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Fragility non-hip fracture patients are at risk

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Fragility fractures are a growing worldwide health care problem. Hip fractures have been clearly associated with poor outcomes. Fragility fractures of other bones are common reasons for hospital admission and short-term disability, but specific long-term outcome studies of non-hip fragility fractures are rare. The aim of our trial was to evaluate the 1-year outcomes of non-hip fragility fracture patients.

Methods

This study is a retrospective cohort review of 307 consecutive older inpatient non-hip fracture patients. Patient data for analysis included fracture location, comorbidity prevalence, pre-fracture functional status, osteoporosis treatments and sociodemographic characteristics. The main outcomes evaluated were 1-year mortality and post-fracture functional status.

Results

As compared to the expected mortality, the observed 1-year mortality was increased in the study group (17.6 vs. 12.2 %, P = 0.005). After logistic regression, three variables remained as independent risk factors for 1-year mortality among non-hip fracture patients: malnutrition (OR 3.3, CI 1.5–7.1), Charlson comorbidity index (CCI) (OR 1.3, CI 1.1–1.5) and the Parker Mobility Score (PMS) (OR 0.85, CI 0.74–0.98). CCI and PMS were independent risk factors for a high grade of dependency after 1 year. Management of osteoporosis did not significantly improve after hospitalization due to a non-hip fragility fracture.

Conclusion

The outcomes of older non-hip fracture patients are comparable to the poor outcomes of older hip fracture patients, and appear to be primarily related to comorbidities, pre-fracture function and nutritional status. The low rate of patients on osteoporosis medications likely reflects the insufficient recognition of the importance of osteoporosis assessment and treatment in non-hip fracture patients. Increased clinical and academic attention to non-hip fracture patients is needed.

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Conflict of interest

None of the authors has conflict of interest regarding the topics discussed in this study.

Author information

Authors and Affiliations

  1. Department of Medicine 2/Geriatris, Klinikum Nürnberg, Nuremberg, Germany

    M. Gosch

  2. Department of Traumatology, Medical University of Innsbruck, 6020, Innsbruck, Austria

    T. Druml, T. Roth, M. Zegg, M. Blauth & C. Kammerlander

  3. Division of Geriatrics, University of Rochester Medical Center Rochester, Rochester, USA

    J. A. Nicholas

  4. Department of Internal Medicine I, Department of Gastroenterology Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria

    Y. Hoffmann-Weltin

Authors
  1. M. Gosch
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  2. T. Druml
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  3. J. A. Nicholas
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  4. Y. Hoffmann-Weltin
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  5. T. Roth
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  6. M. Zegg
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  7. M. Blauth
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  8. C. Kammerlander
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Correspondence to C. Kammerlander.

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Gosch, M., Druml, T., Nicholas, J.A. et al. Fragility non-hip fracture patients are at risk. Arch Orthop Trauma Surg 135, 69–77 (2015). https://doi.org/10.1007/s00402-014-2115-4

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  • DOI: https://doi.org/10.1007/s00402-014-2115-4

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