Risk of hip fracture in community-dwelling and institutionalized osteoporotic patients: A 3-year study.

Background and aims: It has been previously suggested that the incidence of hip fracture is higher among
<br />people living in nursing homes than among community-dwelling people. However, it is not clear
<br />whether this is a consequence of nursing home residency or of the greater age of the residents. We have
<br />examined the relationship between the place of residence and hip fracture incidence, in a prospective 3-
<br />year study.
<br />Methods: Women from nine countries included in this study were part of the placebo group of
<br />a randomized controlled trial having assessed the long-term effect of a new antiosteoporotic drug. All
<br />women were osteoporotic and received placebo and vitamin D during the 3 years of follow-up. All the
<br />institutionalized (nursing home, medical house) women (n ¼ 217) were included in this post hoc analysis
<br />and three noninstitutionalized age- and country-matched controls were included (n ¼ 651).
<br />Results: The mean (and standard deviation) age of the patients was 80.4 (5.6) years in the institutionalized
<br />women and 80.2 (5.8) years in the noninstitutionalized women (p ¼ 0.87). After 3 years of followup,
<br />37 fractures occurred: 12 (5.5%) in institutionalized women and 25 (3.8%) in noninstitutionalized
<br />women. The difference between the two groups was not statistically significant (p ¼ 0.29). After
<br />controlling for age, body mass index, femoral neck bone mineral density and prevalent nonvertebral
<br />fracture, the residence status of the patient (institutionalized vs. noninstitutionalized) was not significantly
<br />associated with hip fracture incidence (p ¼ 0.63).
<br />Conclusions: We suggest that living in an institutionalized place is not an independent risk factor for hip
<br />fracture for osteoporotic women receiving calcium and vitamin D.