Study Investigates Link Between Excess Mortality and Fragility Fractures

There is minimal previous research involving long-term excess mortality following fragility non-hip fractures. A nationwide registry-based follow-up study aimed to determine which fracture was associated with excess mortality and how long the postfracture excess mortality continued, revealing the benefits of early intervention.

Researchers included all individuals in Denmark 50 years or older and who first experienced fragility fractures in 2001. The patients included in the study were followed up until 10 years in order to determine their mortality risk. The main outcome measure that the researchers considered was the contribution of fracture to mortality at precise time intervals postfracture, which was assessed using relative survival analysis and accounted for time-related mortality changes.

"A fracture is the starting point for much wider health issues that persist long after the fracture has healed and can ultimately result in earlier death," Jacqueline Center, MBBS, PhD, of the Garvan Institute of Medical Research in Sydney, Australia, said in a statement. "We tracked the increased risk of death for fractures in different bones and found that they vary. The heightened risk can last for over a decade after a hip fracture, and for most other fractures (apart from distal or minor fractures), the increased risk is for about five years."

In total, there were 21,123 women with an incident fragility fracture in 2001, followed by 10,668 deaths; there were 9481 men with an incident fragility fracture in 2001, followed by 4745 deaths. There was excess mortality observed following all proximal and lower leg fractures. Additionally, the majority of deaths occurred within the first year postfracture. Following the first year, excess mortality continued to gradually decline.

The researchers found that hip fractures were associated with the highest excess mortality, with 33% at 1-year postfracture in men and 20% 1-year postfracture in women. One-year excess mortality was found to be 20%-25% after femur or pelvis, 10% following vertebral, 5%-10% following humerus, rib or clavicle, and 3% following lower leg fractures.

Also, the study noted that there was a smaller, yet significant, excess mortality observed until 10 years for hip, and about 5 years after femur, other proximal and lower leg fractures.

"Our findings emphasize just how crucial early intervention is," Center concluded. "We need to understand the risk of breaking a bone before the fracture happens and treat that individual accordingly. While intervention after the first fracture is critical, we also need to diagnose those at risk of breaking bones before these major health impacts have occurred."

Reference

Tran T, Bliuc D, Hansen L, et al. Persistence of excess mortality following individual non-hip fractures: A relative survival analysis. [published online July 19]. J Clin Endocrinol Metab. doi.org: 10.1210/jc.2017-02656