Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

OBJECTIVE: The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. DESIGN: Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. RESULTS: In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. CONCLUSIONS: Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

Parathyroid-hormone variance is only marginally explained by a panel of determinants: a cross-sectional study of 909 hip-fracture patients.

Several factors affect the levels of parathyroid hormone (PTH) in hip-fracture patients. We hypothesized that a panel of easily assessable determinants could account for both a substantial proportion of PTH variance and the occurrence of secondary hyperparathyroidism. We evaluated 909 of 981 hip-fracture inpatients admitted consecutively to our Rehabilitation division. In each patient we assessed PTH, 25-hydroxyvitamin D, albumin-adjusted total calcium, phosphate, magnesium, and creatinine on a fasting blood sample 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Glomerular filtration rate (GFR) was estimated by the 4-variable Modification of Diet in Renal Disease Study equation. Functional level was assessed using the Barthel index. On multivariate analysis, six factors (phosphate, albumin-adjusted total calcium, estimated GFR (eGFR), 25-hydroxyvitamin D, age, and magnesium) were significantly associated with PTH levels. Overall, the panel of variables accounted for 23.7 % of PTH variance. Among the 909 patients, 304 (33.4 %) had PTH levels exceeding the normal range. Six factors (phosphate, albumin-adjusted total calcium, eGFR, 25-hydroxyvitamin D, age, and Barthel index scores) were significantly associated with the category of PTH level (either normal or elevated). The model correctly classified 70.4 % of cases. For the optimal cut-off point, sensitivity was 80 % and specificity was 61 %. Data shows that six factors were significantly associated with PTH levels in hip-fracture inpatients. However, the six factors accounted for only 23.7 % of PTH variance and the presence or absence of secondary hyperparathyroidism was correctly categorized in a modest proportion of cases. We conclude that more knowledge is needed on the factors affecting PTH levels after hip fracture.

Parathyroid hormone is significantly associated with body fat compartment in men but not in women following a hip fracture.

BACKGROUND AND AIMS: Parathyroid hormone (PTH) exerts several actions beyond mineral metabolism and may affect body composition. The aim of our study was to assess the association between serum PTH and body fat compartment in hip fracture patients. METHODS: We studied 575 of 630 inpatients with hip fracture consecutively admitted to our Rehabilitation ward. Dual-energy X-ray absorptiometry (DXA) was used to measure body composition. DXA scan was performed 18.5 ± 8.6 (mean ± SD) days after hip fracture occurrence. A blood sample was collected within 4 days after DXA scan. In each subject, we evaluated PTH, 25-hydroxyvitamin D, calcium, phosphate, albumin, magnesium, and creatinine. Glomerular filtration rate was estimated by a conventional formula. RESULTS: In the 57 men, we found a significant correlation between PTH and both body mass index (BMI) (ρ = 0.37; p = 0.020) and trunk fat percentage (ρ = 0.62; p < 0.001). After multiple adjustments, we confirmed a significant association between PTH and BMI (r = 0.38; p = 0.004) or trunk fat percentage (r = 0.51; p < 0.001). In the 518 women, we found a slightly significant correlation between PTH and BMI (ρ = 0.09; p = 0.047), but after adjustments the correlation coefficient dropped to 0.02 (p = 0.69). We found no significant relationships between PTH and trunk fat percentage at bivariate correlation (ρ = 0.04; p = 0.35) or after adjustments (r = 0.04; p = 0.38). CONCLUSIONS: PTH serum levels were robustly associated with body fat compartment in men, but not in women following a fracture of the hip. A role of PTH in affecting body composition in hip fracture men is suggested. Its potential role in male prognostic disadvantage needs further investigation.

Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients.

Our aim was to compare the prevalence of sarcopenia in men and women with hip fracture. We studied 591 of 630 hip fracture inpatients consecutively admitted to our Rehabilitation ward. All the patients underwent a Dual-Energy X-Ray Absorptiometry (DXA) scan 18.4 ± 8.7 (mean ± SD) days after hip fracture occurrence. Sarcopenia was defined when appendicular lean mass divided by height squared was less than two standard deviations below the mean of the young reference group obtained from population based studies. Using normative data from the New Mexico Elder Health Study, 340 of the 531 women (64.0%), and 57 of the 60 men (95.0%) had sarcopenia. Using normative data from the survey performed in Rochester, Minnesota, 116 of the 531 women (21.8%), and 52 of the 60 men (86.7%) had sarcopenia. After adjustment for age, time between fracture occurrence and DXA scan, number of medications in use, and number of concomitant diseases, men had a significantly higher prevalence of sarcopenia than women (p < 0.001). The adjusted odds ratio was either 10.54 (95% CI from 3.25 to 34.16) or 23.64 (from 10.8 to 51.6) depending on the reference population adopted. Our data shows a high proportion of sarcopenic subjects after hip-fracture. Sarcopenia was significantly more prevalent in men than in women. Relevancy of prevention and treatment of muscle loss is emphasized, particularly in men.

