Original Article| Volume 28, ISSUE 2, P380-384, March 2023

Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint

Published:January 06, 2022DOI:



      Several studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint.


      We enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR.


      We found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group.


      We found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.
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        • Magaziner J.
        • Fredman L.
        • Hawkes W.
        • Habel J.R.
        • Zimmerman S.
        • Orwig D.L.
        • et al.
        Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged.
        Am J Epidemiol. 2003 June 1; 157: 1023-1031
        • Mariconda M.
        • Costa C.C.
        • Cerbasi S.
        • Recano P.
        • Aitanti E.
        • Gambacorta M.
        • et al.
        The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study.
        Bone Joint Lett J. 2015 Mar; 97-B: 383-390
        • Halm E.A.
        • Wang J.J.
        • Boockvar K.
        • Penrod J.
        • Silberzweig S.B.
        • Magaziner J.
        • et al.
        The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture.
        J Orthop Trauma. 2004 Jul; 18: 369-374
        • Musallam K.M.
        • Tamim H.M.
        • Richards T.
        • Spahn D.R.
        • Rosendaal F.R.
        • Habbal A.
        • et al.
        Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study.
        Lancet. 2011 Oct 15; 378: 1396-1407
        • Sim Y.E.
        • Sim S.D.
        • Seng C.
        • Howe T.S.
        • Koh S.B.
        • Abdullah H.R.
        Preoperative anemia, functional outcomes, and quality of life after hip fracture surgery.
        J Am Geriatr Soc. 2018 Aug; 66: 1524-1531
        • Denny S.D.
        • Kuchibhatla M.N.
        • Cohen H.J.
        Impact of anemia on mortality, cognition, and function in community-dwelling elderly.
        Am J Med. 2006 Apr; 119: 327-334
        • Penninx B.W.
        • Pahor M.
        • Cesari M.
        • Corsi A.M.
        • Woodman R.C.
        • Bandinelli S.
        • et al.
        Anemia is associated with disability and decreased physical performance and muscle strength in the elderly.
        J Am Geriatr Soc. 2004 May; 52: 719-724
        • den Elzen W.P.
        • Willems J.M.
        • Westendorp R.G.
        • de Craen A.J.
        • Assendelft W.J.
        • Gussekloo J.
        Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-Plus study.
        CMAJ (Can Med Assoc J). 2009 Aug 4; 181: 151-157
        • Maezawa K.
        • Nozawa M.
        • Yuasa T.
        • Gomi M.
        • Igarashi E.
        • Sato H.
        • et al.
        Postoperative hemoglobin and recovery of hip muscle strength after total hip arthroplasty.
        J Orthop. 2018 Aug; 15: 886-888
        • Beghe C.
        • Wilson A.
        • Ershler W.B.
        Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature.
        Am J Med. 2004 Apr 5; 116: 3S-10S
        • Balducci L.
        Anemia, fatigue and aging.
        Transfus Clin Biol. 2010 Dec 17; 17: 375-381
        • Gaskell H.
        • Derry S.
        • Andrew Moore R.
        • McQuay H.J.
        Prevalence of anemia in older persons: systematic review.
        BMC Geriatr. 2008 Jan 14; 8: 1
        • Bach V.
        • Schruckmayer G.
        • Sam I.
        • Kemmler G.
        • Stauder R.
        Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort.
        Clin Interv Aging. 2014 Jul 22; 22: 1187-1196
        • Mitrache C.
        • Passweg J.R.
        • Libura J.
        • Petrikkos L.
        • Seiler W.O.
        • Gratwohl A.
        • et al.
        Anemia: an indicator for malnutrition in the elderly.
        Ann Hematol. 2001 May; 80: 295-298
        • Steensma D.P.
        • Tefferi A.
        Anemia in the elderly: how should we define it, when does it matter, and what can be done?.
        Mayo Clin Proc. 2007 Aug; 82: 958-966
        • Guralnik J.M.
        • Eisenstaedt R.S.
        • Ferrucci L.
        • Klein H.G.
        • Woodman R.C.
        Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia.
        Blood. 2004 Oct 15; 104: 2263-2268
        • Stevens L.A.
        • Li S.
        • Wang C.
        • Huang C.
        • Becker B.N.
        • Bomback A.S.
        • et al.
        Prevalence of CKD and comorbid illness in elderly patients in the United States: results from the kidney early evaluation program (KEEP).
        Am J Kidney Dis. 2010 Mar; 55: S23-S33
        • Takahashi S.
        • Okada K.
        • Yanai M.
        The kidney early evaluation program (KEEP) of Japan: results from the initial screening period.
        Kidney Int Suppl. 2010 Mar; 116: S17-S23
        • Bouillanne O.
        • Morineau G.
        • Dupont C.
        • Coulombel I.
        • Vincent J.P.
        • Nicolis I.
        • et al.
        Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.
        Am J Clin Nutr. 2005 Oct; 82: 777-783
      1. Guilford J.P. Fruchter B. Correlation. Fundamental statistics in psychology and education. 5th ed. McGraw-Hill, New York1973
        • Meyer H.E.
        • Tverdal A.
        • Falch J.A.
        Factors associated with mortality after hip fracture.
        Osteoporos Int. 2000 Mar; 11: 228-232
        • Yaoh C.J.C.
        • Fazal M.A.
        ASA grade and elderly patients with femoral neck fracture.
        Geriatr Orthop Surg Rehabil. 2014 Dec; 5: 195-199
        • Meyer H.E.
        • Henriksen C.
        • Falch J.A.
        • Pedersen J.I.
        • Tverdal A.
        Risk factors for hip fracture in a high incidence area: a case–control study from Oslo, Norway.
        Osteoporos Int. 1995 Jul; 5: 239-246
        • Lumbers M.
        • New S.A.
        • Gibson S.
        • Murphy M.C.
        Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centers.
        Br J Nutr. 2001 June; 85: 733-740
        • Eneroth M.
        • Olsson U.B.
        • Thorngren K.G.
        Nutritional supplementation decreases hip fracture-related complications.
        Clin Orthop Relat Res. 2006 Oct; 451: 212-217
        • Kannus P.
        • Uusi-Rasi K.
        • Palvanen M.
        • Parkkari J.
        Non-pharmacological means to prevent fractures among older adults.
        Ann Med. 2005; 37: 303-310
        • Abd-El-Gawad W.M.
        • Abou-Hashem R.M.
        • Maraghy M.O.E.
        • Amin G.E.
        The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment.
        Clin Nutr. 2014 Dec; 33: 1108-1116
        • Liu H.T.
        • Wu S.C.
        • Tsai C.H.
        • Li C.
        • Chou S.E.
        • Su W.T.
        • et al.
        Association between geriatric nutritional risk index and mortality in older trauma patients in the intensive care unit.
        Nutrients. 2020 Dec17; 12: 3861
        • Fransen M.
        • Woodward M.
        • Norton R.
        • Robinson E.
        • Butler M.
        • Campbell A.J.
        Excess mortality or institutionalization after hip fracture: men are at greater risk than women.
        J Am Geriatr Soc. 2002 Apr; 50: 685-690
        • Forte M.L.
        • Virnig B.A.
        • Swiontkowski M.F.
        • Bhandari R.
        • Everly L.E.
        • Kane R.L.
        Ninety-day mortality after intertrochanteric hip fracture: does provider volume matter?.
        J Bone Joint Surg Am. 2010 Apr; 92: 799-806