Early initiation of treatment after primary hip fracture helps reduce second fracture incidence, mortality

Research presented today at the 4th Asia-Pacific Osteoporosis Meeting showed that second hip fractures are more deadly than first hip fractures. Based in Hong Kong, the study evaluated the overall incidence of a second hip fracture and subsequent mortality in 43,832 patients, aged 65 or above, with operatively treated first hip fracture during the years 2000-2011. The patients' mean age was 82-7.38 and the male to female ratio was 3:7. A total of 2,399 second hip fractures were identified.

On average, second hip fractures occurred 2 years and 8 months after the primary hip fracture. Females had a higher incidence of second hip fracture. The overall incidence of a second fracture was 0.88% at 6 months, 1.81% at 1 year, 6.91% at 5 years and 9.95% at 10 years. A total 75% of second fractures occurred within around 4 years after the initial fracture.

The median survival after single fracture was 4 years 10 months, while second fracture was 3 years 8 months. Lower survival was observed in second fracture (HR 5.44, 95%CI 1.67-11.1, p<0.001) and in males (HR 1.91, 95%CI 1.86-1.96, p<0.05). Older patients had a minimal risk for increase mortality (HR 1.061, 95%CI 1.059-1.063, p<0.05).

The authors concluded that further studies are needed to help explain the excessive mortality of second hip fracture compared to primary hip fractures. Furthermore, they suggest that early initiation of treatment and a fragility fracture prevention programme after primary hip fracture could help reduce second fracture incidence and related mortality.