Hip fracture increases death risk. Ten percent of survivors have second hip fracture. It is not known if second hip fracture further increases death risk. Here, we report that second hip fracture increases death risk beyond that expected for an increase in age. Secondary prevention after hip fracture could save lives.
The purpose of this study is to determine if second hip fracture is associated with an increased death rate.
We retrieved 42,435 hospitalization records of patients aged 60 years or older, who were discharged after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to death.
During follow-up, the average monthly death rate was 16.2 (95 % CI 16.0–16.4) per 1000 patient-months for those without second hip fracture and 21.1 (95 % CI 20.2–22.1) per 1000 patient-months for those with second hip fracture. The hazard of death was 55 % higher for patients with second hip fracture compared to those without second hip fracture (HR = 1.55, 95 % CI 1.47–1.63). The hazard of death was 58 % higher for men with second hip fracture than in men without second hip fracture (HR = 1.58, 95 % CI 1.42–1.75). The hazard of death was 54 % higher for women with second hip fracture compared to women without second hip fracture (HR = 1.54, 95 % CI 1.46–1.63). These sex-specific HRs were not statistically different (p = 0.70).
Our results are the first to show that second hip fracture increases the risk of death above that anticipated for an increase in age for both men and women. Effective secondary prevention strategies could not only reduce morbidity after hip fracture but could also save lives.
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Conflicts of interest
Pierre Guy has received grants from the Canadian Institutes of Health Research related to this work. He also receives funding from the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation, and the British Columbia Specialists Services Committee for the work around hip fracture care not related to this manuscript. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopedics (as a product development consultant). He is a board member and shareholder in Traumis Surgical Systems Inc. and a board member for the Canadian Orthopedic Foundation. He also serves on the speakers’ bureaus of AO Trauma North America and Stryker Canada.
Katie Sheehan is a postdoctoral fellow whose salary is paid by the Canadian Institutes of Health Research funding related to this work.
Boris Sobolev and Lisa Kuramoto declare that they have no conflict of interest.
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Sobolev, B., Sheehan, K.J., Kuramoto, L. et al. Excess mortality associated with second hip fracture. Osteoporos Int 26, 1903–1910 (2015). https://doi.org/10.1007/s00198-015-3104-3