Incidence, timing and impact of comorbidity on second hip fracture: a population-based study

Lara Harvey, Barbara Toson, Rebecca Mitchell, Henry Brodaty, Brian Draper, Jacqueline Close

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: To quantify the incidence and timing of second hip fracture, and to evaluate the relative impact of comorbidities on risk of second hip fracture. Methods: Hospitalization records for individuals aged ≥65, admitted to a New South Wales hospital for fall-related hip fracture between 1 January 2005 and 31 December 2009 were linked. Comorbidities were identified from the records using a 1-year look-back period. To calculate second hip fracture rates, individuals were followed until death, fracture or end of study period (31 December 2012). Time-dependent competing-risk hazards regression was used to assess the relative contribution of each comorbidity to fracture risk, adjusting for age and sex. Results: Of the 24500 individuals who sustained at least one hip fracture, 2.9% experienced a second within a year, 6.1% within 3 years and 9.4% within 8 years. Malnutrition/cachexia (hazard ratio (HR): 2.47; 99.9% confidence interval (CI): 1.87-3.26), dementia (HR: 2.15; 99.9% CI: 1.80-2.57), congestive heart failure (HR: 1.62; 99.9% CI: 1.30-2.04), Parkinson's disease (HR: 1.51; 99.9% CI: 1.08-2.10), cerebrovascular disease (HR: 1.41; 99.9% CI: 1.06-1.89) and osteoporosis (HR: 1.36; 99.9% CI: 1.11-1.67) were associated with increased risk of second hip fracture within 3 years. Mortality was high; with 26% of individuals dying within a year, 44.9% within 3 years and 70.2% within 8 years. Conclusions: One in 11 older individuals with an initial hip fracture sustained a second hip fracture. While the priority is to prevent the first hip fracture, those that have sustained a hip fracture should be seen as a high risk population and be targeted for future falls and fracture prevention strategies.

LanguageEnglish
Pages577-581
Number of pages5
JournalANZ Journal of Surgery
Volume88
Issue number6
DOIs
Publication statusPublished - Jun 2018

Fingerprint

Hip Fractures
Comorbidity
Incidence
Population
Confidence Intervals
Cerebrovascular Disorders
Cachexia
New South Wales
Malnutrition
Osteoporosis
Parkinson Disease
Dementia
Hospitalization
Heart Failure
Mortality

Keywords

  • Accidental falls
  • Comorbidity
  • Dementia
  • Hip fracture
  • Hospitalizations

Cite this

Harvey, Lara ; Toson, Barbara ; Mitchell, Rebecca ; Brodaty, Henry ; Draper, Brian ; Close, Jacqueline. / Incidence, timing and impact of comorbidity on second hip fracture : a population-based study. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 6. pp. 577-581.
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abstract = "Background: To quantify the incidence and timing of second hip fracture, and to evaluate the relative impact of comorbidities on risk of second hip fracture. Methods: Hospitalization records for individuals aged ≥65, admitted to a New South Wales hospital for fall-related hip fracture between 1 January 2005 and 31 December 2009 were linked. Comorbidities were identified from the records using a 1-year look-back period. To calculate second hip fracture rates, individuals were followed until death, fracture or end of study period (31 December 2012). Time-dependent competing-risk hazards regression was used to assess the relative contribution of each comorbidity to fracture risk, adjusting for age and sex. Results: Of the 24500 individuals who sustained at least one hip fracture, 2.9{\%} experienced a second within a year, 6.1{\%} within 3 years and 9.4{\%} within 8 years. Malnutrition/cachexia (hazard ratio (HR): 2.47; 99.9{\%} confidence interval (CI): 1.87-3.26), dementia (HR: 2.15; 99.9{\%} CI: 1.80-2.57), congestive heart failure (HR: 1.62; 99.9{\%} CI: 1.30-2.04), Parkinson's disease (HR: 1.51; 99.9{\%} CI: 1.08-2.10), cerebrovascular disease (HR: 1.41; 99.9{\%} CI: 1.06-1.89) and osteoporosis (HR: 1.36; 99.9{\%} CI: 1.11-1.67) were associated with increased risk of second hip fracture within 3 years. Mortality was high; with 26{\%} of individuals dying within a year, 44.9{\%} within 3 years and 70.2{\%} within 8 years. Conclusions: One in 11 older individuals with an initial hip fracture sustained a second hip fracture. While the priority is to prevent the first hip fracture, those that have sustained a hip fracture should be seen as a high risk population and be targeted for future falls and fracture prevention strategies.",
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Incidence, timing and impact of comorbidity on second hip fracture : a population-based study. / Harvey, Lara; Toson, Barbara; Mitchell, Rebecca; Brodaty, Henry; Draper, Brian; Close, Jacqueline.

In: ANZ Journal of Surgery, Vol. 88, No. 6, 06.2018, p. 577-581.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Incidence, timing and impact of comorbidity on second hip fracture

T2 - Australian and New Zealand Journal of Surgery

AU - Harvey, Lara

AU - Toson, Barbara

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AU - Close, Jacqueline

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AB - Background: To quantify the incidence and timing of second hip fracture, and to evaluate the relative impact of comorbidities on risk of second hip fracture. Methods: Hospitalization records for individuals aged ≥65, admitted to a New South Wales hospital for fall-related hip fracture between 1 January 2005 and 31 December 2009 were linked. Comorbidities were identified from the records using a 1-year look-back period. To calculate second hip fracture rates, individuals were followed until death, fracture or end of study period (31 December 2012). Time-dependent competing-risk hazards regression was used to assess the relative contribution of each comorbidity to fracture risk, adjusting for age and sex. Results: Of the 24500 individuals who sustained at least one hip fracture, 2.9% experienced a second within a year, 6.1% within 3 years and 9.4% within 8 years. Malnutrition/cachexia (hazard ratio (HR): 2.47; 99.9% confidence interval (CI): 1.87-3.26), dementia (HR: 2.15; 99.9% CI: 1.80-2.57), congestive heart failure (HR: 1.62; 99.9% CI: 1.30-2.04), Parkinson's disease (HR: 1.51; 99.9% CI: 1.08-2.10), cerebrovascular disease (HR: 1.41; 99.9% CI: 1.06-1.89) and osteoporosis (HR: 1.36; 99.9% CI: 1.11-1.67) were associated with increased risk of second hip fracture within 3 years. Mortality was high; with 26% of individuals dying within a year, 44.9% within 3 years and 70.2% within 8 years. Conclusions: One in 11 older individuals with an initial hip fracture sustained a second hip fracture. While the priority is to prevent the first hip fracture, those that have sustained a hip fracture should be seen as a high risk population and be targeted for future falls and fracture prevention strategies.

KW - Accidental falls

KW - Comorbidity

KW - Dementia

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