Osteoporosis International

, Volume 21, Issue 8, pp 1411–1416 | Cite as

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

  • K. Nakamura
  • S. Takahashi
  • M. Oyama
  • R. Oshiki
  • R. Kobayashi
  • T. Saito
  • Y. Yoshizawa
  • Y. Tsuchiya
Original Article



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.


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


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.


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.


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.


Cohort studies Fracture history Hip fracture Nursing homes Risk factors 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • K. Nakamura
    • 1
  • S. Takahashi
    • 2
  • M. Oyama
    • 1
  • R. Oshiki
    • 3
  • R. Kobayashi
    • 3
  • T. Saito
    • 4
  • Y. Yoshizawa
    • 5
  • Y. Tsuchiya
    • 1
  1. 1.Department of Community Preventive MedicineNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  2. 2.Niigata University School of MedicineNiigataJapan
  3. 3.Department of Physical TherapyNiigata University of Health and WelfareNiigataJapan
  4. 4.Department of Health and NutritionNiigata University of Health and WelfareNiigataJapan
  5. 5.Niigata Council of Institutions for the ElderlyNiigataJapan

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