Sobolev B, Sheehan K J, Kuramoto L, Guy P
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada,
Osteoporos Int. 2015 Jul;26(7):1903-10. doi: 10.1007/s00198-015-3104-3. Epub 2015 Apr 25.
Hip fracture increases death risk. Ten percent of survivors have second hip fracture. It is not known if second hip fracture further increases death risk. Here, we report that second hip fracture increases death risk beyond that expected for an increase in age. Secondary prevention after hip fracture could save lives.
The purpose of this study is to determine if second hip fracture is associated with an increased death rate.
We retrieved 42,435 hospitalization records of patients aged 60 years or older, who were discharged after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to death.
During follow-up, the average monthly death rate was 16.2 (95 % CI 16.0-16.4) per 1000 patient-months for those without second hip fracture and 21.1 (95 % CI 20.2-22.1) per 1000 patient-months for those with second hip fracture. The hazard of death was 55 % higher for patients with second hip fracture compared to those without second hip fracture (HR = 1.55, 95 % CI 1.47-1.63). The hazard of death was 58 % higher for men with second hip fracture than in men without second hip fracture (HR = 1.58, 95 % CI 1.42-1.75). The hazard of death was 54 % higher for women with second hip fracture compared to women without second hip fracture (HR = 1.54, 95 % CI 1.46-1.63). These sex-specific HRs were not statistically different (p = 0.70).
Our results are the first to show that second hip fracture increases the risk of death above that anticipated for an increase in age for both men and women. Effective secondary prevention strategies could not only reduce morbidity after hip fracture but could also save lives.
髋部骨折会增加死亡风险。10%的幸存者会再次发生髋部骨折。尚不清楚再次髋部骨折是否会进一步增加死亡风险。在此，我们报告再次髋部骨折增加的死亡风险超出了因年龄增长所预期的风险。髋部骨折后的二级预防可挽救生命。
本研究的目的是确定再次髋部骨折是否与死亡率增加相关。
我们检索了1990年至2005年期间在加拿大不列颠哥伦比亚省因髋部骨折手术入院后出院的60岁及以上患者的42435份住院记录。结局变量为死亡时间。
在随访期间，未发生再次髋部骨折的患者每1000患者月的平均月死亡率为16.2（95%可信区间16.0 - 16.4），发生再次髋部骨折的患者每1000患者月的平均月死亡率为21.1（95%可信区间20.2 - 22.1）。发生再次髋部骨折的患者的死亡风险比未发生再次髋部骨折的患者高55%（风险比=1.55，95%可信区间1.47 - 1.63）。发生再次髋部骨折的男性的死亡风险比未发生再次髋部骨折的男性高58%（风险比=1.58，95%可信区间1.42 - 1.75）。发生再次髋部骨折的女性的死亡风险比未发生再次髋部骨折的女性高54%（风险比=1.54，95%可信区间1.46 - 1.63）。这些性别特异性风险比无统计学差异（p = 0.70）。
我们的结果首次表明，再次髋部骨折会增加男性和女性的死亡风险，且超出因年龄增长所预期的风险。有效的二级预防策略不仅可以降低髋部骨折后的发病率，还可以挽救生命。
