Osteoporosis International

, Volume 14, Issue 11, pp 879–883 | Cite as

The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies

  • Cathleen Colón-EmericEmail author
  • Maragatha Kuchibhatla
  • Carl Pieper
  • William Hawkes
  • Lisa Fredman
  • Jay Magaziner
  • Sheryl Zimmerman
  • Kenneth W. Lyles
Original Article


Background: The contribution of hip fracture to the risk of subsequent fractures is unclear. Methods: Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture (n=549) and EPESE subjects without previous fractures at baseline (n=10,680) were followed for 2–10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment. Results: The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time. Conclusions: A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.


Aged Epidemiology Hip fracture 



This study was supported by the Hartford/AFAR Academic Geriatric Fellowship Program, the Institute for Medical Research at the Durham VA Medical Center, The Claude A. Pepper Older American’s Independence Center AG-11268, and a Brookdale National Geriatrics Fellowship. Participants were selected from the Established Populations for Epidemiologic Studies of the Elderly, which was performed pursuant to NIA Contract Number N01-AG-1-2102, and the Baltimore Hip Studies funded by NIA R37 A609901.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • Cathleen Colón-Emeric
    • 1
    • 5
    Email author
  • Maragatha Kuchibhatla
    • 1
  • Carl Pieper
    • 1
  • William Hawkes
    • 2
  • Lisa Fredman
    • 3
  • Jay Magaziner
    • 2
  • Sheryl Zimmerman
    • 4
  • Kenneth W. Lyles
    • 1
    • 5
  1. 1.Center for the Study of Aging and Human Development, Department of Biometry and BioinformaticsDuke University Medical CenterDurhamUSA
  2. 2.Department of Epidemiology and Preventive MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of Epidemiology and BiostatisticsBoston University School of Public HealthBostonUSA
  4. 4.Cecil G. Sheps Center for Health Services ResearchUniversity of North CarolinaChapel HillUSA
  5. 5.Geriatrics Research Education and Clinical CenterDurham VA Medical CenterDurhamUSA

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