Risk factors related to contralateral hip fracture following hip fracture in elderly patients: a meta analysis and review

Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis. Methods Pubmed, Cochrane, CBMdisc, CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly. The publication quality was strictly evaluated before the data were extracted concerning gender and age(>65 years) of the patients, concomitant osteoporosis (Singh sign ≥4), primary fracture type, concomitant Parkinson disease, concomitant stroke, concomitant senile dementia, concomitant cataract, concomitant rheumatoid arthritis, concomitant diabetes, type of internal fixation for primary fracture and therapeutic compliance. Revman5.0 was used to perform the statistical analysis and the OR value and 95% CI were calculated fore each index. Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture. The factors related to the refracture of the contralateral hip were the age of the patients (OR=-3.55, 95% CI:-5.60~-1.50, P<0.001), osteoporosis (OR=2.38, 95% CI: 1.36~4.17, P=0.002), Parkinson disease (OR=4.54, 95% CI: 2.74~7.53, P<0.001), stroke (OR=0.33, 95% CI: 0.18~0.59, P<0.001), senile dementia (OR=0.43, 95% CI: 0.29~0.62, P<0.001), cataract (OR=0.37, 95% CI: 0.22~0.63, P< 0.001), rheumatoid arthritis (OR=0.32, 95% CI: 0.21~0.50, P<0.001), diabetes (OR=0.65, 95% CI: 0.47~0.91, P=0.01), type of internal fixation for primary fracture (OR=0.51, 95% CI: 0.30~0.85, P=0.01), and therapeutic compliance (OR=0.36, 95% CI: 0.21~0.64, P<0.001). However, the refracture of the contralateral hip was not related to gender (OR=1.07, 95% CI: 0.45~2.56, P=0.88), smoking (OR=0.86, 95% CI: 0.40~1.86, P=0.70), fracture type (OR=0.97, 95% CI: 0.60~1.57, P=0.90), or hypertension (OR=0.70, 95% CI: 0.41~1.21, P=0.20). Conclusions In elderly patients with hip fracture, the risks for contralateral hip fracture may be advanced age, concomitant osteoporosis, Parkinson disease, stroke, senile dementia, cataract, rheumatoid arthritis and diabetes, type of internal fixation for primary fracture, and poor therapeutic compliance. However, no sufficient evidence has suggested that gender, smoking, type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture. Key words: Elderly; Hip fracture; Meta-analysis; Contralateral hip fracture; Related factors