Exp Clin Endocrinol Diabetes 2011; 119(7): 414-418
DOI: 10.1055/s-0030-1270466
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Mortality after Hip Fracture in Diabetic Patients

N. E. Gulcelik1 , M. Bayraktar1 , O. Caglar2 , M. Alpaslan2 , J. Karakaya3
  • 1Hacettepe Medical School, Department of Endocrinology and Metabolism
  • 2Hacettepe Medical School, Department of Orthopedic Surgery
  • 3Hacettepe Medical School, Department of Biostatistics
Further Information

Publication History

received 17.08.2010 first decision 15.12.2010

accepted 15.12.2010

Publication Date:
06 May 2011 (online)

Abstract

Aim: Type 2 diabetic patients have an increased incidence of hip fracture. In this study, we aimed to evaluate the mortality rate after hip fracture and determine the predictors of mortality in diabetic patients.

Methods: 356 patients who sustained a hip fracture between January 1997 and June 2008 were retrospectively reviewed for the study. Of the eligible 230 patients, 69 had type 2 diabetes. Each of these patients’ medical and nursing notes were reviewed to ascertain additional information, including patient demographic factors, prior co-morbidities, fracture type, length of post-fracture stay and post-operative complications, the presence and duration of diabetes, glucose levels, HbA1c levels, albumin and hemoglobin levels.

Results: 148 women (64.3%) and 82 men (35.7%) were included in the study. The mean age of the study group was 76.1±10.4 years. The mean age for diabetics was 76.1±12.0 years and was 75.1±9.4 years for non-diabetics (p=0.343). Diabetic patients with hip fracture had a higher risk of mortality than the non-diabetic patients. One year survival probabilities of diabetic and non-diabetic patients were respectively 68.0% and 87.3% (p=0.033). In diabetic patients with a hip fracture, predictors of mortality were advanced age, the presence of postoperative complications and elevated HbA1c levels.

Conclusions: Diabetic patients have an increased risk of mortality after hip fracture. The medical care in the post-operative period, including glycemic control and postoperative complications, should be optimized in diabetic patients suffering from hip fracture in order to decrease mortality in these patients.

