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

Abstract

Summary

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.

Introduction

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.

Methods

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).

Results

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).

Conclusion

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

Keywords

Hip fracture Nursing home residents Osteoporosis Osteoporotic fractures 

Notes

Acknowledgements

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.

References

  1. 1.
    Wahren GE, Hawkes WG, Hebel JR et al (2005) Bone mineral density, soft tissue body composition, strength, and functioning after hip fracture. J Gerontol A Bio Sc Med Sci 60:80–84Google Scholar
  2. 2.
    Zimmerman S, Chandler JM, Hawkes W et al (2002) Effect of fracture on the healthcare use of nursing home residents. Arch Intern Med 162:1502–1508PubMedCrossRefGoogle Scholar
  3. 3.
    Colon-Emeric SC, Biggs DP, Schenck AP et al (2003) Risk factors for hip fractures in skilled nursing facilities: who should be evaluated? Osteoporosis Int 14:484–489CrossRefGoogle Scholar
  4. 4.
    Girman CJ, Chandler JM, Zimmerman SI et al (2002) Prediction of fracture in nursing home residents. J Am Geriatr Soc 50:1341–1347PubMedCrossRefGoogle Scholar
  5. 5.
    Sugarman JR, Connell FA, Hansen A et al (2002) Hip fracture incidence in nursing home residents and community-dwelling older people, Washington State, 1993–1995. J Am Geriatr Soc 50:1638–1643PubMedCrossRefGoogle Scholar
  6. 6.
    Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  7. 7.
    Rothman KJ (eds) (1986) Modern epidemiology. Little, Brown, BostonGoogle Scholar
  8. 8.
    Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
  9. 9.
    Lindsay R, Silverman S, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedCrossRefGoogle Scholar
  10. 10.
    Colon-Emeric C, Kuchibhatla M, Pieper C et al (2003) The contribution of hip fracture to the risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–883PubMedCrossRefGoogle Scholar
  11. 11.
    Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  12. 12.
    Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194PubMedCrossRefGoogle Scholar
  13. 13.
    De Laet CEDH, Van Hout BA, Baurger H et al (1998) Hip fracture prediction in elderly men and women: validation of the Rotterdam study. J Bone Miner Res 13:1587–1593PubMedCrossRefGoogle Scholar
  14. 14.
    Melton LJ III, Crowson CS, O’Fallon WM et al (2003) Relative contributions of bone density, bone turnover and clinical risk factors to long-term fracture prediction. J Bone Miner Res 18:312–318PubMedCrossRefGoogle Scholar
  15. 15.
    Taylor BC, Schreiner PJ, Stone KL et al (2004) Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 52:1479–1486PubMedCrossRefGoogle Scholar
  16. 16.
    Ensrud KE, Blackwell T, Mangione CM et al (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163:949–957PubMedCrossRefGoogle Scholar
  17. 17.
    Kanis JA, Borgstrom F, De Laet C et al (2005) Assessment of fracture risk. Osteoporos Int 16:581–589PubMedCrossRefGoogle Scholar
  18. 18.
    National Osteoporosis Foundation (2003) Physician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DCGoogle Scholar
  19. 19.
    Fink HA, Kuskowski MA, Orwoll ES et al (2005) Association between Parkinson’s disease and low bone density and falls in older men: the osteoporotic fractures in men study. J Am Geriatr Soc 53:1559–1564PubMedCrossRefGoogle Scholar
  20. 20.
    Melton LJ III, Beard CM, Kokmen E et al (1994) Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc 42:614–619PubMedGoogle Scholar
  21. 21.
    Whooley M, Kip KE, Cauley JA et al (1999) Depression falls and risk of fracture in older women. Arch Intern Med 159:484–489PubMedCrossRefGoogle Scholar
  22. 22.
    Ramnemark A, Nilsson M, Borssen B et al (2000) Stroke, a major and increasing risk factor for femoral neck fractures. Stroke 31:1572–1577PubMedGoogle Scholar
  23. 23.
    Kanis J, Oden A, Hohnell O (2001) Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 32:702–706PubMedGoogle Scholar
  24. 24.
    Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the Nurses’ Health Study. Diabetes Care 29:1573–1578PubMedCrossRefGoogle Scholar
  25. 25.
    Lipscombe LL, Jamal SA, Booth GL, Hawker GA (2007) The risk of hip fractures in older individuals with diabetes: a population-based study. Diabetes Care 30:835–841PubMedCrossRefGoogle Scholar
  26. 26.
    Whitson HW, Pieper CF, Sander L et al (2006) Adding injury to insult: fracture risk after stroke in veterans. J Am Geriatr Soc 54:1082–1088PubMedCrossRefGoogle Scholar
  27. 27.
    Ray W, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45(7):703–714PubMedCrossRefGoogle Scholar
  28. 28.
    Del Rio RA, Goldman M, Kapella BK, Sulit L, Murray PK (2006) The accuracy of Minimum Data Set diagnoses in describing recent hospitalization at acute care facilities. J Am Med Dir Assoc 7(4):212–218PubMedCrossRefGoogle Scholar
  29. 29.
    Colon-Emeric C, Lyles KW, Levine DA et al (2007) Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporosis Int 18:553–559PubMedCrossRefGoogle Scholar
  30. 30.
    Jachna AC, Shireman T, Whittle J et al (2005) Differing patterns of antiresorptive pharmacotherapy among nursing facility residents and community dwellers. J Am Geriatr Soc 53:1275–1281PubMedCrossRefGoogle Scholar
  31. 31.
    Kamel HK (2004) Underutilization of calcium and vitamin D supplements in an academic long-term care facility. J Am Med Dir Assoc 5:98–100PubMedCrossRefGoogle Scholar

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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