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

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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. Geriatr Gerontol Int 2015; 15: 11–18.

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