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Risk of institutionalization following fragility fractures in older people

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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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Acknowledgements

We thank Marianna Hanke-Ebersoll from the Allgemeine Ortskrankenkasse Bavaria (AOK) for her support of our analyses.

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Author notes

  1. P. Benzinger and S. Riem have equally contributed and shared as first authorship

Authors and Affiliations

  1. Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany

    P. Benzinger & J. Bauer

  2. Faculty of Social and Health Studies, University of Applied Sciences Kempten, Bahnhofstraße 61, 87435, Kempten, Germany

    P. Benzinger

  3. Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany

    P. Benzinger, S. Riem, C. Becker & K. Rapp

  4. Klinik für Unfallchirurgie, Kreiskrankenhaus Lörrach, Spitalstraße 25, 79539, Lörrach, Germany

    S. Riem

  5. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany

    A. Jaensch, G. Büchele & K. Rapp

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  1. P. Benzinger
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Correspondence to P. Benzinger.

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The study was approved by the ethical committee of Ulm University.

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Benzinger, P., Riem, S., Bauer, J. et al. Risk of institutionalization following fragility fractures in older people. Osteoporos Int 30, 1363–1370 (2019). https://doi.org/10.1007/s00198-019-04922-x

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