Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study

Hip structural analysis parameters are not associated with the risk of postmenopausal female second hip fracture: a retrospective study

PURPOSE

Postmenopausal female patients with a history of a single hip fracture are at higher risk of a second fracture. The poorer clinical outcomes of this patient group warrants evaluating the risk of experiencing a second hip fracture. Therefore, this study aimed to investigate the effectiveness of hip structural analysis (HSA) in assessing the risk of second hip fracture in postmenopausal females.

METHODS

This retrospective analysis included 188 patients selected from the Chinese Second Hip Fracture Evaluation (ClinicalTrials.gov identifier: NCT03461237, first registration/posted date: 09/03/2018). They were divided into the second hip fracture (35 cases, with a mean age of 79.33 ± 7.70 years) and the control group (153 cases, with a mean age of 73.41 ± 9.56 years). Parker Mobility Score were determined via telephone follow-up, and two computed tomography scanners were used for images acquisition. All HSA and areal bone mineral density (aBMD) parameters were calculated through Mindways QCTPRO software.

RESULTS

The refracture group showed increased age, decreased cross-sectional area, total hip aBMD, trochanteric aBMD, and intertrochanteric aBMD (p < 0.05). Total hip and intertrochanteric aBMD have a protective effect on the occurrence of a second hip fracture in postmenopausal women, with odd ratios of 0.61 and 0.57, respectively (p < 0.05). Incorporating HSA parameters into the baseline model (used age, type 2 diabetes mellitus, and the PMS as parameters, AUC = 0.729) does not significantly improve the performance of second hip fracture prediction (AUC = 0.748, p < 0.05 in Delong's test).

CONCLUSION

Based on our findings, HSA does not statistically correlate with the incidence of second hip fracture in postmenopausal women. Incorporating HSA parameters into the (baseline) model does not significantly improve the pridictive capabilities.

Barriers to Discharge of Hip Fracture Patients From An Academic Hospital: A Retrospective Data Analysis

Introduction

Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada.

Methods

We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery).

Results

A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR .50, 95% CI .32;.79) compared to a weekday, patients had a total hip replacement (OR .28, 95% CI .10;.80) or dynamic hip screw fixation (OR .49, 95% CI .25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR .05, 95% CI .02;.13), home (OR .26, 95% CI .15;.46), or transferred to another specialty in the hospital (OR .49, 95% CI .29;.84) compared to inpatient rehabilitation.

Conclusions

Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care.

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

Considerable uncertainty prevails regarding risk factors for recurrent fracture among older patients with hip fracture. We aimed to investigate the relationship between prefracture stroke history, baseline mobility, and the risk of recurrent hip fracture. This cohort study was based on the Danish Multidisciplinary Hip Fracture Registry, 2011-2018 (n = 48,230). We estimated cumulative incidence (competing risk of death) of recurrent hip fracture and major osteoporotic fractures within 1 and 2 years comparing patients with/without prefracture stroke history. Analyses were performed overall and stratified on baseline mobility status (good mobility: Cumulated Ambulation Score ≥ 5 versus poor mobility: Cumulated Ambulation Score < 5). Using Cox regression, adjusted cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained. The 1-year cumulative incidence was 4.6% (95% CI: 3.9-5.4) among patients with stroke history and 4.3% (95% CI: 4.1-4.5) among patients without stroke history. For patients with good mobility, the cumulative incidence of recurrent hip fracture was 5.8% (95% CI: 4.3-7.5) versus 3.7% (95% CI: 3.4-4.0) for patients with versus without stroke history. Corresponding numbers for patients with poor mobility were 4.4% (95% CI: 3.6-5.5) and 5.0% (95% CI: 4.7-5.3). Stroke history was associated with an adjusted HR of 1.55 (95% CI: 1.15-2.10) for recurrent fracture among patients with good mobility. In contrast, no association was observed among patients with poor mobility (adjusted HR 0.88 [95% CI: 0.70-1.10]). The associations were attenuated after 2 years of follow-up and for major osteoporotic fractures. In conclusion, stroke history was associated with slightly higher risk of recurrent fracture among patients with first-time hip fracture in the overall analysis, although the CI included a null result. The association was modified by baseline mobility: Patients with stroke history and good mobility had a markedly higher risk, whereas patients with stroke and poor mobility did not. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Second hip fracture in older adults: incidence and risk factors

PURPOSE

A second hip fracture can occur in older adults who have already suffered an initial hip fracture. The aim of this study was to determine the incidence, mortality and risk factors for second hip fractures in older adults with hip fractures.

METHODS

Between 2009 and 2019, 2013 patients (mean age: mean age 76.5 ± 5.4 SD) who were admitted to a tertiary care hospital for a hip fracture surgery were retrospectively analyzed. The patients were divided into two groups: those with a second hip fracture and those without a second hip fracture within the following two years after the initial fracture.

RESULTS

321 patients (15.9%, mean age: 85.3 ± 4.9 SD) sustained a second contralateral hip fracture, the first two years after the initial hip fracture whereas 136 patients (6.8%) sustained a contralateral hip fracture within 12 months. In total 274 (13.6%) died in the first two years after the initial hip fracture; among these, 139 patients (43.3%) had a contralateral second hip fracture. The mean time from the first hip fracture to second hip fracture was 13.2 ± 7.6 months. The advance age, female gender, living alone, dementia, chest and urinary tract infection, chronic heart failure, peripheral vascular disease were identified as risk factors for a second contralateral hip fracture.

CONCLUSIONS

Identifying risk factors for a second contralateral hip fracture can be particularly helpful in providing focused medical assistance.