References

  • 1 Christensen JO, Swendsen OL. Bone mineral in pre- and postmenopausal women with insulin dependent and non-insulin dependent diabetes mellitus.  Osteoporosis Int. 1999;  10 307-311
  • 2 Cornwall R, Gilbert MS, Koval KJ. et al . Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics.  Clin Orthop Relat Res. 2004;  425 64-71
  • 3 Epstein S, Leroith D. Diabetes and fragility fractures – a burgeoning epidemic?.  Bone. 2008 Jul;  43 (1): 3-6
  • 4 Forsen L, Sogaard AJ, Meyer HE. et al . Survival after hip fracture: short- and long-term excess mortality according to age and gender.  Osteoporos Int. 1999;  10 73-78
  • 5 Fox KM, Magaziner J, Hebel JR. et al . Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment and sequelae.  J Gerontol A Biol Sci Med Sci. 1999;  54 M635-M640
  • 6 Goodson WH, Hung TK. Studies of wound healing in experimental diabetes mellitus.  J Surg Res. 1997;  221-227
  • 7 Hadjidakis DI, Androulakis II, Mylonakis AM. et al . Diabetes in Postmenopause: Different Influence on Bone Mass According to Age and Disease Duration.  Exp Clin Endocrinol Diabetes. 2009;  117 199-204
  • 8 Haentejens P, Autier P, Barette M. et al on behalf of the hip fracture study group Survival and functional outcome according to hip fracture type: A one year prospective cohort study in elderly women with an intertorachanteric or femoral neck fracture.  Bone. 2007;  41 958-964
  • 9 Johnell O, Kanis JA, Oden A. Mortality after osteoporotic fractures.  Osteoporosis Int. 2004;  15 38-42
  • 10 Karagiannis A, Papakitsou E, Dretakis K. et al . Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type fracture.  Calcif Tissue Int. 2006;  78 72-77
  • 11 Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures.  BMJ. 1993;  307 1248-1250
  • 12 Koval KJ, Aharonoff GB, Rokito AS. et al . Patients with femoral neck and intertochanteric fractures. Are they the same?.  Clin Orthop. 1996;  330 166-172
  • 13 Leibson CL, Tosteson AN, Gabriel SE. et al . Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study.  J Am Geriatr Soc. 2002;  50 1644-1650
  • 14 Lieberman D, Fried V, Castel H. et al . Factors related to successful rehabilitation after hip fracture: a case control study.  Disabil Rehabil. 1996;  18 224-230
  • 15 Lipscombe LL, Jamal SA, Booth GL. et al . The risk of hip fractures in older individuals with diabetes: a population-based study.  Diabetes Care. 2007;  30 835-884
  • 16 Matthaei S, Bierwirth R, Fritsche A. et al . Medical Antihyperglycaemic Treatment of Type 2 Diabetes Mellitus Update of the evidence-based guideline of the German Diabetes Association.  Exp Clin Endocrinol Diabetes. 2009;  117 522-557
  • 17 Mautalen CA, Vega EM. Different characteristics of cervical and trochanteric hip fractures.  Osteoporos Int Suppl. 1993;  1 102-105
  • 18 McMurry J. Wound healing of diabetes mellitus: better glucose control for better wound healing in diabetes.  Surg Clin North Am. 1984;  64 769-778
  • 19 Mizrahi EH, Fleissig Y, Arad M. et al . Functional outcome of elderly hip fracture patients: Does diabetes matter?.  Arch Gerontol and Geriartrics. 2006;  43 165-173
  • 20 Muraki S, Yamamoto S, Ishibashi H. et al . Factors associated with mortality following hip fracture in Japan.  J Bone Miner Metab. 2006;  24 100-104
  • 21 Nakamura N, Kyou T, Takaoka K. et al . Bone mineral density in the proximal femur and hip fracture type in the elderly.  J Bone Miner Res. 1992;  7 755-759
  • 22 Nicodemus KK, Folsom AR. Iowa Women's Health Study. Type 1 and Type 2 diabetes and incident hip fractures in postmenopausal women.  Diabetes Care. 2001;  7 1192-1197
  • 23 Paksima N, Koval KJ, Aharanoff G. et al . Predictors of Mortality after Hip Fracture. A 10 year prospective study.  Bulletin of YU Hospital for Joint Diseases. 2008;  66 (2): 111-117
  • 24 Partanen J, Syrjala H, Vahanikkila H. et al . Impact of deep infection after hip fracture on function and mortality.  Journal of hospital infection. 2006;  62 44-49
  • 25 Pietschmann P, Patsch JM, Schernthaner G. Diabetes and bone.  Horm Metab Res. 2010 Oct;  42 (11): 763-768
  • 26 Philip BK, Childress PJ, Robling AG. et al . RAGE supports parathyroid hormone-induced gains in femoral trabecular bone.  Am J Physiol Endocrinol Metab. 2010 Mar;  298 (3): E714-E725
  • 27 Piirtola M, Vahlberg T, Löppönen M. et al . Fractures as predictors of excess mortality in the aged – A population-based study with a 12-year follow-up.  Eur J Epidemoiol. 2008;  23 747-755
  • 28 Schurman L, McCarthy AD, Sedlinsky C. et al . Metformin Reverts Deleterious Effects of Advanced Glycation End-Products (AGEs) on Osteoblastic Cells.  Exp Clin Endocrinol Diabetes. 2008;  116 333-340
  • 29 Tang SY, Zeenath U, Vashishth D. Effects of non-enzymatic glycation on cancellous bone fragility.  Bone. 2007 Apr;  40 (4): 1144-1151
  • 30 Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture – effect of pre-morbid conditions and post-fracture complications.  Osteoporosis Int. 2007a;  18 1583-1593
  • 31 Vestergaard P, Rejnmark L, Mosekilde L. Has mortality after a hip fracture increased?.  J Am Geriatr Soc. 2007b;  55 (11): 1720-1726
  • 32 Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes – a meta-analysis.  Osteoporosis Int. 2007;  18 427-444
  • 33 Zhou Z, Immel D, Xi CX. et al . Regulation of osteoclast function and bone mass by RAGE.  J Exp Med. 2006 Apr 17;  203 (4): 1067-1080

Correspondence

N. E. GulcelikMD 

Hacettepe Medical School

Department of Endocrinology

and Metabolism

Sıhhıye/ANKARA – TURKEY

Fax: + 90/312/311 67 68

Email: neseersoz@hotmail.com