Major risk factors for the second contralateral hip fracture in the elderly

Abstract

Objectives: The purpose of this study was to determine which of the predisposing risk factors for the first hip fracture would continue to be effective for the development of the second hip fracture in the elderly. Methods: Data of 125 patients (31 men, 94 women) aged 55 years or older were evaluated, who sustained first (group 1, n=97) and second contralateral (group 2, n=28) hip fracture. Patients who were treated with bisphosphonate, calcitonin, or estrogen were excluded. Results: The incidence of the second hip fracture was higher (78.6%) beyond 12 months of the first fracture. The risk for sustaining a second hip fracture was 3.96-fold greater in patients over 85 years of age (p<0.05). Among comorbid medical conditions, eye diseases (p=0.02) and neurological diseases (p=0.048) were seen significantly more frequent in group 2. There was an obvious relationship between the second hip fracture and lower Singh index grades of ≤3 (p<0.001). Patients over 85 years of age and having a lower Singh index grade were found to have a 6.57-fold increased risk for developing a second hip fracture (95% CI: 2.13-20.3; p=0.001). In univariate analysis, neurological diseases represented a significantly increased risk. Eye diseases were highly associated with an increased risk for second hip fractures in univariate (OR: 3.3, 95% CI: 1.2-9.2, p=0.020) and multivariate (OR: 7.6, 95% CI: 1.9-30.7, p=0.004) analyses. The Singh index of grade ≤3 showed the highest associations with second hip fractures in both univariate (OR: 18.9, 95% CI: 5.8-65.9, p<0.001) and multivariate (OR: 30.00, 95% CI: 7.9-112.9, p<0.001) analyses. Conclusion: We concluded that, of all the risk factors for the first hip fractures, only hypotrophic changes in the proximal femoral trabeculae, eye diseases, and neurological diseases acted as major risk factors for the second contralateral hip fractures in the elderly. © 2009 Turkish Association of Orthopaedics and Traumatology.