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Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

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Abstract

Summary

This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings.

Introduction

The aim of this study was to evaluate the utility of fracture history for the prediction of hip fracture in nursing home residents.

Methods

This was a cohort study with a 1-year follow-up. Subjects were 8,905 residents of nursing homes in Niigata, Japan (mean age, 84.3 years). Fracture histories were obtained from nursing home medical records. ADL levels were assessed by caregivers. Hip fracture diagnosis was based on hospital medical records.

Results

Subjects had fracture histories of upper limbs (5.0%), hip (14.0%), and nonhip lower limbs (4.6%). Among historical single fractures, only prior nonhip lower limbs significantly predicted subsequent fracture (adjusted hazard ratio, 2.43; 95% confidence interval (CI), 1.30–4.57). The stepwise method selected the best model, in which a combined historical fracture at upper limbs or nonhip lower limbs (adjusted hazard ratio, 2.14; 95% CI, 1.30–3.52), dependence, ADL levels, mobility, dementia, weight, and type of nursing home independently predicted subsequent hip fracture.

Conclusions

A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.

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Acknowledgments

We wish to thank the Niigata Council of Institutions for the Elderly for their assistance in data collection. We also thank Ms. A. Kagoshima for help with data analysis. This study was supported in part by a grant from the Chiyoda Mutual Life Foundation, 2006.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan

    K. Nakamura, M. Oyama & Y. Tsuchiya

  2. Niigata University School of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan

    S. Takahashi

  3. Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 951-3198, Japan

    R. Oshiki & R. Kobayashi

  4. Department of Health and Nutrition, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 951-3198, Japan

    T. Saito

  5. Niigata Council of Institutions for the Elderly, Kamitokoro 2-2-2, Chuo-ku, Niigata, 950-0994, Japan

    Y. Yoshizawa

Authors
  1. K. Nakamura
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  2. S. Takahashi
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  3. M. Oyama
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  4. R. Oshiki
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  5. R. Kobayashi
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  6. T. Saito
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  7. Y. Yoshizawa
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  8. Y. Tsuchiya
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Corresponding author

Correspondence to K. Nakamura.

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Nakamura, K., Takahashi, S., Oyama, M. et al. Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people. Osteoporos Int 21, 1411–1416 (2010). https://doi.org/10.1007/s00198-009-1081-0

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  • DOI: https://doi.org/10.1007/s00198-009-1081-0

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