Hospitalization increases fracture risk in elderly

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 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, point out in the Archives of Internal Medicine.

The Health ABC study, funded by the National Institute of Aging, included 3,075 individuals ages 70 to 79 years recruited from two communities from1997 to 1998. Inclusion criteria included no treatment for active cancer within the past 3 years, and the ability to walk a quarter of a mile, climb 10 steps, or perform activities of daily living without difficulty.

During an average follow-up of 6.6 years, 66 percent of the subjects were admitted to a hospital and 26 percent were admitted three or more times. There were 362 fractures after discharge in 285 subjects, including 80 hip fractures in 74 individuals. After considering the effect of age, race, and gender, the subjects who had been hospitalized had a 2-fold increased risk of fracture.

The risk of fracture was greatest during the first year after hospitalization, with a risk of 3.4 percent, Dr. Rebekah L. Gardner and her associates report.

The 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.

"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," 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 treatment for these patients include calcium and vitamin D supplements; bisphosphonate drug treatment, such as alendronate (Fosamax) or risedronate (Actonel); vision correction if needed; and physical therapy, including walking programs and exercises to improve flexibility, strength and balance.

SOURCE: Archives of Internal Medicine, August 11/25, 2008.