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Risk of death increases following a hip fracture

By Marianne Kirby
Individuals admitted to hospital for a hip fracture were significantly more likely to die within 12 months of their admission than their matched noninjured counterparts according to new Australian research.

Reported in Archives in Osteoporosis, this population-based cohort study compared hospital and mortality data for 9748 individuals aged 65 years and older who had been admitted to hospital for a hip fracture with data from a matched cohort of noninjured individuals selected from the electoral roll (matched 1:1 on age, sex and postcode). The researchers aimed to quantify the mortality that could be attributed to hip fracture alone by calculating adjusted mortality rate ratios and the attributable risk percent. 

After adjusting for health of the individuals in the 12 months before the fracture, individuals with hip fracture were more than 3.5 times more likely to die within 12 months of their hip fracture admission date than those in the noninjured group and 72% of the deaths during this time were likely to be attributable to the hip fracture. Adjustments had been made for comorbidities and their severity, alcohol misuse and dependence, mental health and healthcare service use.

The researchers also found that the excess mortality risk was higher in men than in women, and the relative mortality risk was higher in the 65- to 74-year age group compared with older age groups.

Professor Jackie Center, a senior research fellow in osteoporosis and bone biology at Sydney’s Garvan Institute of Medical Research told Endocrinology Today that these findings were consistent with previous studies of hip fracture mortality. ‘There could be some overestimation of the deaths attributed to hip fracture in this study even after adjusting for people’s prefracture health because the hip fracture population was much sicker in the 12 months prefracture than the matched control group. Nevertheless, the fact remains – whatever the actual mortality rate there is still an elevated risk of death as a consequence of hip fracture.’

In addition, an increased mortality rate postfracture is not unique to hip fractures, she added. ‘There is increased postfracture mortality – up to twofold – following all major proximal fractures in the older population including the humerus, elbow, rib, pelvis, femur, proximal tibia and fibula.’ 

As the hip fracture itself was the main predictor of excess mortality in this study, the study researchers concluded that hip fracture prevention should be a priority to reduce mortality risk. Professor Center felt this was an important message.

‘At least 30% of people with hip fractures have had a prior fracture. Yet few of these people are treated for previous fractures. Any fracture signals a higher risk of a subsequent fracture, including a hip fracture. It’s essential that all people presenting with low-trauma fractures are considered for treatment and evaluated for osteoporosis, regardless of their age.’
Arch Osteoporos 2017; 12: 67.

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