Factors associated with a second hip fracture: a systematic review

Objective: To provide a systematic review of factors associated with subsequent hip fracture among individuals who have fractured a hip. Data sources: We searched Ageline, CINAHL, EMBASE and MEDLINE, from database inceptions to the week of 5 June 2006. Review methods: Studies were selected if they provided information regarding risk of subsequent hip fracture among individuals who had fractured a hip. Study quality was assessed using the Jadad criteria for randomized controlled trials (RCTs) and a simple scale based on the MOOSE criteria for cohort studies. Results: Four RCTs and seven cohort studies were identified. Older age, cognitive impairment and lower bone mass appear to increase the risk of subsequent fracture, as did impaired depth perception, impaired mobility, previous falls, dizziness and poor or fair self-perceived health. Pharmacologic treatment for osteoporosis decreased the risk of subsequent fracture. Use of hip protectors by community-dwelling seniors did not appear to protect against a second fracture. Conclusion: A number of easily observed risk factors may help identify those individuals at higher risk for subsequent fracture.