Secondary fracture risk after hip fracture in older patients: an updated sex-specific systematic review and meta analysis with grading of recommendations, assessment, development and evaluation (GRADE) and population attributable fraction (PAF) assessment
Authors' conclusion
Roughly one in ten older adults suffers a secondary hip fracture, with substantially higher rates in women. Muscle degeneration and inadequate calcium/vitamin D intake emerged as the most influential and potentially modifiable contributors.
Study context
- Population
- Older patients after hip fracture; cohort studies searched January 1, 2000 to August 1, 202519 studies
- Comparison
- Females vs males
- Outcome
- Incidence of secondary hip fracture, reported separately for men and women
Methodological detailsNewcastle-Ottawa Scale appraisal, sensitivity and subgroup analyses, GRADE, population attributable fraction (PAF)
- Newcastle-Ottawa Scale appraisal
- Sensitivity and subgroup analyses
- GRADE
- Population attributable fraction (PAF)
Pooled result
As reported in the abstract
Pooled incidence of secondary hip fracture
- Pooled incidence, all older adults
- 10.63% (95% CI, 9.9%-11.4%)
Further pooled results
Risk factors for secondary hip fracture
- Lower G.Med/MinM density, PAF
- 6.54% (moderate quality evidence; 95% CI 0.038-0.093)
- Calcium/vitamin D deficiency, PAF
- 1.12% (moderate quality evidence; 95% CI 0.007-0.016)
- Significant: reduced G.Med/MinM and gluteus maximus muscle density, reduced BMD at hip, femoral neck and intertrochanteric regions, osteoporosis, cognitive impairment, calcium/vitamin D deficiency
Original publication
Secondary fracture risk after hip fracture in older patients: an updated sex-specific systematic review and meta analysis with GRADE and PAF assessment. Osteoporos Int. Published 12 March 2026. doi:10.
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