Osteoporos Int. 2015 Jul;26(7):1903-10. doi: 10.1007/s00198-015-3104-3.
EXCESS MORTALITY ASSOCIATED WITH SECOND HIP FRACTURE
Boris Soboleva, Katie Jane Sheehana, Lisa Kuramotob, Pierre Guyc,d.
a School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
b Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
c Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
d Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
Hip fracture increases death risk. Ten percent of survivors have second hip fracture. It is not known if second hip fracture further increases death risk. Here, we report that second hip fracture increases death risk beyond that expected for an increase in age. Secondary prevention after hip fracture could save lives.
The purpose of this study is to determine if second hip fracture is associated with an increased death rate.
We retrieved 42,435 hospitalization records of patients aged 60 years or older, who were discharged after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to death.
During follow-up, the average monthly death rate was 16.2 (95 % CI 16.0–16.4) per 1000 patient months for those without second hip fracture and 21.1 (95 % CI 20.2–22.1) per 1000 patient-months for those with second hip fracture. The hazard of death was 55 % higher for patients with second hip fracture compared to those without second hip fracture (HR=1.55, 95 % CI 1.47–1.63). The hazard of death was 58 % higher for men with second hip fracture than in men without second hip fracture (HR=1.58, 95 % CI 1.42–1.75). The hazard of death was 54 % higher for women with second hip fracture compared to women without second hip fracture (HR=1.54, 95 % CI 1.46–1.63). These sex specific HRs were not statistically different (p=0.70).
Our results are the first to show that second hip fracture increases the risk of death above that anticipated for an increase in age for both men and women. Effective secondary prevention strategies could not only reduce morbidity after hip fracture but could also save lives.
- Excess mortality persists for a decade after first hip fracture.
- One in ten hip fracture survivors will have a second hip fracture.
- It is not clear if second hip fracture further increases death rate and whether there is a difference between men and women.
- Higher death rate linked to second hip fracture
- No difference in excess mortality after second hip fracture between men and women.
- Secondary prevention should target both men and women.
Related articles published by the research group:
- Sobolev B, Sheehan KJ, Kuramoto L, Guy P. Risk of second hip fracture persists for years after initial trauma. Bone 2015; (75): 72-76. PMID: 25681701
- Sheehan KJ, Sobolev B, Guy P, Bohm E, Sutherland JM, Kuramoto L, Hellsten E, Jaglal S for the Canadian Collaborative on Hip Fractures. Constructing episode of care from acute hospital records for studying effects of timing of hip fracture surgery. Journal of Orthopaedic Research 2015 doi: 10.1002/jor.22997. PMID: 26228250
In the Canadian elderly, hip fractures occur as frequently as common cancers, with 28,000 hospitalized every year. Hip fracture has been dubbed the hip attack, referring to its clinical acuity and lasting dangers. Much like after a heart attack, life will never be the same after hip fracture. Disability, dependence, and social isolation render hip fracture one of the most devastating events in the life of an older adult.
A recent conference in Oxford brought Boris Sobolev to an exhibition showing Dürer’s Four Horsemen, among other rarities. The connection between images on the print and the reality of the hip attack did not escape him. The first horseman, Conquest, the trauma itself, comes to defeat the frail through pain, immobility and suffering. The second horseman, War, brings the battle of competing needs to our health care, making hospitals prioritize one urgent procedure over another. The horseman with scales comes to dispense access to care. And the rider of a pale horse comes to harvest death toll among the injured.
Boris Sobolev, PhD
Professor | School of Population and Public Health
The University of British Columbia | Vancouver
spph.ubc.ca/person/boris-sobolev | amazon.com/author/sobor
The Canadian collaborative study of hip fractures | @HFstudy