Go Figure: Hip Fracture Is Most Fatal in Younger Women


A carefully designed prospective study finds the overall risk of dying after hip fracture greatest among women in their later 60s. But for the healthiest women over age 80, the first 3 months are perilous.

It may be "common knowledge" that for an elderly woman a hip fracture can be the first step toward the grave, but the evidence has been mixed and confusing. Way back in the late 1980s, a multicenter US team of  geriatric researchers began a large prospective study to clarify the situation. At first glance, the results may be a surprise.

Among 1116 community-dwelling women at least 65 years of age who had a hip fracture, the greatest risk of death during the next 20 years was among those between the ages of 65 and 69. Women in this age group had more than a five-fold risk of death within the first year post-fracture, compared to similar women in the same age range who did not have a hip fracture. Their risk declined with time, but remained elevated for a decade after the injury.

Among women over the age of 80, however, a hip fracture did not increase their risk of death, with one exception: the very healthiest of these very aged women. Their risk of death was more than doubled in the first year, compared to women of similar age who did not experience a fracture. In this age group, poorer health status did correlate with the risk of fracturing a hip in the first place. But that did not seem to affect the risk of death afterwards.

Previous studies on this topic have been unable to disentangle the effects of increasing age from those of general health status, for several reasons: They were not prospective and could not provide baseline information about health, or they used patients from nursing homes or hospitals as well as those living independently.

What explains the puzzling results? Women in their late 60s are relatively unlikely to die from any cause, say the authors, so a hip fracture can be a major and noticeable mortality risk. Among women in their 80s, the threat of cancer or cardiovascular disease is more prominent, and hip fracture only has a noteworthy effect on the risk of death for relatively robust women who would be unlikely to die soon from another cause.

The report of the study of mortality risk after hip fracture among elderly women appears in the Archives of Internal Medicine.

The bottom line for your practice, suggested by the researchers, may be counter-intuitive: Because the greatest risk affects the youngest of these older women, your fracture-prevention focus should be on patients in their late 60s, not on the older and potentially more frail.

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