Raised mortality post-osteoporotic fracture is long-lasting
MedWire News: The risk for death following an osteoporosis-related fracture extends beyond 5 years and is more pronounced in men and in younger age groups, Canadian researchers report.
"Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures," remark Suzanne Morin (McGill University health Center, Montreal, Quebec) and colleagues.
"However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites," they add.
Therefore, Morin and team used healthcare databases to determine mortality risk following incident fractures at typical osteoporotic sites in men and women aged 50 years and older. Each fracture case was matched to three fracture-free controls.
During 1986-2007, the team identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths. In women,49,197 incident fractures occurred, followed by 22,018 deaths (44.8%). The majority (76%) of fractures occurred at sites other than the hip and vertebrae.
After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk for death in cases, relative to controls, was increased in men and women with hip, vertebral, humerus, and other fractures, and in men with wrist fractures.
In general, mortality was higher in men than in women. In the first year post-fracture - when the risk for death was highest - the relative risk (RR) for death in men and women, respectively, versus controls was 2.9 and 2.1 after hip fracture, 2.5 and 2.0 after vertebral fracture. It was 2.2 and 1.6 after humerus fracture, 1.5 and 0.8 after wrist fracture and 1.8 and 1.7 after all other types of fracture.
Of note, relative mortality was the highest in the younger age groups (50-59 and 60-69 years) across the spectrum of fracture sites.
Furthermore, the mortality risk remained elevated beyond 5 years in younger age groups after all fractures except wrist fractures. For example, men and women aged 50-59 years were approximately twice as likely to die in years 6-10 post-hip fracture than same-aged controls.
"Post-fracture mortality rates have not changed substantially over the last 20 years," remark Morin and co-authors in the journal Osteoporosis International.
"Better understanding of factors associated with increased post-fracture mortality, particularly in men, should inform the development of prevention and management strategies, including broader use of anti-osteoporosis treatments and different models of integrated multidisciplinary care," they conclude.
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By Laura Dean