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



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.


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.


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.


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.


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.


Epidemiology Falls Femoral fractures Hip factures Humeral fractures Osteoporosis Spinal fractures 



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


Supplementary material

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


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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

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