Hip Pelvis.  2014 Dec;26(4):250-255. 10.5371/hp.2014.26.4.250.

Incidence, Morbidity and Mortality in Patients Older than 50 Years with Second Hip Fracture in a Jeju Cohort Study

• Park YG
• Jang S
• Ha YC

• KMID: 1907701
• DOI: http://doi.org/10.5371/hp.2014.26.4.250

Abstract

PURPOSE
Although the incidence of a second hip fracture is relatively well described, mortality and morbidity after a second hip fracture are seldom evaluated. The purpose of this study was to determine the incidence, morbidity, and mid-term mortality of a second hip fracture and evaluate the cause of death after a second hip fracture.
MATERIALS AND METHODS
Information on patients older than 50 years, who sustained a subsequent hip fracture, were obtained from the records of eight Jeju Island hospitals between 2002 and 2011 to calculate the incidence, morbidity, and mortality of hip fractures in this age group. All patients were followed a minimum of 2 years. A systemic search for death certificates at the National Statistical Office was conducted for patients who were lost to follow-up.
RESULTS
Of 2,055 hip fractures (419 men and 1,636 women), 98 were second hip fractures (13 men and 85 women) during the study period. The mean ages of the patients at the time of the first and second fractures were 78.8 and 80.8 years, respectively. The incidence of a subsequent hip fracture among the first hip fracture was 4.8%. Mean mortality rates at 6 months, 1 year, 2 years, and 5 years were 10.5%, 15.2%, 23.5%, and 42.0% respectively. Cumulative mortality after the second hip fracture at the 5 years follow-up was 41.8%.
CONCLUSION
Our results demonstrate that a secondary fracture prevention program is necessary to prevent second hip fractures in elderly patients.

Keyword

Hip fractures; Second hip fracture; Incidence; Mortality

MeSH Terms

Aged
Cause of Death
Cohort Studies*
Death Certificates
Follow-Up Studies
Hip Fractures
Hip*
Humans
Incidence*
Lost to Follow-Up
Male
Mortality*

Figure

• 

  Fig. 1 Cumulative numbers of second hip fractures.

• 

  Fig. 2 Cumulative mortality rate after a second hip fracture.

Reference

1. Lippuner K, Golder M, Greiner R. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int. 2005; 16:Suppl 2. S8–S17.

2. Choi HJ, Shin CS, Ha YC, et al. Burden of osteoporosis in adults in Korea: a national health insurance database study. J Bone Miner Metab. 2012; 30:54–58.

3. Lim S, Koo BK, Lee EJ, et al. Incidence of hip fractures in Korea. J Bone Miner Metab. 2008; 26:400–405.

4. Yoon HK, Park C, Jang S, Jang S, Lee YK, Ha YC. Incidence and mortality following hip fracture in Korea. J Korean Med Sci. 2011; 26:1087–1092.

5. Lee SR, Ha YC, Kang H, Park YG, Nam KW, Kim SR. Morbidity and mortality in Jeju residents over 50-years of age with hip fracture with mean 6-year follow-up: a prospective cohort study. J Korean Med Sci. 2013; 28:1089–1094.

6. Kang BJ, Lee YK, Lee KW, Won SH, Ha YC, Koo KH. Mortality after hip fractures in nonagenarians. J Bone Metab. 2012; 19:83–86.

7. Dimai HP, Redlich K, Peretz M, Borgström F, Siebert U, Mahlich J. Economic burden of osteoporotic fractures in Austria. Health Econ Rev. 2012; 2:12.

8. Berry SD, Samelson EJ, Hannan MT, et al. Second hip fracture in older men and women: the Framingham study. Arch Intern Med. 2007; 167:1971–1976.

9. Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res. 2009; 24:1299–1307.

10. Hodsman AB, Leslie WD, Tsang JF, Gamble GD. 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program. Arch Intern Med. 2008; 168:2261–2267.

11. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004; 35:375–382.

12. Sawalha S, Parker MJ. Characteristics and outcome in patients sustaining a second contralateral fracture of the hip. J Bone Joint Surg Br. 2012; 94:102–106.

13. Shen SH, Huang KC, Tsai YH, et al. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc. 2014; 15:725–731.

14. Lawrence TM, Wenn R, Boulton CT, Moran CG. Agespecific incidence of first and second fractures of the hip. J Bone Joint Surg Br. 2010; 92:258–261.

15. Lönnroos E, Kautiainen H, Karppi P, Hartikainen S, Kiviranta I, Sulkava R. Incidence of second hip fractures. A population-based study. Osteoporos Int. 2007; 18:1279–1285.

16. Kim SR, Ha YC, Kim JR, Kim R, Kim SY, Koo KH. Incidence of hip fractures in Jeju Island, South Korea: a prospective study (2002-2006). Clin Orthop Surg. 2010; 2:64–68.

17. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–383.

18. Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992; 280:214–222.

19. Korhonen N, Niemi S, Parkkari J, Sievänen H, Palvanen M, Kannus P. Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int. 2013; 24:1599–1603.

20. Dimai HP, Svedbom A, Fahrleitner-Pammer A, et al. Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int. 2011; 22:685–692.

21. Melton LJ 3rd, Atkinson EJ, Madhok R. Downturn in hip fracture incidence. Public Health Rep. 1996; 111:146–150. discussion 151.

22. Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of premorbid conditions and post-fracture complications. Osteoporos Int. 2007; 18:1583–1593.

23. Yoon BH, Baek JH, Kim MK, Lee YK, Ha YC, Koo KH. Poor prognosis in elderly patients who refused surgery because of economic burden and medical problem after hip fracture. J Korean Med Sci. 2013; 28:1378–1381.

24. Liu S, Zhu Y, Chen W, Sun T, Cheng J, Zhang Y. Risk factors for the second contralateral hip fracture in elderly patients: a systematic review and meta-analysis. Clin Rehabil. 2014; pii: 0269215514542358. [Epub ahead of print].

25. Tsuboi M, Hasegawa Y, Suzuki S, Wingstrand H, Thorngren KG. Mortality and mobility after hip fracture in Japan: a ten-year follow-up. J Bone Joint Surg Br. 2007; 89:461–466.

26. Borgquist L, Ceder L, Thorngren KG. Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand. 1990; 61:404–410.

27. Ceder L, Thorngren KG, Wallden B. Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop Relat Res. 1980; 152:173–184.

28. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998; 348:22–28.

29. Lee YK, Ha YC, Choi HJ, et al. Bisphosphonate use and subsequent hip fracture in South Korea. Osteoporos Int. 2013; 24:2887–2892.

30. Lee YK, Ha YC, Yoon BH, Koo KH. Incidence of second hip fracture and compliant use of bisphosphonate. Osteoporos Int. 2013; 24:2099–2104.