Men recover ability to function less than women do: an observational study of 1094 subjects after hip fracture.

OBJECTIVE: The aim of this study was to investigate the association between sex and functional outcome after acute inpatient rehabilitation in hip-fracture patients. DESIGN: We investigated 1094 of 1186 people admitted consecutively to our rehabilitation hospital because of a hip fracture. Functional outcome was assessed using Barthel Index scores. Barthel Index efficiency (improvement per day of stay length) and Barthel Index effectiveness (proportion of potential improvement achieved) were calculated. RESULTS: The median Barthel Index score at discharge from inpatient rehabilitation was 85 in the 970 women and 75 in the 124 men (interquartile range, 65-95 in women and 60-95 in men, P = 0.001). Both Barthel Index efficiency and effectiveness were significantly lower in men (P = 0.030 and P = 0.007, respectively). After adjustment for six confounders, we confirmed that men had lower Barthel Index scores (P = 0.030), Barthel Index efficiency (P = 0.024), and Barthel Index effectiveness (P = 0.040). The risk of achieving a low Barthel Index score (i.e., <85) at the end of acute inpatient rehabilitation was higher for men than for women (adjusted odds ratio, 2.055; 95% CI, 1.212-3.483; P = 0.007). CONCLUSIONS: In our large sample of hip-fracture patients, men had a significantly worse functional outcome than did women after acute inpatient rehabilitation.

Appendicular lean mass does not mediate the significant association between vitamin D status and functional outcome in hip-fracture women.

OBJECTIVE: To investigate whether muscle mass mediates the significant association between vitamin D status and functional recovery after hip fracture in women. DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated white women (N=280) of 305 who were consecutively admitted to a rehabilitation hospital because of their first fracture of the hip. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To assess muscle mass, we measured appendicular lean mass (aLM) by dual-energy x-ray absorptiometry (DXA), 21.2±6.2 (mean ± SD) days after hip fracture occurrence in the 280 women. On the same day, we assessed serum levels of 25-hydroxyvitamin D and parathyroid hormone (PTH). Ability to function in activities of daily living was evaluated by the Barthel Index both before and after acute inpatient rehabilitation. RESULTS: After adjustment for 8 confounders, including age, cognitive impairment, pressure ulcers, neurologic impairment, infections, fracture type, Barthel Index score at admission to rehabilitation, and aLM/height(2) (aLM/ht(2)), 25-hydroxyvitamin D levels were significantly associated both with Barthel Index scores after rehabilitation (P=.003) and their changes during rehabilitation (P=.008). Similar results were obtained when the 25-hydroxyvitamin D/PTH ratio was substituted for 25-hydroxyvitamin D levels. Conversely, aLM/ht(2) was not significantly correlated with Barthel Index scores and their changes during rehabilitation. Furthermore, we found no significant associations between either 25-hydroxyvitamin D levels or the 25-hydroxyvitamin D/PTH ratio and aLM/ht(2). CONCLUSIONS: The significant association between 25-hydroxyvitamin D levels (and 25-hydroxyvitamin D/PTH ratio) and the ability to function in women with hip fractures was not mediated by aLM assessed by DXA.

Low levels of 25-hydroxyvitamin D are associated with the occurrence of concomitant upper limb fractures in older women who sustain a fall-related fracture of the hip.

