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Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures

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Abstract

Summary

This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.

Background

Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.

Objective

This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.

Methods

This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients’ conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.

Results

The mean observation period was 4.0 years (range 0–7 years). The average age at the time of admission was 82 years (range 60–101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82–91), low risk (92–98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]).

Conclusions

We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.

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Abbreviations

ADL:

Activities of daily living

BI:

Barthel index

BW:

Body weight

DVT:

Deep vein thrombosis

FHFs:

Fragility hip fractures

GNRI:

Geriatric nutritional risk index

HDS-R:

Hasegawa dementia rating scale-revised

PTH:

Parathyroid hormone

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English-language review.

Funding

This research was funded in part by the Japan Society for the Promotion of Science’s Grants-in-Aid for Young Scientists (grant number JP18K16626) and the Japanese Orthopaedic Association (JOA-Subsidized Science Project Research 2022-1).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    T. Tsutsui, T. Fujiwara, Y. Matsumoto, A. Kimura, M. Kanahori, S. Arisumi & Y. Nakashima

  2. Department of Orthopaedic Surgery, Saga Handicapped Children’s Hospital, Saga, Japan

    A. Oyamada

  3. Department of Orthopaedic Surgery, Chihaya Hospital, Fukuoka, Japan

    M. Ohishi

  4. Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Saga, Japan

    K. Ikuta

  5. Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Kyushu Hospital, Fukuoka, Japan

    K. Tsuchiya

  6. Department of Orthopaedic Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan

    N. Tayama

  7. Department of Orthopaedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan

    S. Tomari

  8. Department of Orthopaedic Surgery, National Hospital Organization Kyushu Medical Centre, Fukuoka, Japan

    H. Miyahara

  9. Department of Orthopaedic Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan

    T. Mae

  10. Department of Orthopaedic Surgery, Aso Iizuka Hospital, Fukuoka, Japan

    T. Hara

  11. Department of Orthopaedic Surgery, Fukuoka City Hospital, Fukuoka, Japan

    T. Saito

  12. Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan

    T. Arizono

  13. Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan

    K. Kaji & Y. Iwamoto

  14. Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan

    T. Mawatari

  15. Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, Japan

    M. Fujiwara

  16. Department of Orthopaedic Surgery, Harasanshin Hospital, Fukuoka, Japan

    M. Takasaki

  17. Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan

    K. Shin

  18. Department of Orthopaedic Surgery, Koga Hospital 21, Fukuoka, Japan

    K. Ninomiya

  19. Department of Orthopaedic Surgery, National Hospital Organization Fukuoka-Higashi Medical Centre, Fukuoka, Japan

    K. Nakaie

  20. Faculty of Medicine, Hospital Informatic Centre, Oita University, Oita, Japan

    Y. Antoku

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  1. T. Tsutsui
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Correspondence to T. Fujiwara.

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Appendix

Appendix

Fig. 4
figure 4

The study’s flow chart, which clarifies the inclusion and exclusion criteria

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Table 4 Patients’ baseline characteristics and follow-up data by geriatric nutritional risk index (GNRI) class
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Tsutsui, T., Fujiwara, T., Matsumoto, Y. et al. Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures. Osteoporos Int 34, 1207–1221 (2023). https://doi.org/10.1007/s00198-023-06753-3

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  • DOI: https://doi.org/10.1007/s00198-023-06753-3

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