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Osteoporosis International

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01-07-2019 | Femoral Fracture | Original Article

Risk of institutionalization following fragility fractures in older people

Authors: P. Benzinger, S. Riem, J. Bauer, A. Jaensch, C. Becker, G. Büchele, K. Rapp

Published in: Osteoporosis International | Issue 7/2019

Abstract

Summary

Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home.

Introduction

Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture.

Methods

Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied.

Results

Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture.

Conclusions

The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.

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Rapp K, Rothenbacher D, Magaziner J, Becker C, Benzinger P, König HH, Jaensch A, Büchele G (2015) Risk of nursing home admission after femoral fracture compared with stroke, myocardial infarction, and pneumonia. J Am Med Dir Assoc 16:715.e7–715.e12. https://doi.org/10.1016/j.jamda.2015.05.013 CrossRef

Bliuc D (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521. https://doi.org/10.1001/jama.2009.50 CrossRefPubMed

Melton LJ, Achenbach SJ, Atkinson EJ, Therneau TM, Amin S (2013) Long-term mortality following fractures at different skeletal sites: a population-based cohort study. Osteoporos Int 24:1689–1696. https://doi.org/10.1007/s00198-012-2225-1 CrossRefPubMed

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet Lond Engl 353:878–882. https://doi.org/10.1016/S0140-6736(98)09075-8 CrossRef

Browner WS (1996) Mortality following fractures in older women: the study of osteoporotic fractures. Arch Intern Med 156:1521–1525. https://doi.org/10.1001/archinte.1996.00440130053006 CrossRefPubMed

for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group, Dyer SM, Crotty M et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158. https://doi.org/10.1186/s12877-016-0332-0 CrossRef

Nanninga GL, de Leur K, Panneman MJM et al (2014) Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age Ageing 43:648–653. https://doi.org/10.1093/ageing/aft212 CrossRefPubMed

Alnaib M, Waters S, Shanshal Y, Caplan N, Jones S, St Clair Gibson A, Kader D (2012) Combined pubic rami and sacral osteoporotic fractures: a prospective study. J Orthop Traumatol 13:97–103. https://doi.org/10.1007/s10195-012-0182-2 CrossRefPubMedPubMedCentral

Morris RO (2000) Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 76:646–650. https://doi.org/10.1136/pmj.76.900.646 CrossRefPubMedPubMedCentral

10.

Marrinan S, Pearce MS, Jiang XY, Waters S, Shanshal Y (2015) Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence. Age Ageing 44:258–261. https://doi.org/10.1093/ageing/afu123 CrossRefPubMed

11.

Katz PR (2011) An international perspective on long term care: focus on nursing homes. J Am Med Dir Assoc 12:487–492.e1. https://doi.org/10.1016/j.jamda.2011.01.017 CrossRefPubMed

12.

Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM (2010) Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 340:c1718–c1718. https://doi.org/10.1136/bmj.c1718 CrossRefPubMedPubMedCentral

13.

Becker C, Leistner K, Nikolaus T (1998) Introducing a statutory insurance system for long-term care (Pflegeversicherung) in Germany. In: Michel JP, Rubenstein LZ, Vellas BJ, Albarede JL (eds) Geriatr Programs Dep World Serdi. Springer, Paris, pp 55–64

14.

Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, Boonen S (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Osteoporos Int 11:373–380. https://doi.org/10.1007/s001980070102 CrossRefPubMed

15.

Cumming RG, Klineberg R, Katelaris A (1996) Cohort study of risk of institutionalisation after hip fracture. Aust N Z J Public Health 20:579–582. https://doi.org/10.1111/j.1467-842X.1996.tb01069.x CrossRefPubMed

16.

Morin S, Lix LM, Azimaee M, Metge C, Majumdar SR, Leslie WD (2012) Institutionalization following incident non-traumatic fractures in community-dwelling men and women. Osteoporos Int 23:2381–2386. https://doi.org/10.1007/s00198-011-1815-7 CrossRefPubMed

17.

Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284. https://doi.org/10.1056/NEJM199710303371806 CrossRefPubMed

18.

Gill TM, Murphy TE, Gahbauer EA, Allore HG (2013) Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol 178:418–425. https://doi.org/10.1093/aje/kws554 CrossRefPubMedPubMedCentral

19.

Goodwin JS, Howrey B, Zhang DD, Kuo Y-F (2011) Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci 66A:1321–1327. https://doi.org/10.1093/gerona/glr171 CrossRefPubMedCentral

20.

Hill RM, Robinson CM, Keating JF (2001) Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg (Br) 83:1141–1144CrossRef

21.

Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507CrossRefPubMed

22.

Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I, Kristiansen IS (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574. https://doi.org/10.1007/s00198-003-1583-0 CrossRefPubMed

23.

Svensson HK, Olofsson EH, Karlsson J, Hansson T, Olsson LE (2016) A painful, never ending story: older women’s experiences of living with an osteoporotic vertebral compression fracture. Osteoporos Int 27:1729–1736. https://doi.org/10.1007/s00198-015-3445-y CrossRefPubMed

24.

Suzuki N, Ogikubo O, Hansson T (2008) The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months. Eur Spine J 17:1380–1390. https://doi.org/10.1007/s00586-008-0753-3 CrossRefPubMedPubMedCentral

25.

Peasgood T, Herrmann K, Kanis JA, Brazier JE (2009) An updated systematic review of health state utility values for osteoporosis related conditions. Osteoporos Int 20:853–868. https://doi.org/10.1007/s00198-009-0844-y CrossRefPubMed

26.

Hiligsmann M, Ethgen O, Richy F, Reginster J-Y (2008) Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 82:288–292. https://doi.org/10.1007/s00223-008-9117-6 CrossRefPubMed

27.

Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427CrossRefPubMed

28.

Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH (2013) The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany--a demographic simulation model. Osteoporos Int 24:835–847. https://doi.org/10.1007/s00198-012-2020-z CrossRefPubMed

29.

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733. https://doi.org/10.1007/s00198-006-0172-4 CrossRefPubMed

30.

Kanis JA, Oden A, Johnell O, de Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473CrossRefPubMed

31.

van Dijk WA, Poeze M, van Helden SH, Brink PRG, Verbruggen JPAM (2010) Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury 41:411–414. https://doi.org/10.1016/j.injury.2009.12.014 CrossRefPubMed

32.

Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM (2014) Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med 174:1273–1280. https://doi.org/10.1001/jamainternmed.2014.2362 CrossRefPubMedPubMedCentral

33.

Bäßgen K, Westphal T, Haar P et al (2012) Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200 413 inhabitants. J Public Health Oxf Engl 35:255–261. https://doi.org/10.1093/pubmed/fds076 CrossRef

34.

Gaughan J, Gravelle H, Santos R, Siciliani L (2017) Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients. Int J Health Econ Manag 17:311–331. https://doi.org/10.1007/s10754-017-9214-z CrossRefPubMedCentral

35.

Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448. https://doi.org/10.1007/s00198-010-1480-2 CrossRefPubMed

Title: Risk of institutionalization following fragility fractures in older people
Authors: P. Benzinger
S. Riem
J. Bauer
A. Jaensch
C. Becker
G. Büchele
K. Rapp
Publication date: 01-07-2019
Publisher: Springer London
Keywords: Femoral Fracture
Care
Published in: Osteoporosis International / Issue 7/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-04922-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Risk of institutionalization following fragility fractures in older people

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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