Highlights
- •Compared with age- and sex-matched controls, adults with polio had a 2.58-fold higher risk of hip fracture.
- •Middle-aged or male adults with polio had a higher incidence of hip fracture than the controls.
- •People with polio aged >48.2 years were more likely to experience a hip fracture.
- •A hip fracture prevention program for people with polio should be started early from middle-age and should include men.
Abstract
Background
Having motor impairment since childhood and being at risk of osteoporosis and falls,
adults with polio would be more likely to suffer a hip fracture (HF) and may experience
different epidemiological characteristics from the general population.
Objective
To estimate the risk and incidence of HF in adults with polio.
Design
Using a national database, we conducted a population-based cohort study. We identified
patients with polio using the International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) code of 138. For each patient with polio, we randomly
selected five age- and sex-matched control subjects. Those subjects aged <40 years
were excluded. We analyzed participants aged 40˜64 years (middle-aged) and subjects
aged ≥65 years (elderly) separately and recognized subjects who had an HF (ICD-9-CM
code, 820) only when they received hospitalization to care for the illness from January
1, 2003 to December 31, 2008.
Results
We identified 403 adults with polio (mean age ± standard deviation, 47.2 ± 8.6 years).
Compared to the controls, patients with polio had a higher incidence of HF (all, 4.1
vs. 1.1/1000 person-years, p = 0.002; middle-aged, 2.3 vs. 0.3/1000 person-years, p < 0.001; male, 6.2 vs. 0.9/1000 person-years, p < 0.001); had a younger mean age (±standard deviation) of fracturing a hip (61.0±14.9
vs. 74.4±9.3 years, p = 0.015); had a lower cumulative HF-free probability (±standard error) before the
age of 65 years (0.970±0.017 vs. 0.988±0.007, p<0.001) and throughout the study duration (0.415 ± 0.296 vs. 0.682 ± 0.158, p<0.001); and had a higher risk of HF, yielding an adjusted hazard ratio (95% confidence
interval) of 3.58 (1.45˜8.79, p = 0.006). Patients with polio aged >48.2 years were likely to experience an HF.
Conclusions
Adults with polio are at risk of HF. A customized HF prevention program is important
for people with polio. The program should be started early in middle-age and should
include men.
Keywords
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Article info
Publication history
Published online: February 14, 2019
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© 2019 Elsevier Ltd. All rights reserved.
