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The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study

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An Erratum to this article was published on 17 April 2014

Abstract

Summary

We used a large population-based health care database to determine the impact of common co-morbidities on hip fracture risk amongst elderly men. We demonstrated that diabetes, chronic obstructive pulmonary disease, renal failure, HIV infection, dementia, and cerebrovascular disease are independent predictors of hip fracture, as is a Charlson score of ≥3.

Introduction

Risk factors for hip fractures in men are still unclear. We aimed to identify common co-morbidities (amongst those in the Charlson index) that confer an increased risk of hip fracture amongst elderly men.

Methods

We conducted a population-based cohort study using data from the SIDIAP Q database. SIDIAPQ contains primary care and hospital inpatient records of a representative 30 % of the population of Catalonia, Spain (>2 million people). All men aged ≥65 years registered on 1 January 2007 were followed up until 31 December 2009. Both exposure (co-morbidities in the Charlson index) and outcome (incident hip fractures) were ascertained using ICD codes. Poisson regression models were fitted to estimate the effect of (1) each individual co-morbidity and (2) the composite Charlson index score, on hip fracture risk, after adjustment for age, body mass index, smoking, alcohol drinking, and use of oral glucocorticoids.

Results

We observed 186,171 men for a median (inter-quartile range) of 2.99 (2.37–2.99) years. In this time, 1,718 (0.92 %) participants had a hip fracture. The following co-morbidities were independently associated with hip fractures: diabetes mellitus, chronic obstructive pulmonary disease (COPD), renal failure, HIV infection, dementia, and cerebrovascular disease. A Charlson score of ≥3 conferred an increased hip fracture risk.

Conclusion

Common co-morbidities including diabetes, COPD, cerebrovascular disease, renal failure, and HIV infection are independently associated with an increased risk of hip fracture in elderly men. A Charlson score of 3 or more is associated with a 50 % higher risk of hip fracture in this population.

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Acknowledgments

We would like to acknowledge the health professionals (general practitioners and nurses) responsible for the collection of these data, as well as to the patients involved.

Conflicts of interest

CR: none; DPA: unrestricted research grants from BIOIBERICA SA and AMGEN; PO: none; PE: none; FF: none; XN: advisory board Amgen, educational speaker for Amgen, Lilly and MSD; CC: none; ADP: Advisor or speaker for Lilly, Amgen, Novartis, Pfizer and Active Life Scientific; JGM: none.

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Authors and Affiliations

  1. Primary Health Care Center, Eap Sardenya-Biomedical Resarch Institute Sant Pau (IIB Sant Pau), c/Sardenya 466, Barcelona, Spain

    C. Reyes

  2. GREMPAL Research Group, IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    C. Reyes, P. Estrada, P. Orozco & D. Prieto-Alhambra

  3. Primary Health Care Gotic, Institut Catala de la Salut, Universitat de Barcelona, Barcelona, Spain

    P. Estrada & P. Orozco

  4. Unitat de Recerca en Fisiopatologia Òssia i Articular (URFOA) and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Barcelona, Spain

    X. Nogués, A. Díez-Pérez & D. Prieto-Alhambra

  5. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom

    C. Cooper & D. Prieto-Alhambra

  6. Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, OX3 7LD, Oxford, United Kingdom

    C. Cooper & D. Prieto-Alhambra

  7. Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain

    F. Formiga

  8. Department of Internal Medicine, Hospital U.M. Valdecilla-IFIMAV, RETICEF, Santander, Spain

    J. G. Mácias

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  1. C. Reyes
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  2. P. Estrada
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  3. X. Nogués
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  9. D. Prieto-Alhambra
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Corresponding author

Correspondence to D. Prieto-Alhambra.

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Conflict of interest

CR: none; DPA: unrestricted research grants from BIOIBERICA SA and AMGEN; PO: none; PE: none; FF: none; XN: advisory board Amgen, educational speaker for Amgen, Lilly and MSD; CC: none; ADP: Advisor or speaker for Lilly, Amgen, Novartis, Pfizer and Active Life Scientific; JGM: none.

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Reyes, C., Estrada, P., Nogués, X. et al. The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study. Osteoporos Int 25, 1751–1758 (2014). https://doi.org/10.1007/s00198-014-2682-9

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  • DOI: https://doi.org/10.1007/s00198-014-2682-9

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