title: Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people.
abstract: CONCLUSIONS
  This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings.
  
  
  BACKGROUND
  The aim of this study was to evaluate the utility of fracture history for the prediction of hip fracture in nursing home residents.
  
  
  METHODS
  This was a cohort study with a 1-year follow-up. Subjects were 8,905 residents of nursing homes in Niigata, Japan (mean age, 84.3 years). Fracture histories were obtained from nursing home medical records. ADL levels were assessed by caregivers. Hip fracture diagnosis was based on hospital medical records.
  
  
  RESULTS
  Subjects had fracture histories of upper limbs (5.0%), hip (14.0%), and nonhip lower limbs (4.6%). Among historical single fractures, only prior nonhip lower limbs significantly predicted subsequent fracture (adjusted hazard ratio, 2.43; 95% confidence interval (CI), 1.30-4.57). The stepwise method selected the best model, in which a combined historical fracture at upper limbs or nonhip lower limbs (adjusted hazard ratio, 2.14; 95% CI, 1.30-3.52), dependence, ADL levels, mobility, dementia, weight, and type of nursing home independently predicted subsequent hip fracture.
  
  
  CONCLUSIONS
  A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.
authors.affiliation: Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan. kazun@med.niigata-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Oyama
authors.forename: R
authors.initials: R
authors.lastname: Oshiki
authors.forename: R
authors.initials: R
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshizawa
authors.forename: Y
authors.initials: Y
authors.lastname: Tsuchiya
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology; D004812:Epidemiologic Methods; D005121:Extremities / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology*; D006707:Homes for the Aged; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes; D011379:Prognosis; D012008:Recurrence