OBJECTIVE: To investigate the association between serum levels of 25-hydroxyvitamin D and the occurrence of simultaneous fractures of the upper limb in older women who sustain a fall-related fracture of the hip. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: We investigated 472 of 480 white women consecutively admitted to a rehabilitation hospital because of a fall-related hip fracture. Twenty-seven (5.7%) of the 472 women sustained a concomitant upper-limb fracture of either distal radius (20 women) or proximal humerus (seven women). We assessed serum levels of 25-hydroxyvitamin D 14.2 ± 4.1 (mean ± SD) days after surgical repair of the hip fracture in the 472 women by an immunoenzymatic assay. RESULTS: Twenty-five-hydroxyvitamin D levels were significantly lower in the 27 women with concomitant fractures of both hip and upper limb than in the remaining 445 hip-fracture women: mean ± SD values were 6.5 ± 5.0 ng/ml and 11.7 ± 10.4 ng/ml respectively in the two groups (mean difference between groups 5.2 ng/ml: 95% CI 1.2-9.2; p=0.011). Low levels of 25-hydroxyvitamin D were significantly associated with concomitant fractures of the upper limb (p=0.017), after adjustment for eight potential confounders including age, height, weight, hip-fracture type, cognitive impairment, neurologic impairment, previous hip fracture, and previous upper-limb fracture. CONCLUSIONS: Low levels of 25-hydroxyvitamin D were significantly associated with concomitant upper-limb fractures in our sample of older women with a fall-related fracture of the hip. Preventing vitamin D deficiency may lower the incidence of simultaneous fractures due to a singe fall in elderly women.

Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture.

Changes in body composition, including a decrease in muscle and bone mass, accompany aging. Our aim was to assess the prevalence of sarcopenia and its association with osteoporosis in hip-fracture women. We performed a Dual-Energy X-Ray Absorptiometry (DXA) scan in 313 of 340 women, 20.9 ± 6.5 (mean ± S.D.) days after hip-fracture occurrence. To adjust appendicular lean mass for body size we divided it by height squared in each woman. A total of 180 of the 313 women (58%) were sarcopenic, whereas 230 (74%) were osteoporotic. After adjustment for age and interval between fracture and DXA scan we found a significant association between sarcopenia and osteoporosis (p=0.026). For a sarcopenic woman the adjusted odds ratio (OR) for osteoporosis was 1.80 (95%CI=1.07-3.02). Our data shows the high prevalence of sarcopenia and its significant association with osteoporosis in a large sample of hip-fracture women. Data supports a research approach on preventive and treatment strategies for osteoporosis and sarcopenia targeting both bone and muscle tissue. Furthermore, data should be considered when the economic burden of sarcopenia is estimated, given the high proportion of sarcopenic women with bone fragility.

The burden of prevalent vertebral fractures is negatively associated with functional outcome in women with hip fracture.

OBJECTIVE: The aim of this study was to investigate the association between the burden of prevalent vertebral fractures and functional outcome in women with hip fracture. DESIGN: We investigated 164 of 180 women with hip fracture admitted consecutively to a rehabilitation hospital. Lateral radiographs of the spine were taken 20.0 ± 5.1 days (mean ± SD) after fracture occurrence. To obtain a summary measure of vertebral fracture burden, we calculated the spinal deformity index by summing the fracture grades of all vertebrae (T4 to L4), assessed using Genant's method. Functional outcome was assessed using Barthel index scores. RESULTS: In a Spearman rank test, we observed a significant negative correlation between spinal deformity index scores and Barthel index scores at discharge from rehabilitation (ρ = -0.23; P = 0.003). The association between spinal deformity index and Barthel index scores was confirmed (P = 0.039) after adjustment for eight potential confounders. Multiple regression also showed a significant negative association between spinal deformity index scores and increase in Barthel index scores during rehabilitation (P = 0.012). The panel of prognostic factors that we included in the multivariate analysis accounted for 62% of the variance in the Barthel index scores at discharge from rehabilitation and 43% of their increase during rehabilitation. CONCLUSIONS: The burden of prevalent vertebral fractures is negatively associated with functional outcome in women with hip fracture.

Serum levels of insulin-like growth factor-I are positively associated with functional outcome after hip fracture in elderly women.

OBJECTIVE: To investigate the association between serum levels of insulin-like growth factor-I (IGF-I) and functional outcome in hip-fracture women. DESIGN: We investigated 171 of 188 women admitted consecutively to a rehabilitation hospital after hip fracture. IGF-I serum levels were assessed by using an automated chemiluminescence immunoassay 21.3 +/- 6.1 days (mean +/- SD) after fracture occurrence. Functional outcome was assessed using Barthel index scores. RESULTS: At a Spearman rank test we observed a significant positive correlation between IGF-I levels and both Barthel index scores at discharge from inpatient rehabilitation (rho = 0.213; P = 0.005) and changes in Barthel index scores during rehabilitation (rho = 0.222; P = 0.004). At multiple regression, a significant association between IGF-I and both functional scores and their changes during rehabilitation was found after adjustment for several potential confounders, including age, cognitive impairment, pressure ulcers, neurologic impairment, infections, Barthel index score at admission to rehabilitation, and length of stay in hospital (P < 0.05). Overall, the panel of prognostic factors accounted for 55% of the variance in the functional score and 31% of the variance in its change during rehabilitation. CONCLUSIONS: IGF-I serum levels were significantly associated with ability to function after hip fracture in women.

