Simultaneous hip and upper-limb fractures are associated with lower Geriatric Nutritional Index scores than isolated hip
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ORIGINAL ARTICLE
Simultaneous hip and upper‑limb fractures are associated with lower Geriatric Nutritional Index scores than isolated hip fractures: a cross‑sectional study of 858 women Marco Di Monaco1 · Carlotta Castiglioni1 · Francesca Bardesono2 · Edoardo Milano1 · Giuseppe Massazza2 Received: 3 October 2019 / Accepted: 10 October 2019 © Springer Nature Switzerland AG 2019
Abstract Background and aims Factors associated with simultaneous fractures at hip and upper limb have scarcely been investigated. Our aim was to assess the association between Geriatric Nutritional Risk Index (GNRI) scores and concurrent upper-limb fractures in women with a fall-related hip fracture. Methods We investigated 858 of 907 women admitted to our Physical and Rehabilitation Medicine ward following a fallrelated hip fracture. Results GNRI scores were significantly lower in the 41 women with a simultaneous upper-limb fracture than in the 817 with an isolated hip fracture: median (interquartile range) were 85.9 (80.6–94.1) ad 90.3 (83.4–98.0), respectively, in the two groups (p = 0.021). After adjustment for age, height, body mass index, 25-hydroxyvitamin D, parathyroid hormone, femoral-neck bone mineral density, cognitive impairment, neurologic impairment and type of hip fracture we confirmed a significant association between GNRI scores and the concomitant upper-limb fractures (p = 0.001). The adjusted odds ratio for suffering a concomitant fracture was 7.53 (95% CI from 1.79 to 31.72; p = 0.006) for the 190 women of the GNRI lowest class (GNRI score 98). Conclusions Data show that GNRI scores were significantly lower in the subgroup of women with hip fracture and concurrent upper-extremity fracture than in the controls with isolated hip fracture. Although caution is needed in interpreting our results due to the cross-sectional design of the study, we suggest that low GNRI scores may have a role in the genesis of the concurrent fractures. Keywords Hip Fracture · Malnutrition · Vitamin D · Shoulder fracture · Wrist fracture
Introduction In a subgroup of the patients who sustain a fall-related hip fracture a simultaneous fracture occurs at the upper limb, with a single fall resulting in both hip and upper-extremity injuries. The estimated incidence of the concomitant upperlimb fractures varies across studies from 2.7 to 7% of the * Marco Di Monaco [email protected]; m.di‑monaco@h‑sancamillo.to.it 1
Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131 Turin, Italy
Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
2
total number of the patients with a fragility fracture of the hip [1–7]. A recognized high rate of morbidity and mortality characterizes the patients who undergo an isolated hip fracture: excess mortality ranges from 8 to 36% in the first year following the fracture and up to 25% of the survivors may need long
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