Factors Affecting the Prevention of Repeated Fractures in the Elderly after Hip Bone Treatment: Last Data Analysis in Yasothon Hospital

Abstract

Background: Hip fractures in the elderly are a major public health problem. Patients who have previously had a hip fracture have a 2.5-3.0 times higher risk of repeat fracture, with a significant impact on mortality and quality of life, despite evidence that secondary prevention measures are effective. But hospitals in Thailand still face a significant care gap, especially in the northeastern region. Yasothon Hospital found that only 22.7% of patients received anti-osteoporosis medication after a hip fracture. This is lower than the national average of 27.4%, along with an important limitation: there is no DEXA machine for checking bone density. The current patient tracking system lacks in-depth studies on which preventive measures are most effective and can actually be implemented in secondary general hospitals. Which has limited resources and must accommodate a large number of elderly people from both urban and remote rural areas.

Objective: To investigate factors affecting the prevention of subsequent fractures in elderly patients following hip fracture treatment at Yasothon Hospital.

Methods: Retrospective data analysis study, by reviewing medical records of elderly patients (age ≥ 60 years) receiving treatment for hip fractures. Between January 2019 and December 2022, continuous treatment follow-up data were available for 24 months (until the end of follow-up on December 31, 2024), and a total of 180 patients were analyzed. Data were analyzed using descriptive statistics. Univariate and multivariate analysis with logistic regression and person-time analysis.

Results: The incidence of subsequent fractures was 15.6% (28 of 180 patients) during the 24-month follow-up period. Independent risk factors included history of falls (Adjusted OR = 3.21, 95% CI: 1.18-8.73, p = 0.022), age ≥ 75 years (Adjusted OR = 2.89, 95% CI: 1.12-7.45, p = 0.028), and previous fracture history (Adjusted OR = 2.67, 95% CI: 1.05-6.78, p = 0.039). Effective preventive measures included good medication adherence (Adjusted OR = 0.24, 95% CI: 0.07-0.82, p = 0.022) reducing risk by 76%, anti-osteoporotic medication use (Adjusted OR = 0.28, 95% CI: 0.09-0.84, p = 0.023) reducing risk by 72%, participation in fall prevention programs (Adjusted OR = 0.31, 95% CI: 0.10-0.96, p = 0.041) reducing risk by 69%, and regular follow-up visits (Adjusted OR = 0.35, 95% CI: 0.14-0.89, p = 0.027) reducing risk by 65%. Person-time analysis revealed an overall incidence density of 7.8 per 100 person-years. Patients receiving anti-osteoporotic medications had a subsequent fracture rate of 6.3% compared to 18.9% in those not receiving treatment (Risk Difference = -12.6%, RR = 0.33, p = 0.042). However, significant care gaps were identified, with only 26.7% of patients receiving anti-osteoporotic medications.

Conclusion: Preventing recurrent fractures can be effectively achieved through consistent use of anti-osteoporosis medication, enhanced patient compliance, continuous follow-up care, and fall prevention programs. The development of comprehensive care systems tailored to community hospital contexts is crucial for addressing care gaps and enhancing outcomes for this patient population.