Yonsei Med J.  2012 Sep;53(5):1005-1009.

Subsequent Hip Fracture in Osteoporotic Hip Fracture Patients

• Lee SH
• Lee TJ
• Cho KJ
• Shin SH
• Moon KH

Abstract

PURPOSE
A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs.
MATERIALS AND METHODS
We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively.
RESULTS
The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05).
CONCLUSION
Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.

Keyword

Hip fracture; osteoporosis; bone mineral density; subsequent fracture

MeSH Terms

Alcoholism
Body Mass Index
Bone Density
Dementia
Diagnosis
Dizziness
Follow-Up Studies
Hip Fractures
Hip*
Humans
Mortality
Osteoporosis
Risedronate Sodium
Risk Factors
Risedronate Sodium

Figure

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  Fig. 1 A 69-year old woman had a subsequent fracture on the left side after a right side intertrochanteric fracture (initial T-score -5.3). (A) Initial radiographs of right hip side intertrochanteric fracture. (B) Postoperative radiograph after a bipolar hemiarthroplasty. (C) Radiographs of subsequent fracture in the left femur neck (T-score -5.7 with patient who did not have treatment for osteoporosis). (D) Postoperative radiograph after a bipolar hemiarthroplasty. The patient started medication for osteoporosis.

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