NEW YORK (Reuters Health) – The risk of fracture in elderly people is more than tripled during the year following a hospital admission, according to findings from the prospective Health Aging and Body Composition Study.
“Hospitalization is an unrecognized opportunity to assess and reduce the risk of fractures in a very large number of elderly women and men,” researchers at the University of California, San Francisco, state in the August 11/25 issue of the Archives of Internal Medicine.
The Health ABC study, funded by the National Institute of Aging, included 3075 individuals aged 70 to 79 years recruited from two communities from1997 to 1998. Inclusion criteria included no treatment for active cancer within the past three years, and ability to walk a quarter of a mile, climb ten steps, or perform activities of daily living without difficulty.
During mean follow-up of 6.6 years, 66% of the subjects were admitted to a hospital and 26% were admitted three or more times. There were 362 postdischarge fractures in 285 subjects, including 80 hip fractures in 74 individuals. After adjustment for age, race, and gender, subjects who had been hospitalized had an overall 2-fold increased risk of fracture.
The risk of fracture was greatest during the first year after hospitalization, with an age-, sex- and race-adjusted hazard ratio of 3.4, Dr. Rebekah L. Gardner and her associates report.
The adjusted risk of any fracture increased with the number of times a patient was hospitalized, from 1.38 after one admission to 3.17 after three or more. Risks for hip fractures were of similar magnitudes.
“Because the risk of fracture is greatest soon after hospital discharge, assessment and interventions to reduce risk should be started during the hospital stay or shortly after discharge,” Dr. Gardner’s team recommends. Evaluations should include measurement of bone mineral density, assessment of the risk of falling, and vision testing.
According to the authors, appropriate interventions include calcium and vitamin D supplementation; bisphosphonate treatment; vision correction; and physical therapy, including walking programs and exercises to improve flexibility, strength and balance.
Arch Intern Med 2008;168:1671-1677.