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Hip fracture increases mortality risk for up to 10 years
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In the year after experiencing a hip fracture, risk for death increases by 33% in men and 20% in women, with this risk continuing to persist for 10 years, according to a hospital-based registry analysis published in The Journal of Clinical Endocrinology & Metabolism.
“A fracture is the starting point for much wider health issues that persist long after the fracture has healed and can ultimately result in earlier death,” Jacqueline Center, MBBS, PhD, professor and senior research fellow with the Garvan Institute of Medical Research in Sydney, said in a press release. “We tracked the increased risk of death for fractures in different bones and found that they vary. The heightened risk can last for over a decade after a hip fracture, and for most other fractures (apart from distal or minor fractures), the increased risk is for about 5 years.”
In a registry-based follow-up study, Center and colleagues analyzed data from 21,123 women (mean age, 72 years) and 9,481 men (mean age, 67 years) who experienced an incident fragility fracture in Denmark in 2001, using information from the Danish National Hospital Discharge Register. Individual types of fracture included hip, femur, pelvis, vertebrae, clavicle, rib and humerus (proximal fractures), as well as forearm, knee, lower leg, ankle, hand, fingers, foot and toes (distal fractures). Follow-up time was calculated from time to first diagnosis of incident fracture to date of death or December 2011. Mortality incidence rate after fracture was estimated for 100 person-years of follow-up, and researchers calculated age-standardized postfracture mortality incidence rates using the direct standardization method. Researchers examined the contribution of fracture to mortality at precise time intervals postfracture using relative survival analysis.
Within the cohort, one-third of women and half of men sustained a first fragility fracture from age 50 to 64 years, with forearm, hip and humerus fractures contributing to 63% and 42% of total fractures in women and men, respectively. During an average follow-up of 7.2 years, 10,668 women and 4,745 men died.
Researchers found that hip, femur and pelvis fractures were associated with the highest mortality incidence, even after accounting for difference in age at fracture. Age-standardized mortality incidences varied widely depending on fracture site; however, mortality was higher in men vs. women, according to researchers. For men, age-standardized mortality incidences ranged from 20 deaths per 100 person-years after a hip fracture to seven deaths per 100 person-years after a lower leg fracture vs. 13 deaths per 100 person-years after hip fracture and six deaths per 100 person-years after lower leg fracture in women. Approximately 65% of deaths occurred within 5 years postfracture.
In analysis of 1-year excess mortality after fracture, researchers found that postfracture excess mortality was higher in men vs. women, although differences persisted only for hip fracture (excess mortality, 33% in men vs. 20% in women; P = .002) and humerus fracture (excess mortality, 12% in men vs. 5% in women; P = .03). For all fracture types, excess morality increased with increasing age, according to researchers.
In analyzing persistence of excess mortality postfracture, researchers found that excess mortality persisted for more than 10 years after hip fracture for men and women.
“Additionally, the observed mortality following a proximal fracture remained significantly higher than the expected mortality in the comparative matched general population for approximately 5 years postfracture, varying from 3 years after a rib fracture to 6-7 years after a vertebral or humerus fracture,” the researchers wrote.
The researchers noted that the study highlights the importance of early intervention to reduce excess mortality risk from fracture in men and women.
“We need to understand the risk of breaking a bone before the fracture happens and treat that individual accordingly,” Center said in the release. “While intervention after the first fracture is critical, we also need to diagnose those at risk of breaking bones before these major health impacts have occurred.” – by Regina Schaffer
Disclosures: Center reports she has consulted or given educational talks for Actavis, Amgen, Merck and Sanofi. Please see the study for the other authors’ relevant financial disclosures.
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