Prior non-hip fractures predict future hip fracture in institutional settings
MedWire News: Prior fracture of limbs other than the hip independently predicts subsequent hip fracture in elderly nursing home residents, Japanese researchers report.
"Hip fractures affect many aspects of health in elderly populations, including the ability to conduct activities of daily living (ADL) and especially mobility," say Kazutoshi Nakamura, from Niigata University Graduate School of Medical and Dental Sciences, and colleagues.
"Nursing home residents are recognized as a high-risk group for hip fracture," they add.
To evaluate the utility of fracture history for the prediction of hip fracture, Nakamura and team studied 8905 residents (77% women) of 140 nursing homes in Niigata aged 84.3 years on average.
Medical records showed that 5% of participants had a history of upper limb fracture, 14% had a history of hip fracture, and 4.6% had a history of non-hip lower limb fracture.
The 1-year incidence of hip fracture was 14.9 per 1000 person-years for women and 9.7 per 1000 person-years for men.
The researchers report that a history of single fracture to non-hip lower limbs was significantly associated with a 2.43-fold increased risk for subsequent hip fracture, compared with no fracture history.
A combination of historical fractures at upper limbs or non-hip lower limbs was significantly associated with a 2.14-fold increased risk for future hip fracture, independent of ADL levels, mobility, dependence, dementia, weight, and type of nursing home.
In contrast, historical hip fracture did not predict future hip fracture, a finding that is inconsistent with current knowledge.
Nakamura et al suggest this may be because study participants were cared for by nurses or trained caregivers day and night in an institutional setting. "In such a setting, residents with a previous hip fracture may be more carefully treated than those without it," they say.
"The present study is the first to demonstrate the importance of lower limb fractures at sites other than the hip in predicting future hip fracture," remark Nakamura and co-authors in the journal Osteoporosis International.
They conclude: "These findings, in combination with other known risk factors, have practical utility for the prediction of hip fracture in institutional settings."
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By Laura Dean