{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:17:00Z","timestamp":1783693020542,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background\/Objectives: The main objective of this study was to estimate 1- and 3-year overall survival and relative survival in patients aged &gt;65 years who underwent surgery for a second contralateral hip fracture. Methods: Retrospective cohort study including patients aged \u226565 years who underwent surgery for a first or second contralateral hip fracture between June 2010 and December 2021. Overall survival (OS) was estimated from the date of surgery to death from any cause or end of follow-up. Relative survival (RS) was calculated as the ratio between observed survival and expected survival derived from general population mortality tables for Catalonia implemented in the WebSurvCa application. Results: A total of 2642 patients were included (2467 primary fractures; 175 s contralateral fractures). Patients with a second fracture were older and had worse pre-fracture functional and cognitive status. At 3 years, overall survival was 53.8% (95% CI: 51.7\u201355.9) after a first fracture and 43.7% (95% CI: 36.3\u201352.4) after a second contralateral fracture. Relative survival estimates were 70.5% (95% CI: 67.7\u201373.3) and 59.0% (95% CI: 49.1\u201370.8), respectively. Divergence between expected and relative survival became more evident at 3 years than at 1 year. Advanced age, male sex, and worse pre-fracture functional or cognitive status were associated with poorer survival in both cohorts. Conclusions: A second contralateral hip fracture may represent a clinically relevant marker of increased vulnerability and greater clinical complexity, associated with substantial excess mortality compared with general population matched by age and sex. Relative survival highlights the true prognostic burden of a primary or second fracture and supports intensive secondary prevention and tailored follow-up.<\/jats:p>","DOI":"10.3390\/geriatrics11040083","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:16:28Z","timestamp":1783689388000},"page":"83","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Overall and Relative Survival After a Second Contralateral Hip Fracture in Adults over 65 Years: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6339-2430","authenticated-orcid":false,"given":"Maria-Dolors","family":"Rosin\u00e9s-Cubells","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Althaia Xarxa Assistencial Universit\u00e0ria de Manresa, 08243 Manresa, Spain"},{"name":"Doctoral Program in Medicine and Biomedical Sciences, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), 08500 Vic, Spain"},{"name":"Institut de Recerca i Innovaci\u00f3 en Ci\u00e8ncies de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain"},{"name":"Faculty of Medicine, Universitat Internacional de Catalunya (UIC), 08195 Sant Cugat del Vall\u00e8s, Spain"},{"name":"Unitat Funcional de Fractures de F\u00e8mur (UF3), Althaia Xarxa Assistencial Universit\u00e0ria de Manresa, 08243 Manresa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merc\u00e8","family":"Castej\u00f3n","sequence":"additional","affiliation":[{"name":"Institut de Recerca i Innovaci\u00f3 en Ci\u00e8ncies de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain"},{"name":"Unitat Funcional de Fractures de F\u00e8mur (UF3), Althaia Xarxa Assistencial Universit\u00e0ria de Manresa, 08243 Manresa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7057-0901","authenticated-orcid":false,"given":"Joan","family":"Espaulella-Panicot","sequence":"additional","affiliation":[{"name":"Geriatric and Palliative Care Service, Fundaci\u00f3 Hospital de la Santa Creu de Vic, Consorci Hospitalari de Vic, 08500 Vic, Spain"},{"name":"Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovaci\u00f3 en Ci\u00e8ncies de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain"},{"name":"Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVIC-UCC), 08500 Vic, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6512-3330","authenticated-orcid":false,"given":"Andrew","family":"Ore-Zu\u00f1iga","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Althaia Xarxa Assistencial Universit\u00e0ria de Manresa, 08243 Manresa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8939-3469","authenticated-orcid":false,"given":"Anna","family":"Arnau","sequence":"additional","affiliation":[{"name":"Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovaci\u00f3 en Ci\u00e8ncies de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain"},{"name":"Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVIC-UCC), 08500 Vic, Spain"},{"name":"Research, Epidemiology and Biostatistics Unit, Althaia Xarxa Assistencial Universit\u00e0ria de Manresa, 08500 Manresa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3109\/17453674.2013.878831","article-title":"Similar mortality rates in hip fracture patients over the past 31 years","volume":"85","author":"Mundi","year":"2014","journal-title":"Acta Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1007\/s00198-015-3104-3","article-title":"Excess mortality associated with second hip fracture","volume":"26","author":"Sobolev","year":"2015","journal-title":"Osteoporos. 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