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The Framingham Study

Sarah D. Berry, MD, MPH; Elizabeth J. Samelson, PhD; Marian T. Hannan, DSc; Robert R. McLean, DS; Mei Lu, MS; L. Adrienne Cupples, PhD; Michele L. Shaffer, PhD; Alexa L. Beiser, PhD; Margaret Kelly-Hayes, EdD, RN; Douglas P. Kiel, MD, MPH

Arch Intern Med. 2007;167(18):1971-1976.

Background  Older persons with hip fractures remain at increased risk of subsequent hip fractures. However, little is known about the frequency and characteristics of persons who sustain a second hip fracture.

Methods  Participants included 481 members of the Framingham Heart Study who sustained an initial hip fracture between April 1952 and December 31, 2003. Participants were followed up until a second hip fracture, death, dropout, or study completion. Age, sex, falls, stroke, dementia, residence, recent weight change, body mass index, and functional status were considered potential predictors of a second hip fracture.

Results  During a median of 4.2 years of follow-up, 71 subjects (14.8%) experienced a second hip fracture. Following a first hip fracture, 2.5% of subjects experienced a second hip fracture within 1 year, and 8.2% of subjects (9.7% of women) experienced a second hip fracture within 5 years. One-year mortality following an initial hip fracture was 15.9% compared with 1-year mortality following a second hip fracture of 24.1%. The risk of a second hip fracture increased with age (hazard ratio [HR] per 5-year increase in age, 1.5; 95% confidence interval [CI], 1.1-1.8) and with high functional status (HR compared with moderate functional status, 2.7; 95% CI, 1.1-6.9). There was a statistically nonsignificant association between low functional status and the risk of second hip fracture (HR compared with moderate functional status, 3.7; 95% CI, 0.9-14.8).

Conclusions  Among survivors of an initial hip fracture, the incidence of a second hip fracture is substantial. Older age and functional status may be important predictors of a second hip fracture. There seems to be adequate time between the first and second hip fractures for interventions that may reduce second hip fractures.

Author Affiliations: Department of Medicine, Beth Israel Deaconess Medical Center (Dr Berry), Hebrew SeniorLife and Harvard Medical School (Drs Berry, Samelson, Hannan, McLean, and Kiel and Ms Lu), School of Dental Medicine, Tufts University (Ms Lu), and School of Public Health (Drs Cupples, Shaffer, and Beiser) and School of Medicine (Dr Kelly-Hayes), Boston University, Boston, Massachusetts; and Penn State College of Medicine, Hershey, Pennsylvania (Dr Shaffer).

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