Incident falls impair ability to function in hip-fracture survivors: a prospective study of 95 elderly women.

The present study focused on home-dwelling women successfully discharged back to the community after a fall-related fracture of the hip. We investigated the role of incident falls in affecting ability to function in activities of daily living. Ninety-five of 103 consecutive women without cognitive impairment were recruited during in-patient rehabilitation following their first hip fracture. Functional independence in activities of daily living was assessed by using the Barthel Index (BI) score at discharge from in-patient rehabilitation and at a 6-month follow-up. Nineteen of the 95 women sustained one or more falls during a median observation time of 187 days. At a Mann-Whitney test, both BI scores assessed at the 6-month follow-up and gains in BI scores during the follow-up were significantly lower in the 19 fallers than in the 76 non-fallers (p=0.021 and p=0.030, respectively), whereas no significant differences were found in baseline BI scores between the two groups. At linear multiple regression, we found a negative association between incident falls and both functional scores (p=0.01) and their gains (p=0.006) after adjustment for several confounders. We conclude that incident falls were significantly associated with a worse functional score in our sample of hip-fracture women.

Type of hip fracture in patients with Parkinson disease is associated with femoral bone mineral density.

OBJECTIVE: To investigate the association between bone mineral density (BMD) and hip fracture type (cervical or trochanteric) in a sample of fallers with Parkinson disease (PD). DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PATIENTS: We investigated 1040 of 1120 white fallers consecutively admitted to a rehabilitation hospital for hip fracture. Thirty-eight (3.65%) of the 1040 patients suffered from PD secondarily. Thirty-eight controls matched for sex, age, and hip fracture type were found among the 1002 non-PD fallers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry at a mean+/-SD of 21.9+/-7.5 days after fracture occurrence in the 38 PD patients and 21.6+/-5.9 days after fracture occurrence in the 38 controls. RESULTS: BMD assessed at total femur, trochanter, and intertrochanteric region was significantly lower in the 15 PD patients with trochanteric fractures than in the 23 with cervical fractures; the mean T score differences were 0.57 (95% confidence interval [CI], 0.07-1.08; P=.028), 0.66 (95% CI, 0.04-1.28; P=.037), and 0.63 (95% CI, 0.11-1.15; P=.019), respectively. A significant association between femoral BMD and hip fracture type was found at logistic regression after adjustment for several confounders. Results in the 38 controls were similar to those obtained in the 38 PD fallers. CONCLUSIONS: In a sample of PD fallers as in a control group of non-PD fallers, BMD levels assessed at 3 femoral sites were significantly lower in the patients who sustained trochanteric fractures than in those with cervical fractures of the hip.

A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.

Muscle mass and functional recovery in men with hip fracture.

OBJECTIVE: To investigate the association between muscle mass and functional recovery in men after hip fracture. DESIGN: We investigated 27 of 33 men admitted consecutively to a rehabilitation hospital after hip fracture. For each patient, we also studied two control women, matched for age and fracture type. Lean mass (LM) was assessed by dual-energy x-ray absorptiometry (DXA) 21.9 +/- 7.5 (mean +/- SD) days after fracture occurrence in the 27 men (22.8 +/- 7.2 days in the 54 control women). Appendicular LM (aLM) was calculated as the sum of LM in arms and legs. Functional recovery was assessed using Barthel index scores. Barthel index efficiency was calculated as the change in the Barthel index score after rehabilitation divided by the length of stay in hospital. RESULTS: After adjustment for age, height, fat mass, Barthel index scores at admission, and time between fracture occurrence and DXA assessment, aLM was significantly associated with Barthel index scores after rehabilitation (r = 0.480; P = 0.013) and Barthel index efficiency (r = 0.633; P = 0.001) in the 27 men. Conversely, in the 54 control women, no significant associations were found between aLM and the functional scores. CONCLUSIONS: LM assessed after hip fracture is significantly associated with the functional outcome in men.

