Second Hip Fracture: Incidence, Trends, and Predictors

Area of Science:

• Gerontology
• Orthopedics
• Epidemiology

Background:

• Older adults with a hip fracture (HFx) have an elevated risk of subsequent hip fractures (SHFx).
• Previous studies estimated SHFx cumulative incidence at 8.4%, but data from Spain and specific risk markers were limited.

Purpose of the Study:

• To estimate the incidence and explore trends of SHFx in a Spanish suburban population.
• To identify predictors associated with SHFx in this demographic.

Main Methods:

• An observational, longitudinal, retrospective study was conducted using hospital discharge data from 1999-2011.
• Incidence rates were calculated per 100,000 population, and median time to SHFx was determined using Kaplan-Meier analysis.
• Cox regression models were employed to analyze the association between SHFx and baseline predictors.

Main Results:

• Among 3430 patients with a first HFx, 7.4% experienced a SHFx, with a median time of 3.7 years between fractures.
• The annual incidence of SHFx among those with a prior HFx was 956.7 per 100,000 population.
• A declining trend in HFx incidence was observed, with an annual reduction of 10.4% over the study period.
• Predictors for SHFx included female sex (HR 1.41), older age (HR 1.03), nursing home residency (HR 1.46), and moderate to severe liver disease (HR 4.96).

Conclusions:

• The occurrence of SHFx in this Spanish population was 7.4%, indicating a three-fold increased risk compared to those without a prior HFx.
• Key predictors for SHFx are female sex, advanced age, residing in a nursing home, and moderate to severe liver disease.
• The identified time interval between fractures suggests potential opportunities for interventions to mitigate SHFx risk.