Risk of institutionalization following fragility fractures in older people

• Published in: Osteoporosis international 2019-07, Vol.30 (7), p.1363-1370
• Main Authors: Benzinger, P., Riem, S., Bauer, J., Jaensch, A., Becker, C., Büchele, G., Rapp, K.
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Endocrinology; Female; Femur; Fibula; Fractures; Germany - epidemiology; Health risk assessment; Hip; Hip Fractures - mortality; Hip Fractures - rehabilitation; Homes for the Aged - statistics & numerical data; Hospital Mortality; Humans; Humerus; Independent Living - statistics & numerical data; Institutionalization; Institutionalization - statistics & numerical data; Male; Medicine; Medicine & Public Health; Mortality; Nursing homes; Nursing Homes - statistics & numerical data; Older people; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - mortality; Osteoporotic Fractures - rehabilitation; Pelvis; Regression analysis; Rheumatology; Risk assessment; Risk Assessment - methods; Tibia; Well being
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-019-04922-x

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.