Factors associated with hip fracture following a fall-associated hospitalization in older adults: a retrospective cohort study.

UNLABELLED: Among older adults hospitalized after a fall, receiving a DXA scan was associated with a decreased hazard of sustaining a hip fracture within 2 years. Older age, female sex, dementia, parkinsonism, mental health disorder and intermediate frailty were associated with a higher hazard of having a hip fracture post-discharge.

PURPOSE: Identify factors associated with increased hazard of having a hip fracture within 2 years of discharge following a fall-related hospitalization.

METHODS

We conducted a retrospective cohort study of all Ontario adults aged 65 + hospitalized after a fall between November 1, 2015 and October 31, 2020 using administrative health databases. We compared individuals who did or did not experience a hip fracture within 2 years of discharge based on socio-demographics, frailty, comorbidities, receipt of a dual-energy X-ray absorptiometry (DXA) scan, and family physician or geriatrician visits. We performed a Cox proportional hazard regression to identify factors associated with having a subsequent hip fracture, accounting for death as a competing risk.

RESULTS

Among the 88,140 individuals who were discharged after a fall-related hospitalization, 4.6% suffered a hip fracture within 2 years. Older age (hazard ratio [HR] 1.04 per year, 95% confidence interval [CI] 1.04-1.05), female sex (HR 1.16, 95% CI 1.08-1.24), parkinsonism (HR 1.42, 95% CI 1.19-1.70), dementia (HR 1.28, 95% CI 1.17-1.41), mental health disorders (HR 1.10, 95% CI 1.01-1.20), and intermediate frailty risk by HFRS score (HR 6.68, 95% CI 3.28-13.7) were associated with a higher hazard of having a hip fracture. Post-discharge DXA scanning was associated with a decreased hip fracture hazard (HR 0.75, 95% CI 0.66-0.86), yet only 15% of the study population underwent this assessment.

CONCLUSION

Timely fall risk reduction and bone health optimization efforts should focus on the high-risk groups identified in this study to help prevent hip fractures following fall-related hospitalizations.