Incidence of Non-Simultaneous Contralateral Second Hip Fractures: A Single-Center Irish Study

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

BACKGROUND

Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture.

METHODS

A cohort of patients with a hip fracture between 2016-2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery.

RESULTS

In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73-87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60-0.92), 60s (OR:0.81, 95%CI:0.70-0.94) and 70s (OR:0.89, 95%CI:0.81-0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race.

INTERPRETATION

Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.

Second hip fracture in older adults: incidence and risk factors

PURPOSE

A second hip fracture can occur in older adults who have already suffered an initial hip fracture. The aim of this study was to determine the incidence, mortality and risk factors for second hip fractures in older adults with hip fractures.

METHODS

Between 2009 and 2019, 2013 patients (mean age: mean age 76.5 ± 5.4 SD) who were admitted to a tertiary care hospital for a hip fracture surgery were retrospectively analyzed. The patients were divided into two groups: those with a second hip fracture and those without a second hip fracture within the following two years after the initial fracture.

RESULTS

321 patients (15.9%, mean age: 85.3 ± 4.9 SD) sustained a second contralateral hip fracture, the first two years after the initial hip fracture whereas 136 patients (6.8%) sustained a contralateral hip fracture within 12 months. In total 274 (13.6%) died in the first two years after the initial hip fracture; among these, 139 patients (43.3%) had a contralateral second hip fracture. The mean time from the first hip fracture to second hip fracture was 13.2 ± 7.6 months. The advance age, female gender, living alone, dementia, chest and urinary tract infection, chronic heart failure, peripheral vascular disease were identified as risk factors for a second contralateral hip fracture.

CONCLUSIONS

Identifying risk factors for a second contralateral hip fracture can be particularly helpful in providing focused medical assistance.