A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality

Figures & data

Figure 1 The algorithm for selection of studies in this systematic review.

Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Table 1 Summary of the selected studies

Ref	Year	Study design	Study population	Findings	Conclusion
^Citation28	2006	Clinical trial	633 osteoporotic fracture patients	• The highest costs were observed for hip fractures, followed by fracture of the leg and humerus • The lowest cost was observed for fracture of the wrist	Hip fracture is the most costly osteoporotic fracture
^Citation34	2011	Prospective cohort	1,116 men and women 50 years and older, with fractures	• Hip fracture cases were more likely to use rehabilitative and home care services (formal care) compared with nonhip nonvertebral fractures (P<0.001) • Vertebral fracture cases were less likely to use rehabilitative care service compared with nonhip nonvertebral fractures (P<0.001) • Multiple-fractures cases were more likely to use postacute resources than were single-fractures cases • Informal care was used by 47.2% of cases	Hip fracture and multiple-fracture patients were more likely to utilize postacute health care
^Citation35	2012	Prospective cohort	5,764 fracture patients	• Functional tests: worst in the vertebral fracture group (women) (P<0.0001) and the other osteoporotic fractures group (men) (P<0.05) • Risk of hospitalization: increased in vertebral and other osteoporotic fractures (P<0.0001) • Hospital stay: longer in vertebral fractures than nonfractured group (P=0.0001) and other osteoporotic fractures group (P=0.005)	Vertebral fracture patients performed poorly in functional tests, had higher risk of hospitalization, and longer hospital stay
^Citation15	2008	Cross-sectional	350 osteoporotic fracture patients	Of patients with vertebral fracture, 87% were discharged to home, whereas only 55% of patients with hip fracture were discharged to home, and 36% were transferred or discharged to a nursing home	Hip fracture patients were likely to be discharged to a nursing home
^Citation36	2004	Prospective cohort	303 women aged 55–75 years, with a new fracture	• Hip and vertebral fractures have greater and prolonged impact on HRQOL than do humerus and forearm fractures • The number of fractures was inversely correlated with HRQOL	Patients with hip and vertebral fractures had poor quality of life
^Citation37	2013	Prospective cohort	9,986 patients with distal radius fracture and 81,227 patients without distal fracture	• The risk of subsequent hip fracture in patients with distal radius fracture was 5.67 times higher than in the comparison cohort • The HR of subsequent hip fracture in relation to distal radial fracture was 3.45 (95% CI=2.59–4.61)	Patients with radial fracture had higher risk of subsequent hip fracture
^Citation38	2011	Prospective cohort	403 patients aged 45 years or older, with nonvertebral minimal trauma fractures	• Compared with the group receiving active identification and management, the risk of refracture was increased by 5.3 fold in the control group (95% CI: 2.8–12.2, P<0.01), with HR =5.63 (95% CI: 2.73–11.6, P<0.01)	Active identification and management reduced the risk of refracture
^Citation39	2008	Prospective cohort	30,655 nursing home residents aged 50 years and older	• HR of subsequent fractures:  ○ Prior hip fractures, HR =2.99 (95% CI:2.78–3.21)  ○ Nonhip fractures, HR =1.84 (95% CI:1.50–2.25)	The HR of subsequent fractures for nursing home residents with prior hip fractures was higher than for those with nonhip fractures
^Citation40	2008	Retrospective cohort	21,432 women 45 years or older	• HR of subsequent fractures:  ○ Primary wrist fracture: HR =1.58 (95% CI:1.29–1.93)  ○ Other primary fracture: HR =2.26 (95% CI: 2.30–3.08)  ○ Primary wrist fracture was not significantly associated with subsequent hip fracture: HR =1.29 (95% CI: 0.88–1.89, P=0.19) • The 10-year probability of any recurrent fracture:  ○ Primary wrist fracture: HR =14.2% (95% CI: 11.9%–16.5%)  ○ Primary spine fracture: HR =25.7% (95% CI: 21.2%–30.1%)  ○ Primary hip fracture: HR =24.9% (95% CI: 19.2%–30.6%)  ○ Primary humerus fracture: HR =23.7% (95% CI: 19.5%–27.9%)  ○ (P<0.001 for all comparisons vs wrist)	The HR for recurrent osteoporotic fracture after a primary wrist fracture was lower than for other primary fractures
