Association of orthogeriatric co-management with the occurrence of secondary fragility fractures in patients with an initial hip fracture.

Abstract

This study examined the association between the availability of an orthogeriatric co-management and secondary fractures in 97,976 hip fracture patients. We found that the presence of orthogeriatric co-management was associated with a small but sustainable reduction in secondary fragility fractures in patients with an initial hip fracture. The risk of experiencing a subsequent fracture is particularly high immediately following an initial fragility fracture. Geriatricians are increasingly involved in the management of fragility fractures. However, there is currently no evidence indicating whether this orthogeriatric co-management (OGCM) can reduce the incidence of secondary fracture. This study aimed to analyse the association between OGCM and the occurrence of secondary fragility fractures in patients with an initial hip fracture. Nationwide health insurance data from Germany were used to identify hip fracture patients aged ≥ 80 years. According to the presence of an OGCM, hospitals were categorised into those with OGCM and those without OGCM. Outcomes were secondary fragility fractures (i.e. humerus, forearm, hip, pelvis, spine) within different time periods after an initial hip fracture. Crude incidences and hazard rate ratios for a secondary fragility fracture were calculated. The dataset included 97,976 hip fracture patients aged 80 and older from 716 hospitals (71% with OGCM). Within 12 months after the initial fracture, 5487 (5.6%) patients experienced at least one secondary fragility fracture. Patients treated in hospitals with OGCM had a lower incidence of secondary fragility fractures than those treated in hospitals without OGCM. For instance, after 1, 3 and 6 months, there was an absolute risk reduction of 0.1, 0.3 and 0.4% and a relative risk reduction of 27, 14 and 8%. The presence of an OGCM was associated with a small reduction in secondary fragility fractures in patients with an initial hip fracture.