Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: incidence and risk factors. An observational cohort study of 1,229 patients

Anne J H Vochteloo, Boudewijn L S Borger van der Burg, Maarten A Röling, Diederik H van Leeuwen, Peter van den Berg, Arthur H P Niggebrugge, Mark R de Vries, Wim E Tuinebreijer, Rolf M Bloem, Rob G H H Nelissen, Peter Pilot, Anne J H Vochteloo, Boudewijn L S Borger van der Burg, Maarten A Röling, Diederik H van Leeuwen, Peter van den Berg, Arthur H P Niggebrugge, Mark R de Vries, Wim E Tuinebreijer, Rolf M Bloem, Rob G H H Nelissen, Peter Pilot

Abstract

Purpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population.

Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005 and June 2009. Fractures were scored retrospectively for 2005-2008 and prospectively for 2008-2009. Rates of a contralateral hip and other osteoporosis-related fractures were compared between patients with and without a history of a fracture. Previous fractures, gender, age and ASA classification were analysed as possible risk factors.

Results: The absolute risk for a contralateral hip fracture was 13.8 %, for one or more osteoporosis-related fracture(s) 28.6 %. First-, second- and third-year risk for a second hip fracture was 2, 1 and 0 %. Median (IQR) interval between both hip fractures was 18.5 (26.6) months. One-year incidence of other fractures was 6 %. Only age was a risk factor for a contralateral hip fracture, hazard ratio (HR) 1.02 (1.006-1.042, p = 0.008). Patients with a history of a fracture (33.1 %) did not have a higher incidence of fractures during follow-up (16.7 %) than patients without fractures in their history (14 %). HR for a contralateral hip fracture for the fracture versus the non-fracture group was 1.29 (0.75-2.23, p = 0.360).

Conclusion: The absolute risk of a contralateral hip fracture after a hip fracture is 13.8 %, the 1-year risk was 2 %, with a short interval between the 2 hip fractures. Age was a risk factor for sustaining a contralateral hip fracture; a fracture in history was not.

