Bone Abstracts

Purpose: To determine whether and which co-morbidities (amongst those included in the Charlson co-morbidity index) confer an increased risk of hip fracture amongst elderly men.

Methods: We conducted a population-based cohort study using a population database which contains primary care and hospital inpatient records of over >2 million people. All men aged ≥65 years registered on 1/1/2007 were followed up until 31/12/2009. Both exposure (co-morbidities in the Charlson index) and outcome (incident hip fractures) were ascertained using ICD codes. Poisson regression models were fitted to estimate the effect of each individual co-morbidity and the composite Charlson index score, on hip fracture risk, after adjustment for age, BMI, smoking, alcohol drinking, and use of oral glucocorticoids.

Results: We observed 186 171 men for a median (inter-quartile range) of 2.99 (2.37–2.99) years. In this time, 1.718 (0.92%) of them had a hip fracture. The following co-morbidities were independently associated with hip fractures: diabetes mellitus (adjusted RR 1.43 (95% CI 1.25–1.69)), chronic obstructive pulmonary disease (COPD); (adjusted RR 1.20 (95% CI 1.03–1.40)), renal failure (adjusted RR 1.32 (95% CI 1.07–1.65)), HIV infection (adjusted RR 5.03 (95% CI 1.25–20.21)), dementia (adjusted RR 1.65 (95% CI 1.30–2.09)) and cerebrovascular disease (adjusted RR 1.51 (95% CI 1.27–1.80)). A Charlson score of 3 or ≥4 conferred an increased hip fracture risk (adjusted RR 1.52 (95% CI 1.26–1.83) and 1.53 (1.24–1.88) respectively).

Conclusion: Common comorbidities including diabetes, COPD, cerebrovascular disease, renal failure, and HIV infection are independent predictors of hip fracture in elderly men. A Charlson score of 3 or more is associated with a 50% higher risk of hip fracture in this population.