Skip to main content

Trends and Outcomes of Hip Fracture Hospitalization Among Medicare Beneficiaries with Inflammatory Bowel Disease, 2000–2017



Patients with inflammatory bowel disease (IBD) have a higher risk of hip fracture, but lower likelihood of having arthroplasties than non-IBD patients in Nationwide Inpatient Sample. Little is known about hip fracture-associated hospitalization outcomes.


We assessed the trends in hip fracture hospitalization rates from 2000 to 2017 and estimated 30-day readmission, 30-day mortality, and length of stay in 2016 and 2017.


We estimated trends of age-adjusted hospitalization rates using a piecewise linear regression. Medicare beneficiaries aged ≥ 66 years with Crohn’s disease (CD, n = 2014) or ulcerative colitis (UC, n = 2971) hospitalized for hip fracture were identified. We performed propensity score matching to create 1:3 matched samples on age, race/ethnicity, sex, and chronic conditions and compared hospitalization outcomes between matched samples.


In 2017, the age-adjusted hospitalization rates (per 100) were 1.15 [95% CI = (1.07–1.24)] for CD, 0.86 [95% CI = (0.82–0.89)] for UC, and 0.59 [95% CI = (0.59–0.59)] for no IBD. The hospitalization rates for CD and UC decreased from 2000 to 2012 and then increased from 2012 to 2017. Compared to matched cohorts, CD patients had longer hospital stays (5.55 days vs. 5.30 days, p = 0.01); UC patients were more likely to have 30-day readmissions (17.27% vs. 13.71%, p < 0.001), longer hospital stays (5.59 days vs. 5.40 days, p = 0.02), and less likely to have 30-day mortality (3.77% vs. 5.15%, p = 0.003).


Prevention of hip fracture is important for older adults with IBD, especially CD. Strategies that improve quality of inpatient care for IBD patients hospitalized for hip fracture should be considered.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Xu F, Dahlhamer JM, Terlizzi EP, Wheaton AG, Croft JB. Receipt of preventive care services among US adults with inflammatory bowel disease, 2015–2016. Dig Dis Sci. 2019;64:1798–1808.

    Article  PubMed  Google Scholar 

  2. Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–863.

    Article  Google Scholar 

  3. Aniwan S, Harmsen WS, Tremaine WJ, Kane SV, Loftus EV Jr. Overall and cause-specific mortality of inflammatory bowel disease in Olmsted county, Minnesota, from 1970 through 2016. Mayo Clin Proc. 2018;93:1415–1422.

    Article  Google Scholar 

  4. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46.e42–54.e42.

    Article  Google Scholar 

  5. Roman AL, Munoz F. Comorbidity in inflammatory bowel disease. World J Gastroenterol. 2011;17:2723–2733.

    Article  Google Scholar 

  6. Williams H, Walker D, Orchard TR. Extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep. 2008;10:597–605.

    Article  Google Scholar 

  7. Argollo M, Gilardi D, Peyrin-Biroulet C, Chabot JF, Peyrin-Biroulet L, Danese S. Comorbidities in inflammatory bowel disease: a call for action. Lancet Gastroenterol Hepatol. 2019;4:643–654.

    Article  Google Scholar 

  8. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170:1290–1299.

    Article  Google Scholar 

  9. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–1259.

    Article  CAS  Google Scholar 

  10. Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease: a population-based cohort study. Ann Intern Med. 2000;133:795–799.

    Article  CAS  Google Scholar 

  11. Ludvigsson JF, Mahl M, Sachs MC, et al. Fracture risk in patients with inflammatory bowel disease: a nationwide population-based cohort study from 1964 to 2014. Am J Gastroenterol. 2019;114:291–304.

    Article  Google Scholar 

  12. Targownik LE, Bernstein CN, Leslie WD. Inflammatory bowel disease and the risk of osteoporosis and fracture. Maturitas. 2013;76:315–319.

    Article  Google Scholar 

  13. Ehrenpreis ED, Zhou Y. Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease. World J Gastroenterol. 2017;23:4752–4758.

    Article  Google Scholar 

  14. Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. Fracture-associated hospitalizations in patients with inflammatory bowel disease. Dig Dis Sci. 2011;56:176–182.

    Article  PubMed  Google Scholar 

  15. Chronic Conditions Data Warehouse. 2019; Accessed November 15, 2019.

  16. Centers for Medicare & Medicaid Services. Medicare comprehensive care for joint replacement ICD-10 hip fracture codes. 2017; Accessed November 15, 2019.

  17. United States Census Bureau. Census 2000 data for the United States. 2000; Accessed February 25, 2020.

  18. Chronic Condition Data Warehouse. Chronic Conditions Data Warehouse condition categories. 2019; Accessed November 21, 2019.

  19. Cahue SR, Etkin CD, Stryker LS, Voss FR. Procedure coding in the American Joint Replacement Registry. Arthroplast Today. 2019;5:251–255.

    Article  Google Scholar 

  20. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–3107.

    Article  Google Scholar 

  21. Lewiecki EM, Wright NC, Curtis JR, et al. Hip fracture trends in the United States, 2002–2015. Osteoporos Int. 2018;29:717–722.

