
  3. 3.
    Melton LJ, Achenbach SJ, Atkinson EJ, Therneau TM, Amin S (2013) Long-term mortality following fractures at different skeletal sites: a population-based cohort study. Osteoporos Int 24:1689–1696.  https://doi.org/10.1007/s00198-012-2225-1 CrossRefGoogle Scholar
  4. 4.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet Lond Engl 353:878–882.  https://doi.org/10.1016/S0140-6736(98)09075-8 CrossRefGoogle Scholar
  5. 5.
    Browner WS (1996) Mortality following fractures in older women: the study of osteoporotic fractures. Arch Intern Med 156:1521–1525.  https://doi.org/10.1001/archinte.1996.00440130053006 CrossRefGoogle Scholar
  6. 6.
    for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group, Dyer SM, Crotty M et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158.  https://doi.org/10.1186/s12877-016-0332-0 CrossRefGoogle Scholar
  7. 7.
    Nanninga GL, de Leur K, Panneman MJM et al (2014) Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age Ageing 43:648–653.  https://doi.org/10.1093/ageing/aft212 CrossRefGoogle Scholar
  8. 8.
    Alnaib M, Waters S, Shanshal Y, Caplan N, Jones S, St Clair Gibson A, Kader D (2012) Combined pubic rami and sacral osteoporotic fractures: a prospective study. J Orthop Traumatol 13:97–103.  https://doi.org/10.1007/s10195-012-0182-2 CrossRefGoogle Scholar
  9. 9.
    Morris RO (2000) Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 76:646–650.  https://doi.org/10.1136/pmj.76.900.646 CrossRefGoogle Scholar
  10. 10.
    Marrinan S, Pearce MS, Jiang XY, Waters S, Shanshal Y (2015) Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence. Age Ageing 44:258–261.  https://doi.org/10.1093/ageing/afu123 CrossRefGoogle Scholar
  11. 11.
    Katz PR (2011) An international perspective on long term care: focus on nursing homes. J Am Med Dir Assoc 12:487–492.e1.  https://doi.org/10.1016/j.jamda.2011.01.017 CrossRefGoogle Scholar
  12. 12.
    Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM (2010) Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 340:c1718–c1718.  https://doi.org/10.1136/bmj.c1718 CrossRefGoogle Scholar
  13. 13.
    Becker C, Leistner K, Nikolaus T (1998) Introducing a statutory insurance system for long-term care (Pflegeversicherung) in Germany. In: Michel JP, Rubenstein LZ, Vellas BJ, Albarede JL (eds) Geriatr Programs Dep World Serdi. Springer, Paris, pp 55–64Google Scholar
  14. 14.
    Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, Boonen S (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Osteoporos Int 11:373–380.  https://doi.org/10.1007/s001980070102 CrossRefGoogle Scholar
  15. 15.
    Cumming RG, Klineberg R, Katelaris A (1996) Cohort study of risk of institutionalisation after hip fracture. Aust N Z J Public Health 20:579–582.  https://doi.org/10.1111/j.1467-842X.1996.tb01069.x CrossRefGoogle Scholar
  16. 16.
    Morin S, Lix LM, Azimaee M, Metge C, Majumdar SR, Leslie WD (2012) Institutionalization following incident non-traumatic fractures in community-dwelling men and women. Osteoporos Int 23:2381–2386.  https://doi.org/10.1007/s00198-011-1815-7 CrossRefGoogle Scholar
  17. 17.
    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284.  https://doi.org/10.1056/NEJM199710303371806 CrossRefGoogle Scholar
  18. 18.
    Gill TM, Murphy TE, Gahbauer EA, Allore HG (2013) Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol 178:418–425.  https://doi.org/10.1093/aje/kws554 CrossRefGoogle Scholar
  19. 19.
    Goodwin JS, Howrey B, Zhang DD, Kuo Y-F (2011) Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci 66A:1321–1327.  https://doi.org/10.1093/gerona/glr171 CrossRefGoogle Scholar
  20. 20.
    Hill RM, Robinson CM, Keating JF (2001) Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg (Br) 83:1141–1144CrossRefGoogle Scholar
  21. 21.
    Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507CrossRefGoogle Scholar
  22. 22.
    Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I, Kristiansen IS (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574.  https://doi.org/10.1007/s00198-003-1583-0 CrossRefGoogle Scholar
  23. 23.
    Svensson HK, Olofsson EH, Karlsson J, Hansson T, Olsson LE (2016) A painful, never ending story: older women’s experiences of living with an osteoporotic vertebral compression fracture. Osteoporos Int 27:1729–1736.  https://doi.org/10.1007/s00198-015-3445-y CrossRefGoogle Scholar
  24. 24.
    Suzuki N, Ogikubo O, Hansson T (2008) The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months. Eur Spine J 17:1380–1390.  https://doi.org/10.1007/s00586-008-0753-3 CrossRefGoogle Scholar
  25. 25.
    Peasgood T, Herrmann K, Kanis JA, Brazier JE (2009) An updated systematic review of health state utility values for osteoporosis related conditions. Osteoporos Int 20:853–868.  https://doi.org/10.1007/s00198-009-0844-y CrossRefGoogle Scholar
  26. 26.
    Hiligsmann M, Ethgen O, Richy F, Reginster J-Y (2008) Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 82:288–292.  https://doi.org/10.1007/s00223-008-9117-6 CrossRefGoogle Scholar
  27. 27.
    Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427CrossRefGoogle Scholar
  28. 28.
    Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH (2013) The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany--a demographic simulation model. Osteoporos Int 24:835–847.  https://doi.org/10.1007/s00198-012-2020-z CrossRefGoogle Scholar
  29. 29.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733.  https://doi.org/10.1007/s00198-006-0172-4 CrossRefGoogle Scholar
  30. 30.
    Kanis JA, Oden A, Johnell O, de Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473CrossRefGoogle Scholar
  31. 31.
    van Dijk WA, Poeze M, van Helden SH, Brink PRG, Verbruggen JPAM (2010) Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury 41:411–414.  https://doi.org/10.1016/j.injury.2009.12.014 CrossRefGoogle Scholar
  32. 32.
    Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM (2014) Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med 174:1273–1280.  https://doi.org/10.1001/jamainternmed.2014.2362 CrossRefGoogle Scholar
  33. 33.
    Bäßgen K, Westphal T, Haar P et al (2012) Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200 413 inhabitants. J Public Health Oxf Engl 35:255–261.  https://doi.org/10.1093/pubmed/fds076 CrossRefGoogle Scholar
  34. 34.
    Gaughan J, Gravelle H, Santos R, Siciliani L (2017) Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients. Int J Health Econ Manag 17:311–331.  https://doi.org/10.1007/s10754-017-9214-z CrossRefGoogle Scholar
  35. 35.
    Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448.  https://doi.org/10.1007/s00198-010-1480-2 CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Center for Geriatric MedicineBethanien Krankenhaus Heidelberg, University of HeidelbergHeidelbergGermany
  2. 2.Faculty of Social and Health StudiesUniversity of Applied Sciences KemptenKemptenGermany
  3. 3.Department of Clinical GerontologyRobert Bosch Krankenhaus StuttgartStuttgartGermany
  4. 4.Klinik für UnfallchirurgieKreiskrankenhaus LörrachLörrachGermany
  5. 5.Institute of Epidemiology and Medical BiometryUlm UniversityUlmGermany

Personalised recommendations