Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy.
Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy.
Arch Gerontol Geriatr. 2020 Sep-Oct;90:104175. doi: 10.1016/j.archger.2020.104175. Epub 2020 Jul 6.
Although a second hip fracture is not uncommon in the older population, the extent to which such an event may affect health-related outcomes has not been fully clarified. We aimed to evaluate the risk of new falls, functional decline, rehospitalization, institutionalization and mortality in older patients admitted for a second vs. a first hip fracture.
The sample consisted of 288 older patients admitted to the Orthogeriatric Unit of Bolzano Hospital (northern Italy) and surgically treated for a hip fracture from June 2016 to June 2017. Socio-demographic data and hospitalization-related information were collected and a multidimensional assessment was made upon admission and during the hospital stay. Fifteen months after discharge, data on mobility level, functional status, institutionalization, and new falls were obtained from personal or structured phone interviews. Information on rehospitalization and mortality was obtained from local hospital registers.
One out of six patients (14.6 %) admitted was suffering a second hip fracture, of which only 16.7 % were on antiresorptive therapies. At the 15-month follow-up, individuals who had been treated for a second hip fracture were more likely than those treated for their first to have low mobility levels (OR = 4.13, 95 %CI:1.23-13.84), to be rehospitalized (OR = 2.57, 95 %CI:1.12-5.90), and to have a higher mortality (HR = 1.81, 95 %CI:1.05-3.12).
The occurrence of a second hip fracture may further affect the clinical vulnerability and mortality of older adults. These results highlight the need to implement preventive action to minimize the risk of re-fracture after the first event.
虽然老年人中再次发生髋部骨折并不罕见，但这种事件对健康相关结局的影响程度尚未完全阐明。我们旨在评估因第二次髋部骨折而入院的老年患者与因首次髋部骨折而入院的患者发生新跌倒、功能下降、再住院、住院和死亡的风险。
本研究纳入了 2016 年 6 月至 2017 年 6 月期间因髋部骨折入住意大利博尔扎诺医院骨科病房（意大利北部）并接受手术治疗的 288 名老年患者。收集了社会人口统计学数据和与住院相关的信息，并在入院时和住院期间进行了多维评估。出院后 15 个月，通过个人或结构化电话访谈获得了活动能力、功能状态、住院和新跌倒的信息。通过当地医院登记处获得了再住院和死亡的信息。
六分之一（14.6%）入院患者患有第二次髋部骨折，其中仅 16.7%正在接受抗吸收治疗。在 15 个月的随访中，与首次髋部骨折相比，接受第二次髋部骨折治疗的患者更有可能行动不便（OR=4.13，95%CI：1.23-13.84）、再次住院（OR=2.57，95%CI：1.12-5.90），且死亡率更高（HR=1.81，95%CI：1.05-3.12）。
第二次髋部骨折的发生可能进一步影响老年人的临床脆弱性和死亡率。这些结果强调需要采取预防措施，以最大限度地降低首次事件后再次骨折的风险。
