Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients

Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients

Authors

  • Luigi Murena Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
  • Chiara Ratti Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
  • Guido Maritan Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
  • Nicholas Rasio Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
  • Sabrina Pistorio Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy)
  • Marcello Cusitore Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Strada di Fiume 447, 34149 Trieste (Italy)
  • Gianluca Canton Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)

Keywords:

proximal femur fracture, hip fracture, contralateral, bilateral, risk factors

Abstract

 

Summary. Background and aim of the work: Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF. Methods: A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors. Results: Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients. Conclusions: The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF. 

References

Piscitelli P, Feola M, Rao C, et al.Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women. World J Orthop 2014; 5(3):386-391

Ratti C, Vulcano E, La Barbera G, Canton G, Murena L, Cherubino P. The incidence of fragility fractures in Italy. Aging Clin. Exp Res 2013; 25(Suppl 1):S13-S14

Zurlo A, Bellelli G. Orthogeriatrics in Italy: the Gruppo Italiano di Ortogeriatria (GIOG) audit on hip fractures in the elderly. Geriatric Care 2018;4(2):33-35

Vochteloo AJH, Van Der Burg BLSB, Röling MA, et al. Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients. Arch Orthop Trauma Surg 2012;132(8):1191-1197

Boston DA. Bilateral fractures of the femoral neck. Injury 1982;14:207-210

Dretakis E, Kritsikis N, Economou K, Christodoulou N. Bilateral non-contemporary fractures of the proximal femur. Acta Orthop 1981; 52:227-229

Liu, S., Zhu, Y., Chen, W. et al. Risk factors for the second contralateral hip fracture in elderly patients: A systematic review and meta-analysis. Clin Rehabil 2015; 29: 285–294

Chang Jh, Yoo JH, Reddy P, Lee SS, Hwang JH, Kim TY. Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture. Injury 2013;44(12):1930-1933

Zhu Y, Chen W, Sun T, Zhang Q, Liu S, Zhang Y. Epidemiological characteristics and outcome in elderly patients sustaining non-simultaneous bilateral hip fracture: a systematic review and meta-analysis. Geriatr Gerontol Int 2015;15(1):11–18.

Müller F, Galler M, Zellner M, Bäuml C, Roll C, Füchtmeier B. Comparative analysis of non-simultaneous bilateral fractures of the proximal femur. Eur J Trauma Emerg Surg 2019;45(6):1053–1057

Finsen V, Benum P (1986) The second hip fracture an epidemiologic study. An epidemiologic study. Acta Orthop Scand 1986;57(5)431-433

Van Der Steenhoven TJ, Staffhorst B, Van De Velde SK, Nelissen RGHH, Verhofstad MHJ. Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient. J Orthop Trauma 2015;29(3):e103-e108

Aurégan JC, Frison A, Bégué T, et al. Contra-lateral hip fracture in the elderly: are decreased body mass index and skin thickness predictive factors? Int Orthop 2017;41(2)247-252

Shabat S, Gepstein R, Mann G, Kish B, Fredman B, Nyska M. The second hip fracture - An analysis of 84 elderly patients. J Orthop Trauma 2003;17(9):613-617

Pearse EO, Redfern DJ, Sinha M, Edge AJ. Outcome following a second hip fracture. Injury 2003;34(7):518-521

Fukushima T, Sudo A, Uchida A. Bilateral hip fractures. J Orthop Sci. 2006;11(5)435-438

Lönnroos E, Kautiainen H, Karppi P, Hartikainen S, Kiviranta I, Sulkava R. Incidence of second hip fractures. A population-based study. Osteoporos Int 2007;18(9):1279-1285

Gaumetou E, Zilber S, Hernigou P. Non-simultaneous bilateral hip fracture: Epidemiologic study of 241 hip fractures. Orthop Traumatol Surg Res 2011;97(1):22-27

Kaukonen JP, Lüthje P, Nurmi-Lüthje I, Kataja M, Naboulsi H. Second hip fracture and patients’ medication after the first hip fracture: A follow-up of 221 hip fracture patients in Finland. Arch Gerontol Geriatr 2011;52(2)185-189

Khan SK, Rushton SP, Dosani A, Gray AC, Deehan DJ. Factors influencing length of stay and mortality after first and second hip fractures: an event modeling analysis. J Orthop Trauma. 2013;27(2):82–86.

Harvey L, Toson B, Mitchell R, Brodaty H, Draper B, Close J. Incidence, timing and impact of comorbidity on second hip fracture: a population-based study. ANZ J Surg. 2018;88(6):577–581.

Yamanashi A, Yamazaki K, Kanamori M, et al. Assessment of risk factors for second hip fractures in Japanese elderly. Osteoporos Int. 2005;16(10):1239–1246.

Saxena P, Shankar J. Contralateral hip fractures - can predisposing factors be determined?. Injury. 2000;31(6):421–424

Kok LM, van der Steenhoven TJ, Nelissen RG. A retrospective analysis of bilateral fractures over sixteen years: localisation and variation in treatment of second hip fractures. Int Orthop. 2011;35(10):1545–1551.

Lawrence TM, Wenn R, Boulton CT, Moran CG. Age-specific incidence of first and second fractures of the hip. J Bone Joint Surg Br. 2010;92(2):258–261

Sawalha S, Parker MJ. Characteristics and outcome in patients sustaining a second contralateral fracture of the hip. J Bone Joint Surg Br. 2012;94(1):102–106.

Hagino H, Sawaguchi T, Endo N, Ito Y, Nakano T, Watanabe Y. The risk of a second hip fracture in patients after their first hip fracture. Calcif Tissue Int. 2012;90(1):14–21.

Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR. Incidence and risk factors for a second hip fracture in elderly women. The Study of Osteoporotic Fractures. Osteoporos Int. 2003;14(2):130–136

Pellegrini A, Tacci F, Leigheb M, Costantino C, Pedrazzini A, Pedrazzi G, Vaienti E, Ceccarelli F, Pogliacomi F. Injuries of the trochanteric region: can analysis of radiographic indices help in prediction of recurrent osteoporotic hip fractures? Acta Biomed. 2017 Oct 18;88(4 -S):43-9.

Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res. 2009;24(7):1299–1307

Skála-Rosenbaum J, Džupa V, Bartoška R, Říha D, Waldauf P, Báča V. Subsequent contralateral hip fractures: can at-risk patients be identified? An observational study of 5,102 patients. Int Orthop. 2015;39(4):755–760.

Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg. 2016;86(3):157–161.

Hindmarsh D, Loh M, Finch CF, Hayen A, Close JC. Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people. Australas J Ageing. 2014;33(3):E1–E7.

Berry SD, Samelson EJ, Hannan MT, et al. Second hip fracture in older men and women: the Framingham Study. Arch Intern Med. 2007;167(18):1971–1976

Kim SM, Moon YW, Lim SJ, et al. Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone. 2012;50(6):1343–1350

Holt G, Smith R, Duncan K, Hutchison JD, Gregori A, Reid D. Outcome after sequential hip fracture in the elderly. J Bone Joint Surg Am. 2012;94(19):1801–1808

Johnell O, Gullberg B, Allander E, Kanis JA; MEDOS Study Group. The apparent incidence of hip fracture in Europe: a study of national register sources. Osteoporos Int. 1992;2(6):298–302

Melton LJ 3rd, Kearns AE, Atkinson EJ, et al. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009;20(5):687–694.

Mitani S, Shimizu M, Abo M, Hagino H, Kurozawa Y. Risk factors for second hip fractures among elderly patients. J Orthop Sci. 2010;15(2):192–197

Batin S, Ozan F, Gurbuz K, Koyuncu S, Vatansever F, Uzun E. Evaluation of Risk Factors for Second Hip Fractures in Elderly Patients. J Clin Med Res. 2018;10(3):217–220

Pogliacomi F, Pellegrini A, Tacci F, Pedrini MF, Costantino C, Pedrazzini A, Pedrazzi G, Lauretani F, Vaienti E, Ceccarelli F. Risks of subsequent contralateral fractures of the trochanteric region in elderly. Acta Biomed. 2016; 87(3): 275-81.

Sheikh HQ, Hossain FS, Khan S, Usman M, Kapoor H, Aqil A. Short-term risk factors for a second hip fracture in a UK population. Eur J Orthop Surg Traumatol. 2019;29(5):1055–1060.

Mukka S, Knutsson B, Krupic F, Sayed-Noor AS. The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study. Eur J Orthop Surg Traumatol. 2017;27(5):653–658.

Söderqvist A, Ekström W, Ponzer S, et al. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55(5):496–504.

van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000;39(12):1383–1389.

Shen SH, Huang KC, Tsai YH, et al. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc. 2014;15(10):725–731.

Morin S, Rahme E, Behlouli H, Tenenhouse A, Goltzman D, Pilote L. Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures. Osteoporos Int. 2007;18(12):1625–1632.

Lyles KW, Colón-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357(18):1799–1809.

Osaki M, Tatsuki K, Hashikawa T, et al. Beneficial effect of risedronate for preventing recurrent hip fracture in the elderly Japanese women. Osteoporos Int. 2012;23(2):695–703

Lee YK, Ha YC, Yoon BH, Koo KH. Incidence of second hip fracture and compliant use of bisphosphonate [published correction appears in Osteoporos Int. 2014 Sep;25(9):2327]. Osteoporos Int. 2013;24(7):2099–2104.

Besalduch M, Carrera I, Gómez-Masdeu M, De Caso J. Antiresorptive treatment, when initiated after a first hip fracture, may not protect of a second contralateral episode in elderly population: A study with 685 patients. Injury. 2016;47(4):877–880.

Suzuki N, Arai K, Kon S, et al. Challenges to prevent secondary fractures in patients with hip fractures in Joetsu Myoko, Japan through the increased use of osteoporosis treatment and collaboration with family doctors. J Bone Miner Metab. 2017;35(3):315–323

Young Y, Myers AH, Provenzano G. Factors associated with time to first hip fracture. J Aging Health. 2001;13(4):511–526

De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330–1338.

Court-Brown CM, Duckworth AD, Ralston S, McQueen MM. The relationship between obesity and fractures. Injury. 2019;50(8):1423–1428.

Kiel DP, Felson DT, Anderson JJ, Wilson PW, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. N Engl J Med. 1987;317(19):1169–1174.

Cummings SR, Nevitt MC. A hypothesis: the causes of hip fractures. J Gerontol. 1989;44(4):M107–M111

Perez Cano R, Galan Galan F, Dilsen G. Risk factors for hip fracture in Spanish and Turkish women. Bone. 1993;14 Suppl 1: S69–S72.

Zanetti M, Gortan Cappellari G, Ratti C, et al. Poor nutritional status but not cognitive or functional impairment per se independently predict 1-year mortality in elderly patients with hip-fracture. Clin Nutr. 2019;38(4):1607–1612

Downloads

Published

30-05-2020

How to Cite

1.
Murena L, Ratti C, Maritan G, et al. Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients. Acta Biomed. 2020;91(4-S):115-121. doi:10.23750/abm.v91i4-S.9716