The impact of second hip fracture on rehospitalization and mortality in older adults

Purpose: Although a second hip fracture is not uncommon in the older population, the extent to which such an event may affect health-related outcomes has not been fully clarified. We aimed to evaluate the risk of new falls, functional decline, rehospitalization, institutionalization and mortality in older patients admitted for a second vs. a first hip fracture. Methods: The sample consisted of 288 older patients admitted to the Orthogeriatric Unit of Bolzano Hospital (northern Italy) and surgically treated for a hip fracture from June 2016 to June 2017. Socio-demographic data and hospitalization-related information were collected and a multidimensional assessment was made upon admission and during the hospital stay. Fifteen months after discharge, data on mobility level, functional status, institutionalization, and new falls were obtained from personal or structured phone interviews. Information on rehospitalization and mortality was obtained from local hospital registers. Results: One out of six patients (14.6 %) admitted was suffering a second hip fracture, of which only 16.7 % were on antiresorptive therapies. At the 15-month follow-up, individuals who had been treated for a second hip fracture were more likely than those treated for their first to have low mobility levels (OR = 4.13, 95%CI:1.23 - 13.84), to be rehospitalized (OR = 2.57, 95%CI:1.12 - 5.90), and to have a higher mortality (HR = 1.81, 95 %CI:1.05-3.12). Conclusions: The occurrence of a second hip fracture may further affect the clinical vulnerability and mortality of older adults. These results highlight the need to implement preventive action to minimize the risk of re-fracture after the first event.