    Article  Google Scholar 

  22. Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: an ecological analysis. J Bone Miner Res. 2015;30:2179–2187.

    Article  CAS  Google Scholar 

  23. LeBlanc JF, Wiseman D, Lakatos PL, Bessissow T. Elderly patients with inflammatory bowel disease: updated review of the therapeutic landscape. World J Gastroenterol. 2019;25:4158–4171.

    Article  Google Scholar 

  24. Barber GE, Hendler S, Okafor P, Limsui D, Limketkai BN. Rising incidence of intestinal infections in inflammatory bowel disease: a nationwide analysis. Inflamm Bowel Dis. 2018;24:1849–1856.

    Article  Google Scholar 

  25. Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM. Hospital readmission after hip fracture. Arch Orthop Trauma Surg. 2015;135:329–337.

    Article  Google Scholar 

  26. Lizaur-Utrilla A, Serna-Berna R, Lopez-Prats FA, Gil-Guillen V. Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis. Arch Orthop Trauma Surg. 2015;135:1663–1667.

    Article  CAS  Google Scholar 

  27. Ali AM, Gibbons CE. Predictors of 30-day hospital readmission after hip fracture: a systematic review. Injury. 2017;48:243–252.

    Article  Google Scholar 

  28. Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260:244–251.

    Article  Google Scholar 

  29. Hernandez-Meza G, McKee S, Carlton D, Yang A, Govindaraj S, Iloreta A. Association of surgical and hospital volume and patient characteristics with 30-day readmission rates. JAMA Otolaryngol Head Neck Surg. 2019;145:328–337.

    Article  Google Scholar 

  30. Browne JA, Pietrobon R, Olson SA. Hip fracture outcomes: does surgeon or hospital volume really matter? J Trauma. 2009;66:809–814.

    PubMed  Google Scholar 

  31. Okike K, Chan PH, Paxton EW. Effect of surgeon and hospital volume on morbidity and mortality after hip fracture. J Bone Joint Surg Am. 2017;99:1547–1553.

    Article  Google Scholar 

  32. Metcalfe D, Salim A, Olufajo O, et al. Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study. BMJ Open. 2016;6:e010743.

    Article  Google Scholar 

  33. Koutroubakis IE. Venous thromboembolism in hospitalized inflammatory bowel disease patients: the magnitude of the problem is staggering. Am J Gastroenterol. 2008;103:2281–2283.

    Article  Google Scholar 

  34. Hazratjee N, Agito M, Lopez R, Lashner B, Rizk MK. Hospital readmissions in patients with inflammatory bowel disease. Am J Gastroenterol. 2013;108:1024–1032.

    Article  Google Scholar 

  35. Giannoulis D, Calori GM, Giannoudis PV. Thirty-day mortality after hip fractures: has anything changed? Eur J Orthop Surg Traumatol. 2016;26:365–370.

    Article  Google Scholar 

  36. Ehrenpreis ED, Zhou Y, Alexoff A, Melitas C. Effect of the diagnosis of inflammatory bowel disease on risk-adjusted mortality in hospitalized patients with acute myocardial infarction, congestive heart failure and pneumonia. PLoS One. 2016;11:e0158926.

    Article  Google Scholar 

  37. Rahal MA, Karaoui WR, Mailhac A, Tamim H, Shaib Y. Surgical outcomes among inflammatory bowel disease patients undergoing colectomy: results from a national database. Acta Gastroenterol Belg. 2018;81:387–392.

    CAS  PubMed  Google Scholar 

  38. Nguyen GC, Elnahas A, Jackson TD. The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease. J Crohns Colitis. 2014;8:1661–1667.

    Article  Google Scholar 

  39. Rodriguez-Bores L, Barahona-Garrido J, Yamamoto-Furusho JK. Basic and clinical aspects of osteoporosis in inflammatory bowel disease. World J Gastroenterol. 2007;13:6156–6165.

    Article  CAS  Google Scholar 

  40. Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care inflammatory bowel disease. Am J Gastroenterol. 2017;112:241–258.

    Article  Google Scholar 

  41. U.S. Preventive Services Task Force. Tobacco smoking cessation in adults, including pregnant women: behavioral and pharmacotherapy interventions. 2015; Accessed February 26, 2020.

  42. U.S. Preventive Services Task Force. Falls prevention in community-dwelling older adults: interventions. 2018; Accessed November 22, 2019.

  43. Barnes EL, Kochar B, Long MD, et al. Modifiable risk factors for hospital readmission among patients with inflammatory bowel disease in a nationwide database. Inflamm Bowel Dis. 2017;23:875–881.

    Article  Google Scholar 

Download references


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


All authors received no funding for this work.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fang Xu.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xu, F., Wheaton, A.G., Barbour, K.E. et al. Trends and Outcomes of Hip Fracture Hospitalization Among Medicare Beneficiaries with Inflammatory Bowel Disease, 2000–2017. Dig Dis Sci 66, 1818–1828 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Hip fracture hospitalization
  • Trends of hospitalization rate
  • Inflammatory bowel disease
  • 30-day readmission
  • 30-day mortality
  • Length of stay