Epidemiological characteristics and outcome in elderly patients sustaining non-simultaneous bilateral hip fracture: a systematic review and meta-analysis.

Abstract

The present study aimed to quantitatively and comprehensively conclude the epidemiological characteristics and outcome in elderly patients with non-simultaneous bilateral hip fractures. A search was applied to Medline, Embase and Cochrane central database (all up to February 2014). All the studies on non-simultaneous bilateral hip fractures in elderly patients without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. All the data were carefully and independently abstracted by two reviewers, any disagreement was settled by discussion. Data were pooled and a meta-analysis completed. A total of 23 studies (all were observational) including 2168 cases with bilateral hip fractures were identified, showing an accumulated incidence of 8.54%, and of them 71.4% were symmetrical. A total of 70.4% of cases occurred in the first 3 years, especially 36.3% in the first year. Results of meta-analyses showed that patients of female sex (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.10-1.99), advanced age (standardized mean difference 0.25, 95% CI 0.15-0.36), initial trochanteric fractures (OR 1.15, 95% CI 1.01-1.32) and osteoporosis (Singh Index 1-3) (OR 10.02, 95% CI 5.41-18.57) were more likely to sustain a second contralateral hip fracture. Non-simultaneous bilateral hip fracture accounts for a high proportion of hip fractures, and most of the second hip fractures occurred in the first 3 years. Patients of female sex, having initial trochanteric fractures, of more advanced age and having osteoporosis are more likely to sustain a second contralateral hip fracture, and risk-reduction strategies should be implemented.