Abstract
Summary
We studied the incidence of second hip fractures and medication use among the patients with sequential hip fractures. This study shows that the incidence rate of second hip fractures is higher than that of the first hip fractures. Improvement in osteoporosis care and a more critical policy for prescription of psychotropic drugs are needed.
Introduction
This study had two goals: (1) to determine incidence of second hip fractures; (2) to describe changes in pharmacotherapy between first and second hip fractures, especially the use of those psychotropics which increase the risk of falling and also pharmacotherapy for osteoporosis.
Methods
The residents of Central Finland Health Care District who had sustained a hip fracture in 2002–2003 were followed up for subsequent hip fractures until 2006. Hip fracture patients were identified and clinical data were obtained by using hospital registers and medical records.
Results
Five hundred and one persons aged ≥ 60 years suffered their first hip fracture in 2002–2003. During the follow-up of 936 person-years, 34 second hip fractures occurred. The cumulative incidence of second hip fractures was 5.08% (95% CI: 3.30 to 7.78) at one year, and 8.11% (95% CI: 5.73 to 11.43) at two years after the first fracture. The second part of this study investigated 75 patients with two non-contemporaneous hip fractures. Between the first and second fractures, the number of psychotropic drug users rose from 27 (36%) to 44 (59%). At the time of second hip fracture, osteoporosis had been diagnosed in 17 (23%) patients only. Twelve (16%) patients used bisphosphonates or calcitonin, 15 (20%) used calcium and 9 (12%) vitamin D supplements.
Conclusions
There is a high incidence of second hip fractures. Secondary prevention of hip fractures needs to be improved. In addition to adequate treatment for osteoporosis, more attention should be directed toward appropriate use of psychotropic drugs.
Similar content being viewed by others
References
Marks R, Allegrante JP, MacKenzie CR et al (2003) Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2:57–93
Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382
Tinetti ME (2003) Preventing falls in elderly persons. N Engl J Med 348:42–49
Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 47:30–39
Ensrud EK, Blackwell T, Mangione CM et al (2002) Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 50:1629–1637
Ziere G, Dieleman JP, Hofman A et al (2005) Polypharmacy and falls in the middle-aged and elderly population. Br J Clin Pharmacol 61:218–223
Cumming RG, Le Couteur DG (2003) Benzodiazepines and risk of hip fractures in older people. CNS Drugs 17:825–837
Liu B, Anderson G, Mittmann N et al (1998) Use of selective serotonin reuptake-inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 351:1303–1307
Wang PS, Bohn RL, Glynn RJ et al (2001) Zolpidem use and hip fractures in older people. J Am Geriatr Soc 49:1685–1690
Gass M, Dawson-Hughes B (2006) Preventing osteoporosis-related fractures: an overview. Am J Med 119:S3–S11
Boston DA (1982) Bilateral fractures of the femoral neck. Injury 14:207–210
Dretakis E, Kritsikis N, Economou K et al (1981) Bilateral non-contemporary fractures of the proximal femur. Acta Orthop Scand 52:227–229
Finsen V, Benum P (1986) The second hip fracture. An epidemiologic study. Acta Orthop Scand 57:431–433
Chiu KY, Pun WK, Luk KDK (1992) Sequential fractures of both hips in elderly patients - a prospective study. J Trauma 32:584–587
Wolinsky FD, Fitzgerald JF (1994) Subsequent hip fractures among older adults. Am J Public Health 84:1316–1318
Dretakis KE, Dretakis EK, Papakitsou EF (1998) Possible predisposing factors for the second hip fracture. Calcif Tissue Int 62:366–369
Kaper BP, Mayer MB (2001) Incidence of bilateral proximal femoral fractures in a tertiary care center. Orthopedics 24:571–574
Dinah AF (2002) Sequential hip fractures in elderly patients. Injury 33:393–394
Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR et al (2003) Incidence and risk factors for a second hip fracture in elderly women. The study of osteoporotic fractures. Osteoporos Int 14:130–136
Shabat S, Gepstein R, Mann G et al (2003) The second hip fracture - an analysis of 84 elderly patients. Orthop Trauma 17:613–617
Melton LJ, Ilstrup DM, Beckenbaugh RD et al (1982) Hip fracture recurrence. A population-based study. Clin Orthop Relat Res 167:131–138
Schroder HM, Petersen KK, Erlandsen M (1993) Occurrence and incidence of the second hip fracture. Clin Orthop Rel Res 289:166–169
Yamanashi A, Yamazaki K, Kanamori M et al (2005) Assessment of risk factors for second hip fracture in Japanese elderly. Osteoporos Int 16:1239–1246
Lönnroos E, Kautianen H, Karppi P et al (2006) Increased incidence of hip fractures. A population-based study in Finland. Bone 39:623–627
ICD 10 (1992) International statistical classification of diseases and related health problems, tenth revision. World Health Organization, Geneva
World Health Organization (2003) Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDDs). WHO Collaborating Centre for Drug Statistics Methodology, Oslo
Stewart A, Walker LG, Porter RW et al (1999) Predicting a second hip fracture. J Clin Densitom Winter 2:363–370
Colon-Emeric C, Kuchibhatla M, Piper C et al (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–883
Davis CD, Ashe MC, Guy P et al (2006) Undertreatment after hip fracture: a retrospective study of osteoporosis overlooked. J Am Geriatr Soc 54:1019–1020
Harrington JT, Broy SB, Derosa AM et al (2002) Hip fracture patients are not treated for osteoporosis: a call for action. Arthritis Rheum 47:651–654
Follin SL, Black JN, McDermott MT (2003) Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190–198
Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (2004) Effect of vitamin D on falls. A meta-analysis. JAMA 291:1999–2006
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lönnroos, E., Kautiainen, H., Karppi, P. et al. Incidence of second hip fractures. A population-based study. Osteoporos Int 18, 1279–1285 (2007). https://doi.org/10.1007/s00198-007-0375-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-007-0375-3