Subsequent fracture in nursing home residents with a hip fracture: a competing risks approach.
OBJECTIVE
To determine the incidence and predictors of subsequent fracture in nursing home residents with a hip fracture, accounting for the competing risk of death.


METHODS
Dynamic cohort study.


METHODS
Hebrew Rehabilitation Center, a 725-bed, long-term care facility in Boston, Massachusetts.


METHODS
Long-term care residents with a surgically repaired hip fracture (1999-2006) followed through June 30, 2007, for the occurrence of subsequent fracture at any skeletal site.


METHODS
Information on age, sex, anatomic location, type of repair, body mass index (BMI), comorbidities, functional status, cognitive status, and medication use were evaluated as potential risk factors for subsequent fracture.


RESULTS
The study included 184 residents with a baseline hip fracture. Thirty-nine residents (7 men, 32 women) experienced a subsequent fracture over a median follow-up of 1.1 years. After the baseline hip fracture, 6% of residents experienced a subsequent fracture within 6 months, 12% within 1 year, and 21% within 5 years. In addition, 23% of residents died within 6 months, 31% within 1 year, and 60% within 5 years. High functional status was associated with a five times greater risk of subsequent fracture (high vs low functional status, hazard ratio=5.10, P<.005). Age, sex, BMI, comorbidities, cognitive status, and medication use were not associated with subsequent fracture.


CONCLUSIONS
Hip fractures are a sentinel event in nursing home residents, with a high incidence of subsequent fracture and death occurring within 1 year. Identification of prefracture characteristics and postfracture complications associated with mortality should help guide secondary prevention efforts in nursing home residents.
Berry
Sarah D
SD
Hebrew SeniorLife, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts 02131, USA. sarahberry@hrca.harvard.edu
Samelson
Elizabeth J
EJ
Ngo
Long
L
Bordes
Malynda
M
Broe
Kerry E
KE
Kiel
Douglas P
DP
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D015992:Body Mass Index; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009026:Mortality; D009735:Nursing Homes; D012307:Risk Factors