Mortality Rate Increases with Proximal Fractures


Men and women with incident bone fractures face increased mortality by two, but even higher for those with proximal fractures.

As people age, they’re at risk for osteoporotic fractures when falling. Though osteoporosis can be managed and treated, researchers say that a lack of awareness of that connection between mortality and osteoporotic fractures may result in fewer doctors treating it. With this in mind, researchers analyzed the mortality risk of fragility fractures in community dwelling “older” adults in New South Wales, Australia. The results were presented at the 2015 ACR/ARHP annual meeting in San Francisco on Nov. 11.[[{"type":"media","view_mode":"media_crop","fid":"43489","attributes":{"alt":"©sfamphoto/","class":"media-image media-image-right","id":"media_crop_7765993524808","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4746","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]]

In her presentation, Lyn March of the Institute of Bone and Joint Research, University of Sydney, shared data analyzed from the 45 and Up study, a population-based cohort of 238,673 people with a mean age of 63. The study included 125,174 women and 113,499 men. The data used for the study was linked to a number of data collections, including an emergency department and hospital admissions, as well as government registries of birth and death. Researchers identified patient fractures using various procedure codes, including ICD 9 and ICD 10, and followed patients from baseline (2006-2008) until their death or until December, 2013. The mean follow-up time was 5.7 years.

In the study patients had 14,827 fractures, including 9,145 from females, and 5,682 from males. There were 15,621 deaths (5,604 female and 10,017 male). They found that the mortality rate was higher for men in the cohort (15.7/1000 person years) versus women (7.9/1000 person years).

March said in an interview that the subjects were a community-based cohort who didn’t sign up for this specific study, so they didn’t have validated information about what patients were taking osteoporotic medications. They had some unvalidated self-reports that some subjects were taking medications, and this is still being analyzed. “Preliminary analysis suggests that osteoporosis medication rates are suboptimal in those who report previous fractures, consistent with all international studies, as a missed opportunity for secondary prevention,” she said.

The study found that patients having an incident fracture increased their mortality rate by approximately two in both genders. The mortality rate was increased for those with proximal fractures, but not distal ones. The most common fractures in the women were wrist (1,787) hip (1,477) and ankle (1,085). For men they were hip (977), vertebral (508) and wrist (489).

“Fragility fractures double the risk of their elderly patients dying in the next few years,” she said.

Doctors should take notice of a patient’s first fracture and treat it as a serious signal to investigate and treat for osteoporosis and implement falls prevention measures. The study didn’t answer the question of why there might be higher mortality for patients with osteoporotic fractures.

“Further research is needed to explore the reasons and potential modifiers for this increased mortality, as it is still not clear why these people with fracture are dying at twice the rate of their peers,” March said.



"Premature Mortality Due to Fractures in a Population-Based Prospective Cohort Study of 238,673 Older Women and Men," Lyn March. Nov. 10, 2015. ACR/ARHP 2015.

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