Original Article

Osteoporosis International

, Volume 21, Issue 8, pp 1411-1416

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

  • K. NakamuraAffiliated withDepartment of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences Email author 
  • , S. TakahashiAffiliated withNiigata University School of Medicine
  • , M. OyamaAffiliated withDepartment of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
  • , R. OshikiAffiliated withDepartment of Physical Therapy, Niigata University of Health and Welfare
  • , R. KobayashiAffiliated withDepartment of Physical Therapy, Niigata University of Health and Welfare
  • , T. SaitoAffiliated withDepartment of Health and Nutrition, Niigata University of Health and Welfare
  • , Y. YoshizawaAffiliated withNiigata Council of Institutions for the Elderly
  • , Y. TsuchiyaAffiliated withDepartment of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences

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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.

Keywords

Cohort studies Fracture history Hip fracture Nursing homes Risk factors