References

    1. Ahlborg HG, Rosengren BE, Järvinen TLN, Rogmark C, Nilsson J-A, Sernbo I, et al. Prevalence of osteoporosis and incidence of hip fracture in women–secular trends over 30 years. BMC Musculoskelet Disord. 2010;11:11–48. doi: 10.1186/1471-2474-11-48.
    1. Cummings S, Melton L. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–1767. doi: 10.1016/S0140-6736(02)08657-9.
    1. Curran D, Maravic M, Kiefer P, Tochon V, Fardellone P. Epidemiology of osteoporosis-related fractures in France: a literature review. Jt Bone Spine. 2010;77:546–551. doi: 10.1016/j.jbspin.2010.02.006.
    1. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721–739. doi: 10.1359/jbmr.2000.15.4.721.
    1. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, et al. Fracture risk following an osteoporotic fracture. Osteoporos Int. 2004;15:175–179. doi: 10.1007/s00198-003-1514-0.
    1. Bass E, French DD, Bradham DD, Rubenstein LZ. Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol. 2007;17:514–519. doi: 10.1016/j.annepidem.2006.12.004.
    1. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–521. doi: 10.1001/jama.2009.50.
    1. Compston J. Osteoporosis: social and economic impact. Radiol Clin N Am. 2010;48:477–482. doi: 10.1016/j.rcl.2010.02.010.
    1. Hamdy RC. Fracture risk assessment in postmenopausal women. Rev Endocr Metab Disord. 2009;11:229–236. doi: 10.1007/s11154-009-9118-4.
    1. Dell R, Greene D, Schelkun SR, Williams K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Jt Surg Am 90(Suppl 4):188–194
    1. Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteopor Rep. 2003;1:78–85. doi: 10.1007/s11914-003-0013-8.
    1. Blonk MC, Erdtsieck RJ, Wernekinck MG, Schoon EJ. The fracture and osteoporosis clinic: 1-year results and 3-month compliance. Bone. 2007;40:1643–1649. doi: 10.1016/j.bone.2007.01.023.
    1. van Helden S, Cals J, Kessels F, Brink P, Dinant GJ, Geusens P. Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int. 2006;17:348–354. doi: 10.1007/s00198-005-2026-x.
    1. Lönnroos E, Kautiainen H, Karppi P, Hartikainen S, Kiviranta I, Sulkava R. Incidence of second hip fractures. A population-based study. Osteoporos Int. 2007;18:1279–1285. doi: 10.1007/s00198-007-0375-3.
    1. Berry SD, Samelson EJ, Hannan MT, McLean RR, Lu M, Cupples LA, et al. Second hip fracture in older men and women: the Framingham Study. Arch Int Med. 2007;167:1971–1976. doi: 10.1001/archinte.167.18.1971.
    1. Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–243. doi: 10.1097/00000542-197810000-00003.
    1. Lawrence TM, Wenn R, Boulton CT, Moran CG. Age-specific incidence of first and second fractures of the hip. J Bone Jt Surg Br. 2010;92:258–261.
    1. Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR. Incidence and risk factors for a second hip fracture in elderly women. The study of osteoporotic fractures. Osteoporos Int. 2003;14:130–136.
    1. Chiu KY, Pun WK, Luk KD, Chow SP. Sequential fractures of both hips in elderly patients—a prospective study. J Trauma. 1992;32:584–587. doi: 10.1097/00005373-199205000-00008.
    1. Stolee P, Poss J, Cook RJ, Byrne K, Hirdes JP. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci. 2009;64:403–410. doi: 10.1093/gerona/gln035.
    1. Nymark T, Lauritsen JM, Ovesen O, Röck ND, Jeune B. Short time-frame from first to second hip fracture in the Funen County hip fracture study. Osteoporos Int. 2006;17:1353–1357. doi: 10.1007/s00198-006-0125-y.
    1. Kok LM, van der Steenhoven TJ, Nelissen RG. A retrospective analysis of bilateral fractures over sixteen years: localisation and variation in treatment of second hip fractures. Int Orthop. 2011;35:1545–1551. doi: 10.1007/s00264-010-1176-4.
    1. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin C-H, Rizzoli R. Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone. 2007;40:1284–1289. doi: 10.1016/j.bone.2006.12.063.
    1. Fukushima T, Sudo A, Uchida A. Bilateral hip fractures. J Orthop Sci. 2006;11:435–438. doi: 10.1007/s00776-006-1056-3.
    1. Schrøder HM, Petersen KK, Erlandsen M. Occurrence and incidence of the second hip fracture. Clin Orthop Relat Res. 1993;289:166–169.
    1. Silverman SL, Watts NB, Delmas PD, Lange JL, Lindsay R. Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study. Osteoporos Int. 2007;18:25–34. doi: 10.1007/s00198-006-0274-z.
    1. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344–1352. doi: 10.1001/jama.282.14.1344.
    1. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11:83–91. doi: 10.1007/s001980050010.
    1. Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 1995;333:1437–1443. doi: 10.1056/NEJM199511303332201.
    1. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535–1541. doi: 10.1016/S0140-6736(96)07088-2.
    1. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the fracture intervention trial. JAMA. 1998;280:2077–2082. doi: 10.1001/jama.280.24.2077.
    1. Harrington JT, Ste-Marie L-G, Brandi ML, Civitelli R, Fardellone P, Grauer A, et al. Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis. Calcif Tissue Int. 2004;74(2):129–135. doi: 10.1007/s00223-003-0042-4.
    1. Pols HA, Felsenberg D, Hanley DA, Stepán J, Muñoz-Torres M, Wilkin TJ, et al. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax international trial study group. Osteoporos Int. 1999;9:461–468. doi: 10.1007/PL00004171.
    1. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the fracture intervention trial. FIT Research Group. J Clin Endocrinol Metab. 2000;85:4118–4124. doi: 10.1210/jc.85.11.4118.

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