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Second hip fracture in older men and women: the Framingham Study
Sarah D Berry1, Elizabeth J Samelson, Marian T Hannan
1Department of medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. sarahberry@hrca.harvard.edu
Insights
Older adults who survive a hip fracture face a significant risk of a second hip fracture. Advanced age and functional status are key predictors, highlighting opportunities for preventative interventions.
Area of Science:
- Gerontology
- Orthopedics
- Epidemiology
Background:
- Individuals who have experienced a hip fracture are at a heightened risk for subsequent fractures.
- The frequency and characteristics of individuals experiencing a second hip fracture are not well-documented.
Purpose of the Study:
- To investigate the incidence and predictors of second hip fractures in older adults.
- To identify risk factors associated with sustaining a second hip fracture.
Main Methods:
- The Framingham Heart Study cohort, comprising 481 individuals with an initial hip fracture, was analyzed.
- Participants were monitored for second hip fractures, mortality, or study completion, with age, sex, falls, stroke, dementia, and functional status as potential predictors.
Main Results:
- Over a median follow-up of 4.2 years, 14.8% of subjects experienced a second hip fracture.
- The risk of a second hip fracture increased with older age and higher functional status.
- One-year mortality was higher after a second hip fracture (24.1%) compared to an initial hip fracture (15.9%).
Conclusions:
- A substantial proportion of hip fracture survivors sustain a second hip fracture.
- Older age and functional status are potential key predictors for second hip fractures.
- Intervention opportunities exist between initial and subsequent hip fractures to mitigate risk.
Background:
Older persons with hip fractures remain at increased risk of subsequent hip fractures. However, little is known about the frequency and characteristics of persons who sustain a second hip fracture.
Methods:
Participants included 481 members of the Framingham Heart Study who sustained an initial hip fracture between April 1952 and December 31, 2003. Participants were followed up until a second hip fracture, death, dropout, or study completion. Age, sex, falls, stroke, dementia, residence, recent weight change, body mass index, and functional status were considered potential predictors of a second hip fracture.
Results:
During a median of 4.2 years of follow-up, 71 subjects (14.8%) experienced a second hip fracture. Following a first hip fracture, 2.5% of subjects experienced a second hip fracture within 1 year, and 8.2% of subjects (9.7% of women) experienced a second hip fracture within 5 years. One-year mortality following an initial hip fracture was 15.9% compared with 1-year mortality following a second hip fracture of 24.1%. The risk of a second hip fracture increased with age (hazard ratio [HR] per 5-year increase in age, 1.5; 95% confidence interval [CI], 1.1-1.8) and with high functional status (HR compared with moderate functional status, 2.7; 95% CI, 1.1-6.9). There was a statistically nonsignificant association between low functional status and the risk of second hip fracture (HR compared with moderate functional status, 3.7; 95% CI, 0.9-14.8).
Conclusions:
Among survivors of an initial hip fracture, the incidence of a second hip fracture is substantial. Older age and functional status may be important predictors of a second hip fracture. There seems to be adequate time between the first and second hip fractures for interventions that may reduce second hip fractures.
