title: Gender-specific hip fracture risk in community-dwelling and institutionalized seniors age 65 years and older.
abstract: In this study of acute hip fracture patients, we show that hip fracture rates differ by gender between community-dwelling seniors and seniors residing in nursing homes. While women have a significantly higher rate of hip fracture among the community-dwelling seniors, men have a significantly higher rate among nursing home residents.
  
  
  BACKGROUND
  Differences in gender-specific hip fracture risk between community-dwelling and institutionalized seniors have not been well established, and seasonality of hip fracture risk has been controversial.
  
  
  METHODS
  We analyzed detailed data from 1,084 hip fracture patients age 65 years and older admitted to one large hospital center in Zurich, Switzerland. In a sensitivity analysis, we extend to de-personalized data from 1,265 hip fracture patients from the other two large hospital centers in Zurich within the same time frame (total n = 2,349). The denominators were person-times accumulated by the Zurich population in the corresponding age/gender/type of dwelling stratum in each calendar season for the period of the study.
  
  
  RESULTS
  In the primary analysis of 1,084 hip fracture patients (mean age 85.1 years; 78% women): Among community-dwelling seniors, the risk of hip fracture was twofold higher among women compared with men (RR = 2.16; 95% CI, 1.74-2.69) independent of age, season, number of comorbidities, and cognitive function; among institutionalized seniors, the risk of hip fracture was 26% lower among women compared with men (RR = 0.77; 95% CI: 0.63-0.95) adjusting for the same confounders. In the sensitivity analysis of 2,349 hip fracture patients (mean age 85.0 years, 76% women), this pattern remained largely unchanged. There is no seasonal swing in hip fracture incidence.
  
  
  CONCLUSIONS
  We confirm for seniors living in the community that women have a higher risk of hip fracture than men. However, among institutionalized seniors, men are at higher risk for hip fracture.
authors.affiliation: Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Finsterwald
authors.forename: E
authors.initials: E
authors.lastname: Sidelnikov
authors.forename: E J
authors.initials: EJ
authors.lastname: Orav
authors.forename: B
authors.initials: B
authors.lastname: Dawson-Hughes
authors.forename: R
authors.initials: R
authors.lastname: Theiler
authors.forename: A
authors.initials: A
authors.lastname: Egli
authors.forename: A
authors.initials: A
authors.lastname: Platz
authors.forename: H P
authors.initials: HP
authors.lastname: Simmen
authors.forename: C
authors.initials: C
authors.lastname: Meier
authors.forename: D
authors.initials: D
authors.lastname: Grob
authors.forename: S
authors.initials: S
authors.lastname: Beck
authors.forename: H B
authors.initials: HB
authors.lastname: Stähelin
authors.forename: H A
authors.initials: HA
authors.lastname: Bischoff-Ferrari
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012621:Seasons; D017678:Sex Distribution; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology