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Background <p>Subsequent fractures after hip fracture surgery are associated with substantial morbidity, functional decline, and increased mortality in older adults. Early identification of high-risk patients is therefore essential for implementing targeted preventive strategies. This study aimed to develop and temporally validate a prediction model for subsequent fractures within 2 years after hip fracture surgery in older adults.</p> Methods <p>This retrospective cohort study included older adults who underwent surgery for a first unilateral fragility hip fracture between January 2019 and May 2022. Demographic, clinical, laboratory, and lifestyle-related variables were collected from electronic medical records and structured telephone interviews. LASSO Cox regression was used for predictor selection, followed by multivariable Cox proportional hazards regression to identify independent predictors. A nomogram was constructed to estimate individualized risks of subsequent fractures at 1 and 2 years after surgery. Model performance was evaluated using C-index, AUC, calibration plots, and DCA.</p> Results <p>During the 2-year follow-up period, 190 patients (8.9%) experienced subsequent fractures. Based on discharge date, 1,735 patients discharged between January 2019 and December 2021 were assigned to the development cohort, whereas 415 patients discharged between January 2022 and May 2022 constituted the temporal validation cohort. Six independent predictors were identified, including age, hip function, neurodegenerative disease, eye disease, and living alone, whereas exercise was identified as a protective factor. The nomogram demonstrated good discriminative performance, with C-index values of 0.891 and 0.861 in the development and temporal validation cohorts, respectively. The 2-year time-dependent AUCs were 0.925 (95% CI: 0.899–0.952) in the development cohort and 0.896 (95% CI: 0.832–0.941) in the temporal validation cohort. Calibration plots demonstrated good agreement between predicted and observed probabilities, and DCA indicated favorable clinical utility across a wide range of threshold probabilities.</p> Conclusions <p>We developed and temporally validated a nomogram for predicting subsequent fractures within 2 years after hip fracture surgery in older adults. This model may facilitate early postoperative risk stratification and support individualized secondary prevention strategies aimed at reducing the risk of secondary fragility fractures.</p>

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Development and validation of a prediction model for subsequent fractures after hip fracture surgery in older adults: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Linlin Zhang,
  • Yanling Zhou,
  • Jia Jin,
  • Wenping Xue,
  • Wei Wang,
  • Shuqiu Lin

摘要

Background

Subsequent fractures after hip fracture surgery are associated with substantial morbidity, functional decline, and increased mortality in older adults. Early identification of high-risk patients is therefore essential for implementing targeted preventive strategies. This study aimed to develop and temporally validate a prediction model for subsequent fractures within 2 years after hip fracture surgery in older adults.

Methods

This retrospective cohort study included older adults who underwent surgery for a first unilateral fragility hip fracture between January 2019 and May 2022. Demographic, clinical, laboratory, and lifestyle-related variables were collected from electronic medical records and structured telephone interviews. LASSO Cox regression was used for predictor selection, followed by multivariable Cox proportional hazards regression to identify independent predictors. A nomogram was constructed to estimate individualized risks of subsequent fractures at 1 and 2 years after surgery. Model performance was evaluated using C-index, AUC, calibration plots, and DCA.

Results

During the 2-year follow-up period, 190 patients (8.9%) experienced subsequent fractures. Based on discharge date, 1,735 patients discharged between January 2019 and December 2021 were assigned to the development cohort, whereas 415 patients discharged between January 2022 and May 2022 constituted the temporal validation cohort. Six independent predictors were identified, including age, hip function, neurodegenerative disease, eye disease, and living alone, whereas exercise was identified as a protective factor. The nomogram demonstrated good discriminative performance, with C-index values of 0.891 and 0.861 in the development and temporal validation cohorts, respectively. The 2-year time-dependent AUCs were 0.925 (95% CI: 0.899–0.952) in the development cohort and 0.896 (95% CI: 0.832–0.941) in the temporal validation cohort. Calibration plots demonstrated good agreement between predicted and observed probabilities, and DCA indicated favorable clinical utility across a wide range of threshold probabilities.

Conclusions

We developed and temporally validated a nomogram for predicting subsequent fractures within 2 years after hip fracture surgery in older adults. This model may facilitate early postoperative risk stratification and support individualized secondary prevention strategies aimed at reducing the risk of secondary fragility fractures.