Skeletal muscle mass, fat mass, and hip bone mineral density in elderly women with hip fracture.

Soft tissue body composition strongly affects bone health. Our aim was to investigate the relationship between both skeletal muscle mass (SMM) and fat mass (FM) and femoral bone mineral density (BMD) in a sample of elderly women with hip fracture. We assessed 293 of 325 hip fracture women admitted consecutively to a rehabilitation hospital. Soft tissue body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA), 23.2 +/- 7.7 (mean +/- SD) days after fracture occurrence. BMD was measured at four sites (neck, total femur, trochanter, intertrochanteric area) in the unfractured femur. Appendicular lean mass (aLM) was calculated as the sum of LM in arms and legs. We used two approaches to adjust aLM for body size: aLM divided by height squared (aLM/ht(2)), and aLM adjusted for height and FM (residuals). Both FM and aLM were significantly correlated with femoral BMD. However, the correlation coefficients for aLM were lower than for FM; they further decreased after adjustment for height squared, and were no longer significant after correction for both height and FM (residuals). When FM, aLM/ht(2), age, and time spent between fracture occurrence and DXA assessment were included together as the independent variables in a regression model, FM was the only independent variable significantly associated with BMD. The coefficients of partial correlation ranged from 0.414 to 0.647 depending on the femoral region of BMD assessment (P < 0.001). FM, but not SMM emerged as a pivotal determinant of BMD in our sample of hip fracture women.

Fat mass and skeletal muscle mass in hip-fracture women: a cross-sectional study.

OBJECTIVES: To investigate the association between appendicular lean mass (aLM) and age, fat mass (FM), serum levels of Vitamin D, parathyroid hormone, three parameters of the protein nutritional status (total lymphocyte count, serum albumin, and insulin-like growth factor I), levels of independence in activities of daily living (assessed by using Barthel index scores), type both of hip fracture and surgical operation, number of medications in use, and number of concomitant diseases in hip-fracture women. METHODS: We investigated 299 of 327 hip-fracture women admitted consecutively to a rehabilitation hospital. Soft tissue body composition was assessed by dual-energy X-ray absorptiometry, 22.1+/-7.5 (mean+/-S.D.) days after fracture occurrence. Appendicular LM was calculated as the sum of LM in arms and legs. Because metal implants (prostheses and nails) affect the regional assessment of body composition, aLM was corrected by substituting LM in unfractured leg for LM in fractured leg: corrected aLM=(LM in unfractured leg x 2)+LM in arms. We divided corrected aLM by height squared (aLM/ht(2)), to adjust it for body size. RESULTS: Four variables were significantly correlated with corrected aLM: age, height, FM, and Barthel index score. FM was the only variable significantly correlated with aLM/ht(2) (r=0.492; p<0.001). This significant correlation was not affected after adjustment for age and Barthel index score. CONCLUSIONS: FM measured after hip fracture was significantly associated with aLM/ht(2) in women.

Bone mineral density in hip-fracture patients with Parkinson's disease: a case-control study.

OBJECTIVE: To investigate bone mineral density (BMD) levels in patients with Parkinson's disease (PD) who sustained a hip fracture. DESIGN: Case-control study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated 831 out of 887 white patients consecutively admitted to a rehabilitation hospital because of an original hip fracture resulting from a fall. Twenty-eight (3.37%) of the 831 patients were affected by PD. Twenty-eight controls matched for sex, age, and hip-fracture type (cervical or trochanteric) were found among the 803 non-PD patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry (DXA) at the unfractured femur. Five sites were investigated in each subject: total proximal femur, femoral neck, trochanter, intertrochanteric area, and Ward's triangle. DXA scan was performed a mean +/- standard deviation of 22.2 +/- 7.8 days after fracture occurrence in the 28 patients and 22.0 +/- 5.3 days after fracture occurrence in the 28 controls. RESULTS: BMD expressed as a T score did not differ significantly between the 28 PD patients and the 28 controls, whereas z score in the PD patients was significantly lower than 0 +/- 1 in the age- and sex-matched general population at 4 of the 5 sites of BMD assessment. CONCLUSIONS: A sample of PD fallers who sustained a hip fracture had femoral BMD levels similar to those found in matched hip-fracture fallers who did not suffer from PD and significantly lower than those found in the matched reference population.

Body mass index and functional recovery after hip fracture: a survey study of 510 women.

