Osteoporosis International

, Volume 19, Issue 8, pp 1225–1233 | Cite as

Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents

  • K. W. Lyles
  • A. P. Schenck
  • C. S. Colón-Emeric
Original Article



Nursing home residents with a history of hip fractures or prior osteoporotic fractures were found to have an increased risk of another osteoporotic fracture over the ensuing two years when compared to nursing home residents with no fracture history.


Because of the high prevalence of osteoporosis and fall risk factors in nursing home residents, it is possible that the importance of previous fracture as a marker for subsequent fracture risk may be diminished. We tested whether a history of prior osteoporotic fractures would identify residents at increased risk of additional fractures after nursing home admission.


We identified all Medicare enrollees aged 50 and older who were in a nursing home in North Carolina in 2000 (n = 30,655). We examined Medicare hospitalization claims to determine which enrollees had been hospitalized in the preceding 4 years for a hip fracture (n = 7,257) or other fracture (n = 663). We followed participants from nursing home entry until the end of 2002 using Medicare hospital claims to determine which participants were hospitalized with a subsequent fracture (n = 3,381).


Among residents with no recent fracture history, 6.8% had a hospital claim for a subsequent fracture, while 15.1% of those with a prior non-hip fracture and 23.9% of participants with a prior hip fracture sustained subsequent fractures. Multivariate proportional hazards models of time to fracture indicated that persons with prior hip fractures are at three times higher risk (HR = 2.99, 95% CI: 2.78, 3.21) and those hospitalized with other non-hip fractures are at 1.8 times higher risk of subsequent fractures (HR = 1.84, 95% CI: 1.50, 2.25).


Nursing home residents hospitalized with a prior osteoporotic fracture are at increased risk of a fracture.


Hip fracture Nursing home residents Osteoporosis Osteoporotic fractures 



The analyses upon which this publication is based were performed under Contract No. 500-02-NC03 (“Utilization and Quality Control Peer Review Organization for the State of North Carolina”), funded by the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Supported by the Alliance for Better Bone Health, The Claude A. Pepper Older American Independence Center AG-11268, and the VA Medical Research Service. Dr. Colon-Emeric is supported by a Paul A. Beeson award K23 AG024787.

Conflicts of interest

Dr. Lyles: Research support: Novartis, Alliance for Better Bone Health, Amgen; consultant: Novartis, Procter & Gamble, Merck, Amgen, GTx, Lilly, GSK, Bone Medical Ltd; patent—use patent inventor: “Methods for preventing or reducing secondary fractures after hip fracture,” US Patent Application 20050272707; patent—provisional patent application inventor: “Medication Kits and Formulations for Preventing, Treating or Reducing Secondary Fractures After Previous Fracture.” Dr. Colon-Emeric: Research support and a consultant agreement with Novartis Pharmaceuticals.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • K. W. Lyles
    • 1
    • 2
    • 3
  • A. P. Schenck
    • 2
  • C. S. Colón-Emeric
    • 1
    • 3
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.The Carolina Center for Medical ExcellenceCaryUSA
  3. 3.Geriatrics Research, Education and Clinical Center, VA Medical CenterDurhamUSA

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