Journal of orthopaedic trauma · 2025
Predicting Contralateral Second Hip Fracture Risk Within 5 Years of First Hip Fracture: A New Risk Tool to Guide Patient/Family Counseling and Bone Health Treatment.
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Pettit Christopher J, Herbosa Carolyn F, Linker Jacob A, Ganta Abhishek, Egol Kenneth A, Konda Sanjit R
Аннотация
OBJECTIVE: To develop a stratification tool to identify patients with hip fracture at risk for second contralateral hip fracture and mortality within 5 years of an index fracture, and to assess the cost-effectiveness of prophylactic fixation in high fracture risk/low mortality risk patients.
DESIGN: Retrospective prognostic cohort study.
SETTING: Single academic system with 2 Level 1 Trauma Centers, 1 orthopedic specialty hospital, and 1 tertiary care hospital.
PATIENT SELECTION CRITERIA: Patients who were 60 years or older with OTA 31A/B hip fractures from low-energy mechanisms between 11/1/2014 and 11/31/2023 with ≥5-year follow-up or until death were included.
OUTCOME MEASURES AND COMPARISONS: The study included 4 phases: (1) identifying factors associated with second hip fracture within 5 years; (2) using multivariate logistic regression to generate models predicting 5-year second hip fracture (vs. FRAX) and mortality risk; (3) creating a "risk matrix" to identify candidates for prophylactic fixation using Youden Index, which determined cutoff points encompassing the maximum sensitivity and specificity for each risk equation and were used to define a value-based target group; and (4) cost analysis comparing standard versus prophylactic care in high fracture risk/low mortality risk patients.
RESULTS: Of 426 patients (mean age 80.25 years, 73.4% female), 78 sustained second hip fractures (mean interval: 594 days). Predictors included higher FRAX score ( P = 0.004), dementia ( P < 0.001), ICU stay ( P = 0.014), discharge to subacute care ( P < 0.001), and 90-day readmission ( P = 0.011). Logistic regression predicted 5-year second fracture risk (AUC 0.742 vs. FRAX 0.617, P = 0.012) and 5-year mortality (AUC 0.723). The risk matrix used cutoff points of 18.2% (mortality) and 38.2% (second fracture) to define a value-based target group (n = 26; 13 experienced second fracture). Cost analysis showed that prophylactic fixation of all 26 patients ($781,508) would save $353,067 compared with treating the 13 who fractured again ($1,134,575).
CONCLUSIONS: A novel matrix was developed that accurately predicted 5-year second hip fracture and mortality risk. Prophylactic fixation in low mortality, high fracture risk patients may reduce costs and prevent future fractures [Tool available: https://sttgmacom.wpcomstaging.com/predicting-risk-of-second-hip-fractures/ ].
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective prognostic cohort study.
SETTING: Single academic system with 2 Level 1 Trauma Centers, 1 orthopedic specialty hospital, and 1 tertiary care hospital.
PATIENT SELECTION CRITERIA: Patients who were 60 years or older with OTA 31A/B hip fractures from low-energy mechanisms between 11/1/2014 and 11/31/2023 with ≥5-year follow-up or until death were included.
OUTCOME MEASURES AND COMPARISONS: The study included 4 phases: (1) identifying factors associated with second hip fracture within 5 years; (2) using multivariate logistic regression to generate models predicting 5-year second hip fracture (vs. FRAX) and mortality risk; (3) creating a "risk matrix" to identify candidates for prophylactic fixation using Youden Index, which determined cutoff points encompassing the maximum sensitivity and specificity for each risk equation and were used to define a value-based target group; and (4) cost analysis comparing standard versus prophylactic care in high fracture risk/low mortality risk patients.
RESULTS: Of 426 patients (mean age 80.25 years, 73.4% female), 78 sustained second hip fractures (mean interval: 594 days). Predictors included higher FRAX score ( P = 0.004), dementia ( P < 0.001), ICU stay ( P = 0.014), discharge to subacute care ( P < 0.001), and 90-day readmission ( P = 0.011). Logistic regression predicted 5-year second fracture risk (AUC 0.742 vs. FRAX 0.617, P = 0.012) and 5-year mortality (AUC 0.723). The risk matrix used cutoff points of 18.2% (mortality) and 38.2% (second fracture) to define a value-based target group (n = 26; 13 experienced second fracture). Cost analysis showed that prophylactic fixation of all 26 patients ($781,508) would save $353,067 compared with treating the 13 who fractured again ($1,134,575).
CONCLUSIONS: A novel matrix was developed that accurately predicted 5-year second hip fracture and mortality risk. Prophylactic fixation in low mortality, high fracture risk patients may reduce costs and prevent future fractures [Tool available: https://sttgmacom.wpcomstaging.com/predicting-risk-of-second-hip-fractures/ ].
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.