Hip fractures occur earlier in men than women and can lead to earlier mortality

A recent study has determined men have a higher post-injury early mortality rate than women.

Issue: November 2009

Men suffer hip fractures earlier in life and have a higher early mortality rate and lower residual lifetime risk of fracture compared to women from the same cohort, according to a recently presented study.

These results point toward a need for fracture-preventing strategies to consider gender, age and mortality, the investigators said.

The findings were part of a presentation by My von Friesendorff, MD, at the 10th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), which evaluated the long-term survival, new fractures and residual lifetime risk of fracture in men with hip fracture at different ages.

“Little is known about the long-term mortality beyond 10 years,” she said. “Furthermore, the total number of subsequent fractures during the patient’s lifetime has not been studied.”

$Hip fracture in female$
Hip fractures in women were found to occur later in life, though there is a higher residual lifetime risk of fracture.

Image: von Friesendorff M

First of its kind

The study — the first of its kind with a follow-up over 10 years — looked at all men older than 20 years who suffered a hip fracture between 1984 and 1985 in Malmo, Sweden. Follow-up lasted for 22 years or up until the patient’s death, with new radiographic examinations related to musculoskeletal trauma with or without fracture being individually registered.

Survival and fractures were evaluated within the study in 5-year age bands and age groups, with the Kaplan Meier survival analyses being used to evaluate mortality and fracture risk.

A total of 263 men ranging from ages 33 to 101 and averaging 74.2 years of age were evaluated as having an index hip fracture due to low-energy trauma. Fifty-six percent were reported to have cervical fractures and 44% were reported as trochanteric, with 6% having concomitant fractures. Ten percent had suffered a previous hip fracture.

High early mortality rate

After 22 years 94% of the men studied were dead. One-third of the men passed within 1 year, six of 10 within 5 years and almost four of five within 10 years. This gives an average of death occurring at 6 years after fracture, von Friesendorff told Orthopedics Today.

The study also shows that men older than 85 years when fracturing the hip only survive 3 months on average. Furthermore, almost one in three suffered at least one new fracture, while the mortality-adjusted lifetime risk of fracture wad doubled after 22 years. The mortality-adjusted 10-year risk of fracture was 47% in this group.

Compared to a previous study by von Friesendorff, men suffer hip fractures earlier in life and have higher early mortality and lower residual lifetime risk of fracture compared to women from the same cohort. Von Friesendorff said the high early mortality rate probably mirrors a higher morbidity among male hip fracture patients.

Moderator questions

“Men older than 85 years of age with hip fractures have a short survival and low risk of subsequent fractures,” von Friesendorff said. “Men between 75 and 84 years of age have relatively short survival and a comparatively low risk of fracture. Men below 75 years of age have higher survival and higher risk of subsequent fracture.”

Von Freisendorff’s paper was received well, but still subject to several questions upon the completion of the presentation.

Moderator Hans-Christoph Pape, MD, asked, “You said the median survival for patients over the age of 85 was 3 months. That was 25 years ago. What is the corresponding figure today?”

Von Friesendorff responded by saying she believes the figures have stayed relatively similar.

For more information:

Hans-Christoph Pape, MD, can be reached at University Hospital Aachen Department of Orthopaedic and Trauma Surgery, Pauwelsstraße 30, 52074 Aachen ; 49 241 80-0; e-mail: hpape@ukaachen.de.

My von Friesendorff, MD, can be reached at My.vonFriesendorff@skane.se. Neither source has any direct financial interest in any company or product mentioned in this article.

References:

von Friesendorff M, Akesson K, et al. Long-term survival and fracture risk after hip fracture: A 22-year follow-up study in 263 men. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.

von Friesendorff M, Besjakov J, et al. Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res, 2008; 23:1832-1841.