title: Excess mortality associated with second hip fracture.
abstract: Hip fracture increases death risk. Ten percent of survivors have second hip fracture. It is not known if second hip fracture further increases death risk. Here, we report that second hip fracture increases death risk beyond that expected for an increase in age. Secondary prevention after hip fracture could save lives.
  
  
  BACKGROUND
  The purpose of this study is to determine if second hip fracture is associated with an increased death rate.
  
  
  METHODS
  We retrieved 42,435 hospitalization records of patients aged 60 years or older, who were discharged after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to death.
  
  
  RESULTS
  During follow-up, the average monthly death rate was 16.2 (95 % CI 16.0-16.4) per 1000 patient-months for those without second hip fracture and 21.1 (95 % CI 20.2-22.1) per 1000 patient-months for those with second hip fracture. The hazard of death was 55 % higher for patients with second hip fracture compared to those without second hip fracture (HR = 1.55, 95 % CI 1.47-1.63). The hazard of death was 58 % higher for men with second hip fracture than in men without second hip fracture (HR = 1.58, 95 % CI 1.42-1.75). The hazard of death was 54 % higher for women with second hip fracture compared to women without second hip fracture (HR = 1.54, 95 % CI 1.46-1.63). These sex-specific HRs were not statistically different (p = 0.70).
  
  
  CONCLUSIONS
  Our results are the first to show that second hip fracture increases the risk of death above that anticipated for an increase in age for both men and women. Effective secondary prevention strategies could not only reduce morbidity after hip fracture but could also save lives.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, boris.sobolev@ubc.ca.
authors.forename: B
authors.initials: B
authors.lastname: Sobolev
authors.forename: K J
authors.initials: KJ
authors.lastname: Sheehan
authors.forename: L
authors.initials: L
authors.lastname: Kuramoto
authors.forename: P
authors.initials: P
authors.lastname: Guy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000401:mortality* / Q000601:surgery; D012008:Recurrence