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The Risk of Fracture Following Hospitalization in Older Women and Men
Rebekah L. Gardner, MD;
Fran Harris, MS;
Eric Vittinghoff, PhD;
Steven R. Cummings, MD
Arch Intern Med. 2008;168(15):1671-1677.
Background Hospitalization may cause bone loss and decrease physical function; however, the risk of fracture following hospitalization is not known.
Methods A prospective study of a cohort of 3075 white and black women and men, aged 70 to 79 years, recruited from 2 communities from 1997 to 1998. Incident hospitalizations and fractures were validated by medical records by investigators blinded to patient groupings. Analyses of the association between hospitalization, length of stay, number of admissions, and risk of fracture were adjusted for age, race, sex, and other potential confounding factors.
Results During follow-up with a mean duration of 6.6 years, 2030 (66%) of the 3075 participants were admitted to a hospital and 809 (26%) were admitted 3 or more times; 285 experienced a fracture, including 74 hip fractures. After adjusting for age, race, and sex, those who had any hospitalization had a 2-fold increased risk of fracture (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.57-2.57), including an increased risk of hip fracture (HR, 2.15; 95% CI, 1.32-3.50). Those who were hospitalized twice during the follow-up period had a 2.42-fold increased risk of hip fracture (95% CI, 1.16-5.05), and 3 or more hospital stays indicated a 3.66-fold increased relative hazard for hip fracture (95% CI, 1.78-7.53).
Conclusions Hospitalizations, particularly multiple admissions, are very common in elderly individuals and are strongly associated with an increased risk of hip and other types of fracture. Hospitalizations present opportunities to take measures to reduce the risk of fractures.
Author Affiliations: Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco (Drs Gardner, Vittinghoff, and Cummings and Ms Harris), and San Francisco Coordinating Center, California Pacific Research Institute (Dr Cummings), San Francisco.
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