^Citation41	2007	Prospective cohort	2,245 women and 1,760 men aged 60 years or older	• Relative risk of subsequent fracture in women was 1.95 (95% CI: 1.70–2.25) and in men was 3.47 (95% CI: 2.68–4.48) • Women and men aged 60 to 69 years had absolute refracture rates of 36/1,000 person-years (95% CI: 26–48/1,000) and 37/1,000 person-years (95% CI: 23–59/1,000), respectively	The risk of subsequent fracture was higher in men than women
^Citation42	2004	Prospective cohort	1,918 men and women aged 60 years or older, with fractures at spine, hip, or shoulder	• Men age 60 years, following a prior spine, hip or shoulder fracture: the risks of hip, forearm, and spine fractures were significantly increased • Women age 60 years: similar pattern, except that the increase in risk of forearm fracture following a spine or hip fracture was not statistically significant	The immediate fracture risk was higher than that of the general population, more especially at the age of 60 than at 80 years
^Citation45	2007	Retrospective cohort	163,313 hip fracture patients	• The relative 1-year survival in hip fracture patients was lower than controls • There was greater mortality in patients with hip fracture than in controls at all time periods. The excess mortality increased from HR of 1.80 (1981–1985) to 3.84 (1996–2001) (P<0.01)	Hip fracture patients had higher mortality rate
^Citation46	2009	Prospective cohort	1,295 women and men aged 60 years and older, who sustained a fracture	Age-adjusted SMR following fracture were increased for both women and men, respectively as below: • hip fractures:  ○ 2.43 (95% CI: 2.02–2.93)  ○ 3.51 (95% CI: 2.65–4.66) • vertebral fractures:  ○ 1.82 (95% CI:1.52–2.17)  ○ 2.12 (95% CI:1.66–2.72) • major fractures:  ○ 1.65 (95% CI: 1.31–2.08)  ○ 1.70 (95% CI: 1.23–2.36) • minor fractures  ○ 1.42 (95% CI:1.19–1.70)  ○ 1.33 (95% CI: 0.99–1.80)	There were higher mortality rates after a hip or vertebral fracture and major or minor fracture for both sexes
^Citation47	2009	Retrospective cohort	786,717 hip fractures patients aged 65 years or older	Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-,180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively	The mortality risk reduced with time after a fracture
^Citation48	2009	Prospective cohort	1,944 hip fracture patients aged 65 years or older	• Mortality rates at 4 months and 24 months after hip fracture were 16% and 38%, respectively • ASA and SPMSQ scores can be combined to predict mortality risks after hip fractures in elderly	ASA and SPMSQ scores could predict hip fracture patients with high mortality rate
^Citation49	2010	Retrospective cohort	440,890 death certificates which reported an osteoporotic fracture	• 2.2% reported deaths were due to osteoporotic fractures; 1.5% of death or 69% of all osteoporotic fractures were identified as hip fracture • The mortality rate for hip fracture was higher in women than men	Hip fractures were the main cause of mortality due to osteoporotic fractures
^Citation50	2011	Retrospective cohort	428 hip fracture patients aged 65 years or older	• The cumulative postoperative mortality for hip fracture was:  ○ 1 year: 27.3%  ○ 3 years: 48.8%  ○ 7 years: 73.6% • The age-adjusted mortality after hip fracture surgery was higher in men than in women, with HR =1.55 (95% CI: 1.21–2.00) • The age- and sex-standardized mortality after hip fracture was three-fold higher than that of the general population	Men had higher mortality rate after hip fracture surgery
^Citation51	2004	Prospective cohort	16,051 men and women aged 50 years or more, with a vertebral fracture	• The mortality risk was markedly increased immediately after fracture at all ages (RR: 7.3 to 0.99)(br) • The risk increased with age at a rate that was higher than that of the general population and comparable to that 1 year after hip fracture	Patients with vertebral fracture had higher mortality rates

Abbreviations: ASA, American Society of Anesthesiologists; CI, confidence interval; HR, hazard ratio; HRQOL, health-related quality of life; RR, relative risk; SMR, standardized mortality ratio; SPMSQ, Short Portable Mental Status Questionnaire.

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