Calcified Tissue International

, Volume 102, Issue 6, pp 619–626 | Cite as

Second Hip Fracture: Incidence, Trends, and Predictors

  • Ramón Mazzucchelli
  • Elia Pérez-Fernández
  • Natalia Crespí
  • Alberto García-Vadillo
  • Gil Rodriguez Caravaca
  • Angel Gil de Miguel
  • Loreto Carmona
Original Research


Older persons who have suffered a hip fracture (HFx) are at increased risk of subsequent hip fractures. The cumulative incidence of a second hip fracture (SHFx) has been estimated in 8.4%; however, no studies have been carried out in our country, and the information on risk markers of SHFx is limited. The aim of this study was to estimate the incidence, explore trends, and examine predictors of SHFx in a suburban population of Spain. An observational longitudinal retrospective study was performed in a universal health coverage setting (Alcorcón, 1999–2011). Data were obtained from the area hospital discharge database. Annual incidence of HFx was estimated over 100,000 population (general and persons with HFx), and median time to SHFx by Kaplan–Meier tables. Cox regression was used for the analysis of association between SHFx and baseline predictors, measured by hazard ratio (HR). Among the 3430 patients who suffered a first HFx in the study period, 255 (7.4%) experienced a SHFx (4.5% of men and 8.5% of women). Median time between the first and second HFx was 3.7 years (SD 3.2). Annual incidence of HFx in population over 45 was 290.5 per 100,000 inhabitants (131.03 in men and 433.11 in women). Annual incidence of SHFx among persons with a HFx was 956.7 per 100,000 (1052.1 in women and 595.5 in men). There was a decline trend along the study period with an annual reduction of 10.4% (95% CI 7.7–13.0%; p < 0.001) in both sexes. The following associations were found: female sex (HR 1.41, 95% CI 0.97–2.02), age (HR 1.03, 95% CI 1.01–1.04), living in a nursing house (HR 1.46, 95% CI 1.10–1.94), and moderate to severe liver disease (HR 4.96, 95% CI 1.23–20.06). In our environment the occurrence of a SHFx is 7.4%, three-fold risk compared to no previous HFx. Being woman, elderly, living in a nursing home, and having severe to moderate liver disease may be important predictors of a SHFx. There seems to be adequate time between the first and the SHFx for interventions that may reduce the risk.


Second Hip Fracture Incidence Epidemiology Osteoporosis 


Compliance with Ethical Standards

Conflict of interest

Ramón Mazzucchelli, Elia Pérez-Fernández, Natalia Crespí, Alberto García-Vadillo, Gil Rodriguez Caravaca, Angel Gil de Miguel and Loreto Carmona declare no conflict of interest in relation to the study and data presented herein.

Human and Animal Rights and Informed Consent

The study was approved by the ethical committee of our hospital. Patient consent is not required by the Spanish law for study based on routine electronic data.

Supplementary material

223_2017_364_MOESM1_ESM.tif (109 kb)
Supplementary material 1 (TIFF 109 kb)
223_2017_364_MOESM2_ESM.docx (33 kb)
Supplementary material 2 (DOCX 33 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of RheumatologyHospital Universitario Fundación AlcorcónMadridSpain
  2. 2.Department of Clinical InvestigationHospital Universitario Fundación AlcorcónMadridSpain
  3. 3.Centro de Salud La Rivota (Alcorcón)MadridSpain
  4. 4.Department of RheumatologyHospital Universitario de la PrincesaMadridSpain
  5. 5.Department of Preventive Medicine and Public HealthUniversidad Rey Juan CarlosMadridSpain
  6. 6.Instituto de Salud MusculoesqueléticaMadridSpain

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