BACKGROUND AND AIMS: Low body mass index (BMI) is associated with high risk of osteoporosis and fractures, but its impact on functional recovery after fractures is unknown. Our aim was to investigate the association between BMI and both functional recovery and period of rehabilitation in hip-fractured women. METHODS: 510 out of 580 Caucasian women with hip fracture, admitted consecutively to a rehabilitation hospital, were investigated in this retrospective study. Functional recovery was assessed using the Barthel index score. RESULTS: In the 510 women, BMI was 22.8 +/- 4.1 kg/m2 (mean +/- SD). After adjustment for age, femur bone mineral density, and the Barthel index assessed on admission to rehabilitation, a significant negative association was found between BMI and both the Barthel index score after rehabilitation and changes in it resulting from rehabilitation (p < 0.001). After adjustment for age and the Barthel index assessed on admission to rehabilitation, a significant positive association was found between BMI and period of rehabilitation (p < 0.001). The results were similar when BMI was evaluated either as individual values or after categorization according to World Health Organization criteria. CONCLUSIONS: In a sample of hip-fractured women, BMI was negatively associated with Barthel index scores and positively associated with period of rehabilitation. BMI may affect function after hip fracture, apart from hip fracture risk: subjects with higher BMI and low hip fracture risk may have poorer functional recovery in case of hip fracture, despite prolonged rehabilitation. Conversely, subjects with lower BMI and high hip fracture risk may have better functional recovery in case of hip fracture.

Muscle mass and functional recovery in women with hip fracture.

OBJECTIVE: To investigate the association between muscle mass and functional recovery in women with hip fracture. DESIGN: A total of 200 of 230 women with hip fracture admitted consecutively to a rehabilitation hospital were investigated in this survey study. Lean mass (LM) was assessed by dual-energy x-ray absorptiometry, 23.1 +/- 7.9 (mean +/- SD) days after fracture occurrence. Appendicular LM (aLM) was calculated as the sum of LM in arms and legs. Because metal implants (prostheses and nails) affect the regional assessment of body composition, aLM was corrected by substituting LM in the unfractured leg for LM in the fractured leg: corrected aLM = (LM in unfractured leg x 2) + LM in arms. We used two approaches to adjust corrected aLM for body size: corrected aLM divided by height squared (aLM/ht), and corrected aLM adjusted for height and fat mass (residuals). Functional recovery was assessed by using Barthel index scores. RESULTS: After adjustment for body size, corrected aLM was neither significantly correlated with Barthel index scores nor with the change in Barthel index scores after rehabilitation. Also, after stratification for quintiles of aLM/ht and residuals, no significant differences in functional recovery were found among the five groups. CONCLUSIONS: LM assessed after hip fracture is not associated with functional outcome in women.

25-hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients.

There is increasing interest in the effects of vitamin D and parathyroid hormone (PTH) on extraskeletal tissues, including the muscle. These effects may explain impairment in functional ability found in vitamin D-deficient subjects. Our aim was to investigate the roles of vitamin D and PTH in affecting the ability to perform activities of daily living after hip fracture. We studied 456 of 521 hip-fracture patients admitted consecutively to a rehabilitation hospital. Functional outcome was assessed after acute inpatient rehabilitation by using the Barthel index score. The functional scores were significantly correlated with serum levels of 25-hydroxyvitamin D (rho = 0.190; P < 0.001) and PTH (rho = -0.164; P < 0.001) and the 25-hydroxyvitamin D/PTH ratio (rho = 0.261; P < 0.001). At multiple regression, 25-hydroxyvitamin D and PTH levels were independently associated with Barthel index scores. The correlation between the 25-hydroxyvitamin D/PTH ratio and Barthel index scores was significantly stronger than the one between 25-hydroxyvitamin D and Barthel index scores (difference between the two correlation coefficients = 0.071; 95% CI = 0.009-0.133; P = 0.011). The significant association between the 25-hydroxyvitamin D/PTH ratio and the Barthel index scores persisted after adjustment for 12 prognostic factors (P = 0.012). On the whole, the panel of prognostic factors we studied predicted 50.1% of the variance of the functional score. Data shows that PTH and 25-hydroxyvitamin D were significantly associated with the ability to function after hip fracture and suggest that the two hormones act through independent mechanisms. The 25-hydroxyvitamin D/PTH ratio significantly contributed to a predictive model of functional outcome.