Increased morbidity risk seen at 5 to 10 years following osteoporotic fractures

Australian researchers identified an increased risk of mortality compared to the general population 5 years after older men and women sustained low-trauma osteoporotic fractures of the hip and vertebra, as well as other major fractures.

Increased risk of death persisted through 10 years in those sustaining hip fractures, but mortality risk decreased after 5 years in those with other types of fractures, according to a study that Dana Bliuc and colleagues at the Garvan Institute of Medical Research, St. Vincent’s Hospital in Sydney conducted.

For individuals with minor fractures, an increased mortality risk only existed at 5 years post-fracture for those aged 75 years or older, according to the 18-year study published in the Journal of the American Medical Association.

“Overall, this study highlights the premature mortality associated with all types of fractures, particularly that which occurs after subsequent fracture across the whole age spectrum of older men and women,” the researchers said in a press release.

Investigators studied individuals who sustained a fracture between April 1989 and May 2007 among 1,760 men and 2,245 women aged 60 years and older in Dubbo, Australia, in 1989. They found 343 low-energy fractures in the men and 197 later deaths compared to 952 fractures in the women and 461 deaths. Researchers compared their findings to individuals of all ages in the general population.

Ten years after a fracture, mortality rates were similar to an age-matched population, but when subsequent fractures occurred, mortality increased three to four times for the next 5 years. Investigators found mortality declined 5 years after a subsequent fracture, but stayed higher than in the general population.

Key predictors of mortality for all those studied included older age, quadriceps weakness and subsequent fracture. Gender-specific predictors were low bone mineral density, smoking, sway in women and reduced physical activity in men.

Researchers said half the fractures studied did not involve the hip or vertebra but accounted for 29% of the mortality. “Given these findings, more attention should be given to nonhip, nonvertebral fractures,” they said in the press release.

Reference:
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009; 301(5):513-521.