Rates of second hip fracture high in elderly

Last Updated: 2007-10-25 15:11:38 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Older men and women who have fractured a hip have a high risk of fracturing the other hip, according to a study that included members of the Framingham Heart Study.

"All persons with a hip fracture should be given calcium and vitamin D and should be evaluated for risk of falls," Dr. Sarah D. Berry told Reuters Health. "Persons who are at particularly high risk for second fracture, such as older persons who were functionally active at the time of a first hip fracture, should be considered for additional osteoporotic therapy (such as a bisphosphonate) as well."

Berry from Beth Israel Deaconess Medical Center, Boston, and colleagues investigated the timing, incidence, risk factors, and mortality associated with second hip fractures among 481 members of the Framingham Heart Study with a first hip fracture.

After an average follow-up of 4.2 years, 14.8 percent of the subjects sustained a second hip fracture, with most involving the hip opposite the initial fracture, the authors report in the Archives of Internal Medicine.

The rate was nearly twice as high among women (2.5 cases per 100 persons per year) as among men (1.3 cases per 100 persons per years).

Mortality in the first year after a second hip fracture (24.1 percent) was higher than that in the first year after an initial hip fracture, at 24.1 and 15.9 percent, respectively, the investigators found.

Further analysis revealed that older age and higher functional status were significant predictors of a second hip fracture, with the risk increasing 1.5-fold for each 5 years of advancing age, and 2.7-fold for high-functioning persons compared with moderate-functioning persons.

"High functional status predicts improved physical recovery following an initial hip fracture, which may result in increased opportunities for these individuals to survive and fall after the initial hip fracture," the researchers suggest.

The study only evaluated the rate of second hip fractures, Berry said. "If the incidence of all fractures was calculated following an initial hip fracture, it is likely to be even higher."

Berry is currently conducting a small study to determine whether patients will follow recommendations of a program designed to reduce the risk of additional falls and fractures, which would be introduced during rehabilitation for a first fracture.

She said that this program would include "medications for osteoporosis (bisphosphonates, calcium, and vitamin D) plus common sense recommendations to reduce the risk of future falls."

SOURCE: Archives of Internal Medicine, October 8, 2007.