title: Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.
abstract: OBJECTIVE
  Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated.
  
  
  METHODS
  Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated.
  
  
  RESULTS
  Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age <75 years and male sex were risk factors for subsequent fracture.
  
  
  CONCLUSIONS
  This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all patients with hip fracture, with or without subsequent fractures, need the same robust holistic care. The risks of subsequent fractures should be addressed in patients with hip fracture and should be reduced where possible by education regarding fracture prevention and regular rehabilitation programs. Efforts should be made to decrease the rates of major long-bone fractures and their burdens, even though such fractures have only a minor effect on survival in community-dwelling individuals.
authors.affiliation: Orthopaedic Trauma Unit, Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University, Thailand.
authors.forename: Chayanin
authors.initials: C
authors.lastname: Angthong
authors.forename: Wirana
authors.initials: W
authors.lastname: Angthong
authors.forename: Thos
authors.initials: T
authors.lastname: Harnroongroj
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Naito
authors.forename: Thossart
authors.initials: T
authors.lastname: Harnroongroj
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000293:injuries*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000401:mortality*; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors