Second Hip Fracture: Incidence, Trends, and Predictors
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Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999–2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan–Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7 years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7–13.0%; p < 0.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97–2.02), age (HR 1.03, 95% CI 1.01–1.04), living in a nursing house (HR 1.46, 95% CI 1.10–1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23–20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions that may reduce the risk.
KeywordsSecond Hip Fracture Incidence Epidemiology Osteoporosis
Compliance with Ethical Standards
Conflict of interest
Ramón Mazzucchelli, Elia Pérez-Fernández, Natalia Crespí, Alberto García-Vadillo, Gil Rodriguez Caravaca, Angel Gil de Miguel and Loreto Carmona declare no conflict of interest in relation to the study and data presented herein.
Human and Animal Rights and Informed Consent
The study was approved by the ethical committee of our hospital. Patient consent is not required by the Spanish law for study based on routine electronic data.
- 14.Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373CrossRefPubMedGoogle Scholar
- 33.Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefPubMedGoogle Scholar
- 35.Pueyo-Sanchez MJ, Larrosa M, Suris X, Casado E, Auleda J, Fuste J, Ortun V (2016) Secular trend in the incidence of hip fracture in Catalonia, Spain, 2003–2014. Age Ageing 46:324–328Google Scholar
- 36.Hawley S, Leal J, Delmestri A, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A, REFReSH Study Group (2016) Anti-osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in england and wales: an interrupted time-series analysis. J Bone Miner Res 31:2008–2015CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Giannini S, Sella S, Rossini M, Braghin D, Gatti D, Vilei MT, Amabile A, Fusaro M, Frigo AC, Sergi G, Lovato R, Nobile M, Fabris F, Adami S (2016) Declining trends in the incidence of hip fractures in people aged 65 years or over in years 2000–2011. Eur J Intern Med 35:60–65CrossRefPubMedGoogle Scholar
- 46.Toledano Martínez E, Hernández García MA, PuñetPellise R y García Vadillo JA (2009) Instauración de tratamiento de la osteoporosis y su cumplimiento tras la fractura de cadera en el area sanitaria 2 de la Comunidad de Madrid. Reumatol Clin. 2009;5(EspecCong 1):62:62Google Scholar