Risk of Hip Fracture in Community-dwelling and Institutionalized Osteoporotic Patients: A 3-year Study

SummaryBackground and aimsIt has been previously suggested that the incidence of hip fracture is higher among people living in nursing homes than among community-dwelling people. However, it is not clear whether this is a consequence of nursing home residency or of the greater age of the residents. We have examined the relationship between the place of residence and hip fracture incidence, in a prospective 3-year study.MethodsWomen from nine countries included in this study were part of the placebo group of a randomized controlled trial having assessed the long-term effect of a new antiosteoporotic drug. All women were osteoporotic and received placebo and vitamin D during the 3 years of follow-up. All the institutionalized (nursing home, medical house) women (n = 217) were included in this post hoc analysis and three noninstitutionalized age- and country-matched controls were included (n = 651).ResultsThe mean (and standard deviation) age of the patients was 80.4 (5.6) years in the institutionalized women and 80.2 (5.8) years in the noninstitutionalized women (p = 0.87). After 3 years of follow-up, 37 fractures occurred: 12 (5.5%) in institutionalized women and 25 (3.8%) in noninstitutionalized women. The difference between the two groups was not statistically significant (p = 0.29). After controlling for age, body mass index, femoral neck bone mineral density and prevalent nonvertebral fracture, the residence status of the patient (institutionalized vs. noninstitutionalized) was not significantly associated with hip fracture incidence (p = 0.63).ConclusionWe suggest that living in an institutionalized place is not an independent risk factor for hip fracture for osteoporotic women receiving calcium and vitamin D.